Abstract
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.
Keywords
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Article info
Publication history
Published online: February 05, 2018
Footnotes
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).
Conflicts of Interest: ARH receives personal fees (on Ad board) from Actelion, GSK, Bayer, and United Therapeutics and a grant from the National Institutes of Health (NIH). EDA receives personal fees (on Ad board) from Acceleron Pharma, Inc., and a grant from the NIH. FR receives grants from United Therapeutics, Gilead, Actelion, and Bayer.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
