Abstract 14974: Diabetic Cardiomyopathy is Associated With Worsening of Quality of Life Long Before the Development of Overt Heart Failure: Lessons From the Baseline Analysis of the Arise-Hf Study

Abstract

Introduction: Diabetic Cardiomyopathy (DbCM) is a form of HF occurring in the absence of other causes of cardiac dysfunction such as hypertension, CAD, or valvular diseases in individuals with diabetes. The ARISE-HF study is designed to investigate the efficacy of AT-001, a novel aldose reductase inhibitor, in preventing the worsening of functional capacity in patients with DbCM. Hypothesis: The impact of DbCM on quality of life is greater than previously recognized, as patients with DbCM often adopt lifestyle changes to mitigate the impact of early symptoms. The hypothesis of the present study is that avoidance of physical activities in patients with DbCM may mask the clinical presentation of structural and functional myocardial changes that have occurred. Methods: The objective of the study was to investigate the physical activity levels in individuals with DbCM. We included patients with T2DM, age ≥60 years (or age ≥40 to <60 years with duration of diabetes ≥10 years or eGFR <60 mL/min/1.73 m 2 ), LVEF ≥45% in the presence of either elevated NTproBNP levels or elevated hs-cTn or echocardiographic abnormalities. Patients enrolled in the study had an impaired functional capacity measured as peak VO 2 < 75% of predicted normal. Patients completed the Physical Activity Scale (PASE) questionnaire, a validated test designed to measure the amount of physical activity carried out during the prior week. Exclusion criteria included prior diagnosis of overt HF, history of CVD leading to cardiac dysfunction, elevated BP levels, and uncontrolled 2TDM (HbA1c>8.5%). Results: We evaluated 363 patients (mean age 67.5 + 7.1 years, 47% female, BMI 30.3 + 4.6, NTproBNP 113.4 + 252.7 pg/mL, and HbA1c 7.0 + 0.8%) with diagnosis of DbCM. PASE score (mean 157.9 + 94) was indicative of reduced physical activity and was associated (p<0.001) with peak VO 2 uptake (r= 0.31), underscoring the relationship between functional capacity and physical activity level. Conclusions: DbCM is a form of HF leading to decreased cardiac functional capacity. Many patients with DbCM have reduced their daily physical activities to mitigate the presentation of symptoms of fatigue; however, their quality of life is significantly affected by the disease even before the progression to overt HF.