Abstract 18679: Abnormal Stress Induced Changes in Arterial Stiffness in Middle Aged Men and Women With Impaired Fasting Glucose at Risk of Their First Episode of Symptomatic Heart Failure
Background: Abnormal arterial stiffness is associated with future heart failure (HF). We hypothesized that abnormal stress associated increase in arterial stiffness may be present in middle aged and elderly individuals with diabetes (DM) or the pre-diabetic state of impaired fasting glucose (IFG) that are at risk for their first episode of symptomatic HF.
Methods: We analyzed dobutamine magnetic resonance stress imaging (DMRI) results from 373 consecutively recruited community dwelling individuals aged 55-85 years at risk for but yet to develop symptomatic HF, that had resting LVEF >45% and were without inducible ischemia. According to previously published techniques, personnel blinded to participant identifiers measured arterial stiffness (brachial pulse pressure/left ventricular stroke volume indexed to body surface area (PP/SVI) and the aortic elastance index or EaI (brachial end-systolic pressure/SVI) at rest and peak stress (80% of maximum predicted heart rate response for age). Participants were classified as normal fasting glucose (NFG), IFG or DM according to the ADA criteria.
Results: Participants averaged 69 ± 8 years, were 79% white, 92% hypertensive and 66% women. After accounting for hypertension, gender, coronary artery disease, smoking, medications, dyslipidemia and visceral fat, we observed an abnormal paradoxical elevation in PP/SVI and EaI in those with IFG or DM aged 55 to 69 years; whereas in those ≥ 70 years, this abnormal increase was seen in all individuals regardless of their glucose state (Figure 1).
Conclusion: Middle aged individuals with DM or the prediabetic state of IFG exhibit abnormal increases in arterial stiffness during dobutamine stress that is similar to elderly individuals’ ≥ 70 years at risk of their first episode of symptomatic heart failure. These data may help to explain why middle aged men and women with DM or IFG are predisposed to stress induced increase in episodic HF.
- © 2013 by American Heart Association, Inc.