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Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study

Compared with patients with hypertension only, those with hypertension and diabetes (HTN/DM) have worse prognosis. We aimed to characterize morphological differences between hypertension and HTN/DM using cardiovascular magnetic resonance; and compare differentially expressed proteins associated with...

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Autores principales: Pua, Chee Jian, Loo, Germaine, Kui, Michelle, Moy, Wai Lun, Hii, An-An, Lee, Vivian, Chin, Chee-Tang, Bryant, Jennifer A., Toh, Desiree-Faye, Lee, Chi-Hang, Cook, Stuart A., Richards, A. Mark, Le, Thu-Thao, Chin, Calvin W.L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351902/
https://www.ncbi.nlm.nih.gov/pubmed/37431660
http://dx.doi.org/10.1161/CIRCIMAGING.123.015051
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author Pua, Chee Jian
Loo, Germaine
Kui, Michelle
Moy, Wai Lun
Hii, An-An
Lee, Vivian
Chin, Chee-Tang
Bryant, Jennifer A.
Toh, Desiree-Faye
Lee, Chi-Hang
Cook, Stuart A.
Richards, A. Mark
Le, Thu-Thao
Chin, Calvin W.L.
author_facet Pua, Chee Jian
Loo, Germaine
Kui, Michelle
Moy, Wai Lun
Hii, An-An
Lee, Vivian
Chin, Chee-Tang
Bryant, Jennifer A.
Toh, Desiree-Faye
Lee, Chi-Hang
Cook, Stuart A.
Richards, A. Mark
Le, Thu-Thao
Chin, Calvin W.L.
author_sort Pua, Chee Jian
collection PubMed
description Compared with patients with hypertension only, those with hypertension and diabetes (HTN/DM) have worse prognosis. We aimed to characterize morphological differences between hypertension and HTN/DM using cardiovascular magnetic resonance; and compare differentially expressed proteins associated with myocardial fibrosis using high throughput multiplex assays. METHODS: Asymptomatic patients underwent cardiovascular magnetic resonance: 438 patients with hypertension (60±8 years; 59% males) and 167 age- and sex-matched patients with HTN/DM (60±10 years; 64% males). Replacement myocardial fibrosis was defined as nonischemic late gadolinium enhancement on cardiovascular magnetic resonance. Extracellular volume fraction was used as a marker of diffuse myocardial fibrosis. A total of 184 serum proteins (Olink Target Cardiovascular Disease II and III panels) were measured to identify unique signatures associated with myocardial fibrosis in all patients. RESULTS: Despite similar left ventricular mass (P=0.344) and systolic blood pressure (P=0.086), patients with HTN/DM had increased concentricity and worse multidirectional strain (P<0.001 for comparison of all strain measures) compared to hypertension only. Replacement myocardial fibrosis was present in 28% of patients with HTN/DM compared to 16% of those with hypertension (P<0.001). NT-proBNP (N-terminal pro-B-type natriuretic peptide) was the only protein differentially upregulated in hypertension patients with replacement myocardial fibrosis and independently associated with extracellular volume. In patients with HTN/DM, GDF-15 (growth differentiation factor 15) was independently associated with replacement myocardial fibrosis and extracellular volume. Ingenuity Pathway Analysis demonstrated a strong association between increased inflammatory response/immune cell trafficking and myocardial fibrosis in patients with HTN/DM. CONCLUSIONS: Adverse cardiac remodeling was observed in patients with HTN/DM. The novel proteomic signatures and associated biological activities of increased immune and inflammatory response may partly explain these observations.
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spelling pubmed-103519022023-07-18 Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study Pua, Chee Jian Loo, Germaine Kui, Michelle Moy, Wai Lun Hii, An-An Lee, Vivian Chin, Chee-Tang Bryant, Jennifer A. Toh, Desiree-Faye Lee, Chi-Hang Cook, Stuart A. Richards, A. Mark Le, Thu-Thao Chin, Calvin W.L. Circ Cardiovasc Imaging Original Articles Compared with patients with hypertension only, those with hypertension and diabetes (HTN/DM) have worse prognosis. We aimed to characterize morphological differences between hypertension and HTN/DM using cardiovascular magnetic resonance; and compare differentially expressed proteins associated with myocardial fibrosis using high throughput multiplex assays. METHODS: Asymptomatic patients underwent cardiovascular magnetic resonance: 438 patients with hypertension (60±8 years; 59% males) and 167 age- and sex-matched patients with HTN/DM (60±10 years; 64% males). Replacement myocardial fibrosis was defined as nonischemic late gadolinium enhancement on cardiovascular magnetic resonance. Extracellular volume fraction was used as a marker of diffuse myocardial fibrosis. A total of 184 serum proteins (Olink Target Cardiovascular Disease II and III panels) were measured to identify unique signatures associated with myocardial fibrosis in all patients. RESULTS: Despite similar left ventricular mass (P=0.344) and systolic blood pressure (P=0.086), patients with HTN/DM had increased concentricity and worse multidirectional strain (P<0.001 for comparison of all strain measures) compared to hypertension only. Replacement myocardial fibrosis was present in 28% of patients with HTN/DM compared to 16% of those with hypertension (P<0.001). NT-proBNP (N-terminal pro-B-type natriuretic peptide) was the only protein differentially upregulated in hypertension patients with replacement myocardial fibrosis and independently associated with extracellular volume. In patients with HTN/DM, GDF-15 (growth differentiation factor 15) was independently associated with replacement myocardial fibrosis and extracellular volume. Ingenuity Pathway Analysis demonstrated a strong association between increased inflammatory response/immune cell trafficking and myocardial fibrosis in patients with HTN/DM. CONCLUSIONS: Adverse cardiac remodeling was observed in patients with HTN/DM. The novel proteomic signatures and associated biological activities of increased immune and inflammatory response may partly explain these observations. Lippincott Williams & Wilkins 2023-07-11 2023-07 /pmc/articles/PMC10351902/ /pubmed/37431660 http://dx.doi.org/10.1161/CIRCIMAGING.123.015051 Text en © 2023 The Authors. Circulation: Cardiovascular Imaging is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
spellingShingle Original Articles
Pua, Chee Jian
Loo, Germaine
Kui, Michelle
Moy, Wai Lun
Hii, An-An
Lee, Vivian
Chin, Chee-Tang
Bryant, Jennifer A.
Toh, Desiree-Faye
Lee, Chi-Hang
Cook, Stuart A.
Richards, A. Mark
Le, Thu-Thao
Chin, Calvin W.L.
Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study
title Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study
title_full Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study
title_fullStr Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study
title_full_unstemmed Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study
title_short Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study
title_sort impact of diabetes on myocardial fibrosis in patients with hypertension: the remodel study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351902/
https://www.ncbi.nlm.nih.gov/pubmed/37431660
http://dx.doi.org/10.1161/CIRCIMAGING.123.015051
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