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Pathophysiological effects of different risk factors for heart failure


Yang, H and Wang, Y and Negishi, K and Nolan, M and Marwick, TH, Pathophysiological effects of different risk factors for heart failure, Open Heart, 3, (1) Article e000339. ISSN 2053-3624 (2016) [Refereed Article]


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Copyright 2016 by the BMJ Publishing Group Ltd & British Cardiovascular Society Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

DOI: doi:10.1136/openhrt-2015-000339


BACKGROUND: Hypertension and type 2 diabetes mellitus (T2DM) are important causes of non-ischaemic heart failure (HF). Understanding the pathophysiology of early HF may guide screening. We hypothesised that the underlying physiology differed according to aetiology.

METHODS: In this cross-sectional study of 521 asymptomatic community-based subjects ≥65 years with ≥1 HF risk factors, 187 participants (36%) had T2DM and hypertension (T2DM+/HTN+), 109 (21%) had T2DM with no hypertension (T2DM+/HTN-) and 72 (14%) had neither T2DM nor hypertension (T2DM-/HTN-). In 153 patients (29%), clinic blood pressure was ≥140/90 mm Hg, defined as active hypertension (T2DM-/HTN+). All underwent a comprehensive echocardiogram, including conventional parameters for systolic and diastolic function as well as global longitudinal strain (GLS), diastolic strain (DS) and DS rate (DSR). A 6 min walk (6MW) test was used to assess functional capacity.

RESULTS: GLS in T2DM-/HTN+ group (-18.92.7%) was similar to that in T2DM-/HTN- group (-19.42.4%) and greater than T2DM+/HTN- (-18.02.8%, p=0.005). DS in T2DM-/HTN- (0.470.15%) exceeded that in T2DM-/HTN+ (0.430.14%) and T2DM+/HTN- (0.430.13%). 6MW distance was preserved in T2DM-/HTN+ (48285 m) and reduced in T2DM+/HTN- (46993, p<0.001). Those with T2DM and active hypertension had worst GLS, DS, DSR and shortest 6MW distance (p<0.002). In multivariable analysis, GLS was associated with T2DM but neither active hypertension nor a history of hypertension. Diastolic markers and left ventricular (LV) mass were associated with hypertension and T2DM. Thus, patients with HF risk factors show different functional disturbances according to aetiology.

CONCLUSIONS: Patients with hypertension had relatively less impaired GLS and preserved 6MW distance but more impaired diastolic function.

Item Details

Item Type:Refereed Article
Keywords:Heart failure
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Yang, H (Ms Hong Yang)
Author:Wang, Y (Ms Ying Wang)
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Nolan, M (Mr Mark Nolan)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:108490
Year Published:2016
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-04-20
Last Modified:2017-01-23
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