Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry
Andrea Salzano, Roberta D’Assante, Massimo Iacoviello, Vincenzo Triggiani, Giuseppe Rengo, Francesco Cacciatore, Ciro Maiello, Giuseppe Limongelli, Daniele Masarone, Angela Sciacqua, Pasquale Perrone Filardi, Antonio Mancini, Maurizio Volterrani, Olga Vriz, Roberto Castello, Andrea Passantino, Michela Campo, Pietro Amedeo Modesti, Alfredo De Giorgi, Michele Arcopinto, Paola Gargiulo, Maria Perticone, Annamaria Colao, Salvatore Milano, Agnese Garavaglia, Raffaele Napoli, Toru Suzuki, Eduardo Bossone, Alberto M. Marra, Antonio Cittadini, T.O.S.CA. Investigators, Antonio Cittadini, Alberto M. Marra, Michele Arcopinto, Roberta D’Assante, Luigi Saccà, Maria Giuseppina Monti, Raffaele Napoli, Margherita Matarazzo, Francesca M. Stagnaro, Lucrezia Piccioli, Anna Lombardi, Veronica Panicara, Martina Flora, Luisa Golia, Valentina Faga, Antonio Ruocco, D. Della Polla, Raúl Franco‐Gutiérrez, Alessandra Schiavo, A. Gigante, Emanuele Spina, Monica Sicuranza, Federica Monaco, Michael A. Apicella, C. Miele, A. G. Campanino, Louise Mazza, Raffaele Abete, Antonio Farro, Federica Luciano, Roberto Polizzi, Giuseppe Ferrillo, Mariarosaria De Luca, Giulia Crisci, Francesco Ruben Giardino, M. Barbato, Andrea Salzano, B. Ranieri, Eduardo Bossone, Francesco Ferrara, Valentina Russo, M. Malinconico, Rodolfo Citro, E. Guastalamacchia, Massimo Iacoviello, Marta Leone, Vincenzo Triggiani, Vito Angelo Giagulli, Francesco Cacciatore, Ciro Maiello, Cristiano Amarelli, I. Mattucci, Giuseppe Limongelli, Daniele Masarone, Paolo Calabrò, R. Calabrò, Alfredo D’Andrea, Valeria Maddaloni, Giuseppe Pacileo, R. Scarafile, Francesco Perticone, A. Belfiore, Angela Sciacqua, Antonio Cimellaro, Pasquale Perrone Filardi, Laura Casaretti, Stefania Paolillo, Paola Gargiulo, Antonio Mancini
Abstract
Abstract 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 VO 2 ) 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 VO 2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO 2 ). 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