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Association of ambulatory blood pressure with coronary microvascular and cardiac dysfunction in asymptomatic type 2 diabetes

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posted on 2024-05-08, 13:03 authored by JL Yeo, GS Gulsin, EM Brady, A Dattani, JM Bilak, AM Marsh, M Sian, L Athithan, KS Parke, J Wormleighton, MPM Graham-Brown, A Singh, JR Arnold, C Lawson, MJ Davies, H Xue, P Kellman, GP McCann
Background: Type 2 diabetes (T2D) and hypertension commonly coexist and are associated with subclinical myocardial structural and functional changes. We sought to determine the association between blood pressure (BP) and left ventricular (LV) remodeling, systolic/diastolic function, and coronary microvascular function, among individuals with T2D without prevalent cardiovascular disease. Methods: Participants with T2D and age-, sex-, and ethnicity-matched controls underwent comprehensive cardiovascular phenotyping including fasting bloods, transthoracic echocardiography, cardiovascular magnetic resonance imaging with quantitative adenosine stress/rest perfusion, and office and 24-h ambulatory BP monitoring. Multivariable linear regression was performed to determine independent associations between BP and imaging markers of remodeling and function in T2D. Results: Individuals with T2D (n = 205, mean age 63 ± 7 years) and controls (n = 40, mean age 61 ± 8 years) were recruited. Mean 24-h systolic BP, but not office BP, was significantly greater among those with T2D compared to controls (128.8 ± 11.7 vs 123.0 ± 13.1 mmHg, p = 0.006). Those with T2D had concentric LV remodeling (mass/volume 0.91 ± 0.15 vs 0.82 ± 0.11 g/mL, p < 0.001), decreased myocardial perfusion reserve (2.82 ± 0.83 vs 3.18 ± 0.82, p = 0.020), systolic dysfunction (global longitudinal strain 16.0 ± 2.3 vs 17.2 ± 2.1%, p = 0.004) and diastolic dysfunction (E/e’ 9.30 ± 2.43 vs 8.47 ± 1.53, p = 0.044) compared to controls. In multivariable regression models adjusted for 14 clinical variables, mean 24-h systolic BP was independently associated with concentric LV remodeling (β = 0.165, p = 0.031), diastolic dysfunction (β = 0.273, p < 0.001) and myocardial perfusion reserve (β = − 0.218, p = 0.016). Mean 24-h diastolic BP was associated with LV concentric remodeling (β = 0.201, p = 0.016). Conclusion: 24-h ambulatory systolic BP, but not office BP, is independently associated with cardiac remodeling, coronary microvascular dysfunction, and diastolic dysfunction among asymptomatic individuals with T2D. (Clinical trial registration. URL: https://clinicaltrials.gov/ct2/show/NCT03132129 Unique identifier: NCT03132129).

Funding

Heart failure in type 2 diabetes: improving diagnosis and management in a multi-ethnic population.

NIHR Academy

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Prevalence and determinants of subclinical cardiovascular dysfunction in adults with Type 2 Diabetes Mellitus (Dr Gaurav Gulsin)

British Heart Foundation

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University of British Columbia Advanced Cardiac Imaging Fellowship: 1) Understanding bioprosthetic leaflet degeneration in patients with and without type 2 diabetes - a pilot study, and 2) Coronary artery plaque characteristics and their association with outcomes - analyses from the ISCHEMIA trial

British Heart Foundation

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A novel cardiac magnetic resonance technique to quantify altered myocardial calcium handling in diabetic cardiomyopathy and the response to lifestyle intervention (Dr Abhishek Dattani)

British Heart Foundation

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Cardiac rest and stress metabolism in patients with Type 2 Diabetes

British Heart Foundation

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History

Citation

Yeo, J.L., Gulsin, G.S., Brady, E.M. et al. Association of ambulatory blood pressure with coronary microvascular and cardiac dysfunction in asymptomatic type 2 diabetes. Cardiovasc Diabetol 21, 85 (2022). https://doi.org/10.1186/s12933-022-01528-2

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

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  • VoR (Version of Record)

Published in

Cardiovascular Diabetology

Volume

21

Issue

1

Pagination

85

Publisher

Springer Science and Business Media LLC

issn

1475-2840

eissn

1475-2840

Acceptance date

2022-05-20

Copyright date

2022

Available date

2024-05-08

Spatial coverage

England

Language

eng

Data Access Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Rights Retention Statement

  • No

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