Impact of diabetes mellitus on right ventricular dysfunction and ventricular interdependence in hypertensive patients with heart failure with reduced ejection fraction assessed via 3.0 T cardiac magnetic resonance imaging (MRI)
Authors' conclusion
In hypertensive HFrEF patients, comorbid DM may have aggravated RV dysfunction and was an independent determinant of impaired RV strain. RV dysfunction might be directly affected by DM and partially mediated by LV strain through unfavorable ventricular independence.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF), with or without hypertension (HTN) and comorbid diabetes mellitus (DM)
- Participants
- 249 patients
- Exposure
- HTN-HFrEF with DM vs HTN-HFrEF without DM vs HFrEF controls
- HFrEF controlsn = 77reference
- HTN-HFrEF (DM-)n = 97
- HTN-HFrEF (DM+)n = 75
- Outcome
- Cardiac MRI-derived biventricular GRS, GCS and GLS peak strains
Methodological detailscardiac MRI feature tracking, multivariable linear regression, mediation analysis
- Cardiac MRI feature tracking
- Multivariable linear regression
- Mediation analysis
Main finding
As reported in the abstract
Biventricular strain
- Biventricular GLS and GLS of interventricular septum (IVS) segments 8, 9 and 14 decreased gradually from HFrEF controls to HTN-HFrEF (DM-) to HTN-HFrEF (DM+) (all P < 0.05)
- DM had even lower biventricular GCS and IVS strains in all directions in specific segments than those without DM and HFrEF controls (all P < 0.05)
- DM independently associated with impaired RVGLS and RVGCS in hypertensive HFrEF (both P < 0.05)
Observational data: associations, not effects.
Further findings
Mediation of RVGLS difference between hypertensive HFrEF subgroups by LVGLS
- β (95% CI 0.39-1.31), partial mediation
- 0.80
Mediation of RVGCS difference between hypertensive HFrEF subgroups by LVGCS
- β (95% CI 0.01-0.62), partial mediation
- 0.28
Original publication
Impact of diabetes mellitus on right ventricular dysfunction and ventricular interdependence in hypertensive patients with heart failure with reduced ejection fraction assessed via 3.0 T cardiac MRI. Cardiovasc Diabetol. Published 23 October 2024. doi:10.
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