Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry
Background
Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF.
Methods
Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D.
Results
Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis.
Trial registration ClinicalTrials.gov identifier: NCT023358017
Funding
Merck Serono Italy
Novartis Farma SpA
History
School
- Sport, Exercise and Health Sciences
Published in
Cardiovascular DiabetologyVolume
21Issue
1Publisher
Springer Science and Business Media LLCVersion
- VoR (Version of Record)
Rights holder
© The Author(s)Publisher statement
This is an Open Access Article. It is published by Springer Science and Business Media LLC under the Creative Commons Attribution 4.0 International Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/Acceptance date
2022-05-16Publication date
2022-06-16Copyright date
2022Notes
The T.O.S.CA. investigators include: Cittadini A, Marra AM, Arcopinto M, D’Assante R, Saccà L, Monti MG, Napoli R, Matarazzo M, Stagnaro FM, Piccioli L, Lombardi A, Panicara V, Flora M, Golia L, Faga V, Ruocco A, Della Polla D, Franco R, Schiavo A, Gigante A, Spina E, Sicuranza M, Monaco F, Apicella M, Miele C, Campanino AG, Mazza L, Abete R, Farro A, Luciano F, Polizzi R, Ferrillo G, De Luca M, Crisci G, Giardino F, Barbato M (Department of Translational Medical Sciences, Federico II University, Naples, Italy); Salzano A, Ranieri B (IRCCS S.D.N., Naples, Italy); Bossone E (AORN A Cardarelli, Naples, Italy); Ferrara F, Russo V, Malinconico M, Citro R (Heart Department, Cardiology Division, "Cava de’ Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy); Guastalamacchia E, Iacoviello M, Leone M, (University of Bari “Aldo Moro”, Bari. Italy); Triggiani V, Giagulli VA (Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. University of Bari "A. Moro", Bari, Italy) Cacciatore F, Maiello C, Amarelli C, Mattucci I (Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy); Limongelli G, Masarone D, Calabrò P, Calabrò R, D’Andrea A, Maddaloni V, Pacileo G, Scarafile R (Cardiology SUN, Monaldi Hospital, Azienda Ospedaliera dei Colli, Second University of Naples, Naples, Italy); Perticone F, Belfiore A, Sciacqua A, Cimellaro A (University Magna Graecia of Catanzaro, Catanzaro, Italy); Perrone Filardi P, Casaretti L, Paolillo S, Gargiulo P (Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy); Mancini A, Favuzzi AMR, Di Segni C, Bruno C, Vergani E (Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome); Volterrani M, Massaro R (IRCCS S. Raffaele Pisana, Roma, Italy); Vriz O, Grimaldi F (Azienda Ospedaliero-Universitaria “Santa Maria della Misericordia” San Daniele del Friuli, Udine, Italy); Castello R, Frigo A (Azienda Ospedaliera Universitaria Integrata di Verona, Italy); Campo MR, Sorrentino MR (Ospedali Riuniti di Foggia, Italy); Modesti PA, Malandrino D (Università di Firenze, Italy); Manfredini R, De Giorgi A, Fabbian F (Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy); Puzzo A, Ragusa L (I.R.C.S.S. Oasi Maria SS, Troina, Italy.); Caliendo L, Carbone L (Ospedale Santa Maria della Pietà, Nola, Napoli, Italy); Frigiola A, Generali T, Giacomazzi F, De Vincentiis C, Ballotta A (IRCCS San Donato Milanese, Milano, Italy); Garofalo P, Malizia G (Ospedali Riuniti "Villa Sofia – Cervello”, Palermo, Italy); Milano S, Misiano G (Policlinico P. Giaccone, Palermo, Italy); Suzuki T, Israr MZ, Bernieh D, Cassambai S, Yazaki Y (Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK); Heaney LM (School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK); Eagle KA (Michigan Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan); Ventura HO (John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana, USA); Colao A (Clinical Medicine and Surgery Department—Federico II University, Naples, Italy); Bruzzese D, Statistical Management (Department of Public Health, University Federico II of Naples, Naples, Italy).eISSN
1475-2840Publisher version
Language
- en
Depositor
Dr Liam Heaney. Deposit date: 22 June 2022Article number
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