Abstract 13515: Unique Profile of Diabetic Patients With Heart Failure and Preserved Ejection Fraction
Background: Diabetes mellitus (DM) may increase ventricular and vascular stiffness via multiple mechanisms and uniquely contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF).
Hypothesis: In HFpEF, the presence of DM is associated with increased vascular stiffness and diastolic dysfunction as compared with non-DM HFpEF patients.
Methods: 580 consecutive HFpEF patients (Framingham criteria and EF ≥50%) from a prospective population based study (Olmsted County, MN) underwent echocardiography and medical record review.
Results: See table. Prevalence of DM in HFpEF was 34%. Compared with HFpEF without DM (HFpEF-no DM), those with HFpEF and DM (HFpEF-DM) were younger, more obese, had more hypertension and coronary disease, and were on more aggressive medical therapy but had similar sex distribution and EF. HFpEF-DM subjects had more evidence of vascular stiffening with higher pulse pressure and smaller aortic diameter (AoD) indicative of increased central arterial stiffness. The smaller AoD was apparent after adjustment for age, sex and body size (p<0.001). In contrast systemic vascular resistance (SVR) was lower and thus arterial elastance was lower in HFpEF-DM compared with HFpEF-no DM. HFpEF-DM group tended to have higher filling pressures (mitral E/è ratio) than HFpEF-no DM. Indexed LV mass was numerically greater in HFpEF-DM than HFpEF-no DM, but this was not statistically significant.
Conclusions: In the community, DM is highly prevalent in HFpEF and is associated with increased central aortic stiffening and trends towards increased filling pressures. The underlying mechanisms and therapeutic implications of DM induced vascular and ventricular remodeling in HFpEF deserve further investigation.
- © 2011 by American Heart Association, Inc.