Abstract 16155: Advanced Peripheral Endothelial Dysfunction Rather Than Increased Aortic Stiffness Correlates With Left Ventricular Diastolic Dysfunction and Heart Failure With Preserved Left Ventricular Ejection Fraction in Patients With Diabetes Mellitus
Background: Left ventricular (LV) diastolic dysfunction (DD) and vascular functions including peripheral endothelial function play an important role in the pathogenesis of heart failure (HF) with preserved LV ejection fraction (EF) (HFPEF). Diabetes mellitus (DM) has been shown to be frequently observed in patients with HFPEF and associated with poor outcome in HFPEF. However, the importance of vascular functions in DM patients with LVDD or HFPEF remains yet undetermined. We investigated the association between vascular functions, LVDD, and HFPEF in patients with DM.
Methods and Results: We evaluated cardiac function by echocardiography measuring the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’) and LVEF. We also noninvasively assessed vascular functions; peripheral endothelial function by reactive hyperemia-peripheral arterial tonometry (RH-PAT) as the RH-PAT index (RHI), and aortic stiffness by brachial-ankle pulse wave velocity (baPWV), in 203 DM patients with preserved LVEF (LVEF>50%), comprising 102 HFPEF and 101 non-HF patients (LVDD; E/e’>15, non-HF with LVDD; n=43, non-HF without LVDD; n=58). RHI negatively correlated with E/e’ (r=-0.15, P=0.03) and B-type natriuretic peptide (r=-0.18, P=0.009). RHI was significantly lower in DM patients with HFPEF than in non-HF DM patients (0.47±0.18 vs. 0.60±0.19, P<0.001). Furthermore, RHI was significantly lower in non-HF DM patients with LVDD than those without LVDD (0.54±0.19 vs. 0.65±0.19, P=0.006). Values of baPWV were comparable among HFPEF patients, non-HF patients with or without LVDD. Multivariate logistic regression analysis identified that lower RHI independently correlated with the presence of HFNEF in DM patients with normal LVEF (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.52-0.80, P<0.001) and with the presence of LVDD in non-HF DM patients (OR: 0.67, 95% CI: 0.51-0.88, P=0.005).
Conclusions: RHI, but not baPWV, was independently associated with the presence of HFPEF and LVDD in DM patients with preserved LVEF. Peripheral endothelial dysfunction in microcirculation rather than the increased stiffness of large vessels could play a crucial role in the pathogenesis of LVDD and HFPEF in DM patients.
- © 2013 by American Heart Association, Inc.