The Adverse Impact of Diabetes Mellitus on Left Ventricular Remodeling and Function in Patients With Severe Aortic Stenosis
Open accessAbstract
Background—: The diabetic heart exhibits increased left ventricular (LV) mass and reduced ventricular function. However, this relationship has not been studied in patients with aortic stenosis (AS), a disease process that causes LV hypertrophy and dysfunction through a distinct mechanism of pressure overload. The aim of this study was to determine how diabetes mellitus (DM) affects LV remodeling and function in patients with severe AS. Methods and Results—: Echocardiography was performed on 114 patients with severe AS (mean aortic valve area [AVA], 0.6 cm 2 ) and included measures of LV remodeling and function. Multivariable linear regression models investigated the independent effect of DM on these aspects of LV structure and function. Compared to patients without diabetes (n=60), those with diabetes (n=54) had increased LV mass and LV end-systolic and end-diastolic dimensions, and decreased LV ejection fraction (EF) and longitudinal systolic strain (all P <0.01). In multivariable analyses adjusting for age, sex, systolic blood pressure, AVA, body surface area, and coronary disease, DM was an independent predictor of increased LV mass (β=26 g, P =0.01), LV end-systolic dimension (β=0.5 cm, P =0.008), and LV end-diastolic dimension (β=0.3 cm, P =0.025). After also adjusting for LV mass, DM was associated with reduced longitudinal systolic strain (β=1.9%, P =0.023) and a trend toward reduced EF (β=−5%, P =0.09). Among patients with diabetes, insulin use (as a marker of disease severity) was associated with larger LV end-systolic dimension and worse LV function. LV mass was a strong predictor of reduced EF and systolic strain (both P <0.001). Conclusions—: DM has an additive adverse effect on hypertrophic remodeling (increased LV mass and larger cavity dimensions) and is associated with reduced systolic function in patients with AS beyond known factors of pressure overload.
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The pattern and magnitude of LV hypertrophic remodelling in AS are influenced by AS severity and by age, sex, genetic factors, metabolic factors, and coexisting coronary artery disease or hypertension.
“The pattern and magnitude of LV hypertrophic remodelling is influenced not only by AS severity but also by several other factors including age, sex, genetic factors, metabolic factors and the coexistence of coronary artery disease or hypertension116–119.”
From Calcific aortic stenosis (2016) · cites this paper as [119]
The Introduction (page not available in our copy) identifies AS-related pressure overload, blood pressure, and sex as influences on LV remodelling. The Discussion and Conclusion report an additional association with diabetes, a metabolic factor. The paper does not establish genetic factors, age, or coexisting coronary artery disease as influences on the pattern or magnitude of remodelling; it adjusts for age and coronary disease instead. (LLM, conf=0.86)
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- Authors
- Lindman, B. R., Arnold, S. V., Madrazo, J. A., Zajarias, A., Johnson, S. N., Pérez, J. E., & Mann, D. L.
- Affiliations
- Washington University in St. Louis (US)
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO.
- Venue
- Circulation: Heart Failure
- Published
- 2011-05
- Volume
- 4
- Issue
- 3
- Pages
- 286-292
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC3100796
- OpenAlex
- W1991215013
- Cited by
- 68
- References
- 33
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 9 · 2022: 6 · 2021: 3 · 2020: 3 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 3 · 2013: 5 · 2012: 5
- FWCI
- 3.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association
- National Institutes of Health (KL2TR000450, UL1TR000448, RR024992)
- National Center for Research Resources (RR-024992, KL2RR024994, UL1RR024992)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, aortic stenosis, left ventricular remodeling, left ventricular hypertrophy, left ventricular mass, left ventricular function, ejection fraction, insulin use, pressure overload, diabetic heart
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve Stenosis, Female, Humans, Male, Ultrasonography, Hypertrophy, Left Ventricular, Ventricular Remodeling, Diabetic Cardiomyopathies
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