Abstract 11866: Left Ventricular Diastolic Function Assessed by Echocardiography and Tissue Doppler Imaging is a Strong Predictor of Cardiovascular Events in Patients With Diabetes Mellitus Type 2

Aims: The aim of the study was to evaluate the independent role of left ventricular systolic function in terms of global longitudinal strain, and diastolic function expressed as the ratio between early diastolic transmitral flow- and mitral annular motion velocities (E/é) in predicting cardiovascular events in patients with diabetes mellitus type 2. Methods: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, carotid intima media thickness, carotid-femoral pulse wave velocity, pulse pressure measurement (pp) and glycosylated hemoglobin (HbA1c) were analysed. Results: Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 ± 17 months. Univariate Cox regression analysis showed that E/é was a strong predictor of cardiovascular events (HR 1.12; 95 % CI 1.06 to 1.18, p < 0.001) and in a multivariate analysis E/é was prospectively associated with cardiovascular events independent of age, sex, global longitudinal strain, pulse wave velocity, carotid intima media thickness, pp and HbA1c. The addition of HbA1c and pp to E/é increased the predictive value of the model significantly, [(E/é vs. E/é + HbA1c vs. E/é + HbA1c + pp) χ 2 = 18.1 vs. χ 2 = 23.0 vs. χ 2 =30.0, p = 0.030 vs. p = 0.007], but global longitudinal strain did not. An elevated E/é ratio, defined as > 15, was also predictive of major cardiovascular events in a Kaplan-Meyer analysis. The cumulative probability of the development of an event during the follow-up period for patients with an E/é ratio > 15 was 8.6 % compared with 2.6 % for patients E/é ratio ≤ 15, p = 0.021. Conclusion: Left ventricular diastolic dysfunction expressed as E/é is a strong predictor of myocardial infarction and stroke in middle-aged patients with diabetes mellitus, superior to global longitudinal strain, arterial stiffness and carotid intima media thickness.

Download Full-text

Angiogenic Factors and Long-Term Cardiovascular Risk in Women That Developed Preeclampsia During Pregnancy

Hypertension ◽

10.1161/hypertensionaha.120.15830 ◽

2020 ◽

Vol 76 (6) ◽

pp. 1808-1816

Author(s):

Carmen Garrido-Gimenez ◽

Manel Mendoza ◽

Monica Cruz-Lemini ◽

Laura Galian-Gay ◽

Olga Sanchez-Garcia ◽

...

Keyword(s):

Cardiovascular Risk ◽

High Density Lipoprotein ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Density Lipoprotein ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Left Ventricular ◽

Media Thickness

Preeclampsia is caused by placental impairment with increased expression of sFlt-1 (soluble fms-like tyrosine kinase 1) and decreased PlGF (placental growth factor); it has been associated with cardiovascular morbidity and mortality later in life, but the underlying mechanism remains unknown. The aim of this study was to determine whether sFlt-1 and PlGF levels during preeclampsia are associated to long-term cardiovascular risk. We prospectively recruited 43 women with previous preeclampsia and 21 controls with uncomplicated pregnancies. Cardiovascular risk assessment ≈12 years later included maternal hemodynamic, cardiac function and structure, biomarker analysis, and carotid-intima thickness evaluation. Women with previous preeclampsia had higher prevalence of hypertensive disorders and dyslipidemia than controls. In addition, they had worse global longitudinal strain, thicker left ventricular septal and posterior walls, more myocardial mass and increased carotid intima-media thickness compared with controls. PlGF during pregnancy correlated positively with high-density lipoprotein ( r =0.341; P =0.006), and negatively with global longitudinal strain ( r =−0.581; P <0.001), carotid intima-media thickness ( r =−0.251; P =0.045), and mean arterial blood pressure ( r =−0.252; P =0.045), when adjusted by study group. sFlt correlated negatively with high-density lipoprotein ( r =−0.372; P =0.002) and apolipoprotein A-1 ( r =−0.257; P =0.040), and positively with carotid intima-media thickness ( r =0.269; P =0.032) and left ventricular posterior wall thickness ( r =0.368; P =0.003). The antiangiogenic state present in preeclampsia is related to greater prevalence of cardiovascular risk factors ≈12 years after delivery. The knowledge of altered angiogenic factors may help detect women with a higher risk for premature cardiovascular disease, who will require earlier follow-up after delivery.

Download Full-text