Abstract
Background: Apelin is a regulatory vasoactive peptide, which plays a pivotal role in adverse cardiac remodeling and heart failure (HF) with reduced ejection fraction. The purpose of the study was to investigate whether serum levels of apelin is associated with HF with preserved election fraction (HFpEF) in patients with T2DM. Methods: The study retrospectively involved 101 T2DM patients aged 41 to 62 years (48 patients with HFpEF and 28 non-HFpEF patients). The healthy control group consisted of 25 individuals with matched age and sex. Data collection included demographic and anthropometric information, hemodynamic performances and biomarkers of the disease. Transthoracic B-mode echocardiography, Doppler and TDI were performed at baseline. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and apelin were measured by ELISA in all patients at the study entry. Results: Unadjusted multivariate logistic model yielded the only apelin to NT-proBNP ratio (OR = 1.44; p = 0.001), BMI > 34 кг/м2 (OR = 1.07; p = 0.036), NT-proBNP > 458 pmol/mL (OR = 1.17; p = 0.042), LAVI > 34 mL/m2 (OR = 1.06; p = 0.042) and E/e’ > 11 (OR = 1.04; p = 0.044) remained to be strong predictors for HFpEF. After obesity adjustment, multivariate logistic regression showed that the apelin to NT-proBNP ratio < 0.82 × 10−2 units remained sole independent predictor for HFpEF (OR = 1.44; 95% CI: 1.18–2.77; p = 0.001) HFpEF in T2DM patients. In conclusion, we found that apelin to NT-proBNP ratio < 0.82 × 10−2 units better predicted HFpEF in T2DM patients than apelin and NT-proBNP alone. This finding could open new approach for CV risk stratification of T2DM at higher risk of HF.
Highlights
Heart failure (HF) with preserved ejection fraction (HFpEF) is a highly prevalent and intractable phenotype of heart failure (HF) which commonly occurs in patients with hypertension, metabolic diseases including type 2 diabetes mellitus (T2DM), abdominal obesity, metabolic syndrome and female gender [1,2]
76 T2DM patients) were retrospectively recruited to the study from the database consisted of the outpatients and in-patients who were treated in the private hospital Vita-Centre (Zaporozhye, Ukraine) from October 2020 to October 2021
As well as patients having other conventional CV risk factors, such as dyslipidemia, abdominal obesity, microalbuminuria and Left ventricular (LV) hypertrophy, LV diastolic dysfunction were noticed in entire cohort compared to healthy volunteers
Summary
Heart failure (HF) with preserved ejection fraction (HFpEF) is a highly prevalent and intractable phenotype of HF which commonly occurs in patients with hypertension, metabolic diseases including type 2 diabetes mellitus (T2DM), abdominal obesity, metabolic syndrome and female gender [1,2]. NPs, such as N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and BNP, along with high-sensitive cardiac troponins (hs-cTn) remain the dominant predictors of all-cause and CV mortality for patients with HFrEF/HFmrEF, but their importance in predicting events among HFpEF individuals especially having T2DM has not been extensively elucidated and continue to consider as non-optimal [9,10]. In this context, discovery of new biomarkers reflecting key stages of the pathogenesis of HFpEF with the aim of identifying patients with unfavorable functional profiles and higher risk of poor clinical outcomes appears promising [11]. Transthoracic B-mode echocardiography, Doppler and TDI were performed at baseline
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