TY - JOUR
T1 - Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus
T2 - insights from the T.O.S.CA. Registry
AU - T.O.S.CA. Investigators
AU - Salzano, Andrea
AU - D’Assante, Roberta
AU - Iacoviello, Massimo
AU - Triggiani, Vincenzo
AU - Rengo, Giuseppe
AU - Cacciatore, Francesco
AU - Maiello, Ciro
AU - Limongelli, Giuseppe
AU - Masarone, Daniele
AU - Sciacqua, Angela
AU - Filardi, Pasquale Perrone
AU - Mancini, Antonio
AU - Volterrani, Maurizio
AU - Vriz, Olga
AU - Castello, Roberto
AU - Passantino, Andrea
AU - Campo, Michela
AU - Modesti, Pietro A.
AU - De Giorgi, Alfredo
AU - Arcopinto, Michele
AU - Gargiulo, Paola
AU - Perticone, Maria
AU - Colao, Annamaria
AU - Milano, Salvatore
AU - Garavaglia, Agnese
AU - Napoli, Raffaele
AU - Suzuki, Toru
AU - Bossone, Eduardo
AU - Marra, Alberto M.
AU - Cittadini, Antonio
AU - Cittadini, A.
AU - Marra, A. M.
AU - Arcopinto, M.
AU - D’Assante, R.
AU - Saccà, L.
AU - Monti, M. G.
AU - Napoli, R.
AU - Matarazzo, M.
AU - Stagnaro, F. M.
AU - Piccioli, L.
AU - Lombardi, A.
AU - Panicara, V.
AU - Flora, M.
AU - Golia, L.
AU - Faga, V.
AU - Ruocco, A.
AU - Della Polla, D.
AU - Franco, R.
AU - Schiavo, A.
AU - Carbone, L.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods: Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results: Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion: The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov
AB - Background: Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods: Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results: Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion: The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov
KW - Cardiopulmonary exercise test
KW - Chronic heart failure
KW - Diabetes
KW - Insulin resistance
KW - Right ventricle
KW - TOSCA
UR - http://www.scopus.com/inward/record.url?scp=85132131004&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132131004&partnerID=8YFLogxK
U2 - 10.1186/s12933-022-01543-3
DO - 10.1186/s12933-022-01543-3
M3 - Article
C2 - 35710369
AN - SCOPUS:85132131004
SN - 1475-2840
VL - 21
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 108
ER -