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RESEARCH PRODUCT

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

A SalzanoR D'assanteM IacovielloV TriggianiG RengoF CacciatoreC MaielloG LimongelliD MasaroneA SciacquaP Perrone FilardiA ManciniM VolterraniO VrizR CastelloA PassantinoM CampoPa ModestiA De GiorgiM ArcopintoP GargiuloM PerticoneA ColaoS MilanoA GaravagliaR NapoliT SuzukiE BossoneAm MarraA CittadiniL SaccàMg MontiM MatarazzoFm StagnaroL PiccioliA LombardiV PanicaraM FloraL GoliaV FagaA RuoccoD Della PollaR FrancoA SchiavoA GiganteE SpinaM SicuranzaF MonacoM ApicellaC MieleAg CampaninoL MazzaR AbeteA FarroF LucianoR PolizziG FerrilloM De LucaG CrisciF GiardinoM BarbatoB RanieriF FerraraV RussoM MalinconicoR CitroE GuastalamacchiaM LeoneVa GiagulliC AmarelliI MattucciP CalabròR CalabròA D'andreaV MaddaloniG PacileoR ScarafileA BelfioreA CimellaroL CasarettiS PaolilloAmr FavuzziC Di SegniC BrunoE VerganiR MassaroF GrimaldiA FrigoMr SorrentinoD MalandrinoR ManfrediniF FabbianA PuzzoL RagusaL CaliendoL CarboneA FrigiolaT GeneraliF GiacomazziC De VincentiisA BallottaP GarofaloG MaliziaG MisianoMz IsrarD BerniehS CassambaiY YazakiLm HeaneyKa EagleHo VenturaD Bruzzese

subject

RegistrieHeart FailureEndocrinology Diabetes and MetabolismVentricular Dysfunction RightDiabetesInsulinsSocio-culturaleStroke VolumeInsulin resistanceDiabeteCardiopulmonary exercise test Chronic heart failure Diabetes Insulin resistance Right ventricle TOSCA Registry..Chronic heart failureDiabetes Mellitus Type 2TOSCA RegistryExercise TestVentricular Function RightHumansInsulinRight ventricleRegistriesCardiology and Cardiovascular MedicineCardiopulmonary exercise testTOSCAHumanLS4_7

description

Abstract 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 identifier: NCT023358017

yearjournalcountryeditionlanguage
2022-06-16
https://doi.org/10.21203/rs.3.rs-1482200/v1