19 Prospective longitudinal characterization of the relationship between diabetes and cardiac structural and functional changes

Amrit Chowdhary,Altaf Almutairi,Anshuman Sengupta,Lavanya Atithan,Sven Plein,Arka Das,Sharmaine Thirunavukarasu,Nicholas Jex,Noor Sharrack,Manali Jain,Klaus Witte ,Thomas Craven ,John P Greenwood ,Lee D Roberts ,Amanda D V Maccannell ,Peter Swoboda ,Richard M Cubbon ,Christopher Saunderson ,Natalie Haywood ,Eylem Levelt

doi:10.1136/heartjnl-2021-bcs.19

Abstract

<h3>Objectives</h3> In a cohort of type 2 diabetes (T2D) patients who underwent baseline cardiac magnetic resonance (CMR) and biomarker testing, during a median follow-up of 6-years we aimed to determine longitudinal changes in the phenotypic expression of heart disease in diabetes; report clinical outcomes; and compare baseline clinical characteristics and CMR findings of patients who experienced major adverse cardiovascular events (MACE) to those remaining MACE free <b>(figure 1)</b>. <h3>Background</h3> T2D increases the risk of heart failure (HF) and cardiovascular mortality. The long-term impact of T2D on cardiac phenotype in the absence of cardiovascular disease and other clinical events is unknown. <h3>Methods</h3> T2D patients (n=100) with no history of cardiovascular disease or hypertension were recruited at baseline. Biventricular volumes, function, and myocardial extracellular volume fraction (ECV) were assessed by CMR and blood biomarkers taken. Follow-up CMR was repeated in those without interim clinical events after 6-years. <h3>Results</h3> Follow-up was successful in 83 participants. Of those, 29 experienced cardiovascular/clinical events (36%) (<b>figure 2</b>). Of the remaining 59, 32 patients who experienced no events received follow-up CMR. In this cohort, despite no significant changes in blood pressure, weight, or glycated-hemoglobin, significant reductions in biventricular end-diastolic-volumes and ejection fractions occurred over time <b>(tables 1 & 2)</b>. The mean ECV was unchanged. Baseline plasma high-sensitivity cardiac-troponin-T (hs-cTnT) was significantly associated with change in left ventricular (LV) ejection fraction. Patients who experienced MACE had higher LV mass and greater LV concentricity than those who remained event-free. <h3>Conclusions</h3> T2D results in reductions in biventricular size and systolic function over time even in the absence of cardiovascular/clinical events. <h3>Conflict of Interest</h3> Nil

Highlights

Mitral regurgitation (MR) is commonly observed following acute myocardial infarction (MI)
Fabry disease is a recognised lysosomal storage disorder associated with aortic root dilatation, the exact mechanism remains incompletely understood
In our patient cohort the degree of aortic dilatation was mild, not reaching surgical requirement, and was not related to a history of hypertension

Summary

Introduction

Mitral regurgitation (MR) is commonly observed following acute myocardial infarction (MI). Localised left ventricular (LV) remodelling in the region of papillary muscles together with impaired myocardial contractility promote MR. There is a paucity of long-term follow-up studies to determine whether the severity of MR observed post-MI, changes with time. Purpose This study retrospectively followed up patients with MR detected following acute MI (AMI) to investigate changes in MR severity with time and assess for pre-discharge predictors of MR regression or progression

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Results

Conclusion