TY - JOUR
T1 - Diabetes Mellitus Associates with Increased Right Ventricular Afterload and Remodeling in Pulmonary Arterial Hypertension
AU - Whitaker, Morgan E.
AU - Nair, Vineet
AU - Sinari, Shripad
AU - Dherange, Parinita A.
AU - Natarajan, Balaji
AU - Trutter, Lindsey
AU - Brittain, Evan L.
AU - Hemnes, Anna R.
AU - Austin, Eric D.
AU - Patel, Kumar
AU - Black, Stephen M.
AU - Garcia, Joe G.N.
AU - Yuan, MD PhD, Jason X.
AU - Vanderpool, Rebecca R.
AU - Rischard, Franz
AU - Makino, Ayako
AU - Bedrick, Edward J.
AU - Desai, Ankit A.
N1 - Funding Information:
Funding: This study received support from the National Institutes of Health—National Heart, Lung, and Blood Institute (NHLBI) U01 HL125208 Award (PVDOMICS), NHLBI HL60190, and NHLBI R01 HL136603 (AAD).
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/6
Y1 - 2018/6
N2 - Background: Diabetes mellitus is associated with left ventricular hypertrophy and dysfunction. Parallel studies have also reported associations between diabetes mellitus and right ventricular dysfunction and reduced survival in patients with pulmonary arterial hypertension. However, the impact of diabetes mellitus on the pulmonary vasculature has not been well characterized. We hypothesized that diabetes mellitus and hyperglycemia could specifically influence right ventricular afterload and remodeling in patients with Group I pulmonary arterial hypertension, providing a link to their known susceptibility to right ventricular dysfunction. Methods: Using an adjusted model for age, sex, pulmonary vascular resistance, and medication use, associations of fasting blood glucose, glycated hemoglobin, and the presence of diabetes mellitus were evaluated with markers of disease severity in 162 patients with pulmonary arterial hypertension. Results: A surrogate measure of increased pulmonary artery stiffness, elevated pulmonary arterial elastance (P =.012), along with reduced log(pulmonary artery capacitance) (P =.006) were significantly associated with the presence of diabetes mellitus in patients with pulmonary arterial hypertension in a fully adjusted model. Similar associations between pulmonary arterial elastance and capacitance were noted with both fasting blood glucose and glycated hemoglobin. Furthermore, right ventricular wall thickness on echocardiography was greater in pulmonary arterial hypertension patients with diabetes, supporting the link between right ventricular remodeling and diabetes. Conclusion: Cumulatively, these data demonstrate that an increase in right ventricular afterload, beyond pulmonary vascular resistance alone, may influence right ventricular remodeling and provide a mechanistic link between the susceptibility to right ventricular dysfunction in patients with both diabetes mellitus and pulmonary arterial hypertension.
AB - Background: Diabetes mellitus is associated with left ventricular hypertrophy and dysfunction. Parallel studies have also reported associations between diabetes mellitus and right ventricular dysfunction and reduced survival in patients with pulmonary arterial hypertension. However, the impact of diabetes mellitus on the pulmonary vasculature has not been well characterized. We hypothesized that diabetes mellitus and hyperglycemia could specifically influence right ventricular afterload and remodeling in patients with Group I pulmonary arterial hypertension, providing a link to their known susceptibility to right ventricular dysfunction. Methods: Using an adjusted model for age, sex, pulmonary vascular resistance, and medication use, associations of fasting blood glucose, glycated hemoglobin, and the presence of diabetes mellitus were evaluated with markers of disease severity in 162 patients with pulmonary arterial hypertension. Results: A surrogate measure of increased pulmonary artery stiffness, elevated pulmonary arterial elastance (P =.012), along with reduced log(pulmonary artery capacitance) (P =.006) were significantly associated with the presence of diabetes mellitus in patients with pulmonary arterial hypertension in a fully adjusted model. Similar associations between pulmonary arterial elastance and capacitance were noted with both fasting blood glucose and glycated hemoglobin. Furthermore, right ventricular wall thickness on echocardiography was greater in pulmonary arterial hypertension patients with diabetes, supporting the link between right ventricular remodeling and diabetes. Conclusion: Cumulatively, these data demonstrate that an increase in right ventricular afterload, beyond pulmonary vascular resistance alone, may influence right ventricular remodeling and provide a mechanistic link between the susceptibility to right ventricular dysfunction in patients with both diabetes mellitus and pulmonary arterial hypertension.
KW - Diabetes mellitus
KW - Pulmonary arterial capacitance
KW - Pulmonary arterial elastance
KW - Pulmonary arterial hypertension
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U2 - 10.1016/j.amjmed.2017.12.046
DO - 10.1016/j.amjmed.2017.12.046
M3 - Article
AN - SCOPUS:85044578485
SN - 0002-9343
VL - 131
SP - 702.e7-702.e13
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 6
ER -
