Association Between Type 2 Diabetes and Changes in Myocardial Structure, Contractile Function, Energetics, and Blood Flow Before and After Aortic Valve Replacement in Patients With Severe Aortic Stenosis

Jex, N; Greenwood, JP; Cubbon, RM; Rider, OJ; Chowdhary, A; Thirunavukarasu, S; Kotha, S; Giannoudi, M; McGrane, A; Maccannell, A; Conning-Rowland, M; Straw, S; Procter, H; Papaspyros, S; Evans, B; Javangula, K; Ferrara, A; Elmahdy, W; Kaul, P; Xue, H; Swoboda, P; Kellman, P; Valkovič, L; Roberts, L; Beech, D; Kearney, MT; Plein, S; Dweck, MR; Levelt, E

doi:10.1161/circulationaha.122.063444

Valvular & structural heart disease

Association Between Type 2 Diabetes and Changes in Myocardial Structure, Contractile Function, Energetics, and Blood Flow Before and After Aortic Valve Replacement in Patients With Severe Aortic Stenosis

CirculationPublished 25 Sep 2023Prospective cohort study

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Authors' conclusion

Among patients with severe AS, those with T2D demonstrate persistent abnormalities in myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function after AVR; AVR effectively normalizes myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function in patients without T2D.

Study context

Population: Patients with severe aortic stenosis (AS) without CAD awaiting aortic valve replacement (AVR)
Participants: 95 AS patients

Exposure: AS with T2D vs AS without T2D, before and after AVR
AS and T2D (AS-T2D)n = 30
AS-noT2Dn = 65reference
Healthy volunteers (HVs)n = 30
T2D controlsn = 30
Outcome: Myocardial energetics (PCr/ATP) and vasodilator stress MBF
Follow-up: 1 month before and 6 months after AVR

Methodological detailscase-control comparison with healthy volunteers and T2D controls

Case-control comparison with healthy volunteers and T2D controls

Main finding

As reported in the abstract

PCr/ATP and vasodilator stress MBF, before and after AVR

AS-T2D vs AS-noT2D: P = 0.002
AS-T2D vs AS-noT2D: P = 0.001
AS-T2D vs AS-noT2D: P = 0.0006
AS-T2D vs AS-noT2D: P = 0.03

Observational data: associations, not effects.

Further findings

Outcome	P value
AS (combined) vs HVs, before AVRAS vs HVs · PCr/ATP 1.66 [1.56, 1.75] vs 2.15 [1.89, 2.34]	P < 0.0001
AS (combined) vs HVs, before AVRAS vs HVs · stress MBF 1.54 [1.41, 1.66] vs 2.11 [1.89, 2.34]	P < 0.0001
AS-T2D vs T2D controlsAS-T2D vs T2D controls	P = 0.04
AS-T2D vs T2D controlsAS-T2D vs T2D controls	P = 0.001
AS-T2D vs T2D controlsAS-T2D vs T2D controls	P = 0.12
AS-T2D vs T2D controlsAS-T2D vs T2D controls	P = 0.82

AS-T2D vs T2D controls: PCr/ATP before AVR/baseline: 1.44 [1.30, 1.60] vs 1.66 [1.56, 1.75]
AS-T2D vs T2D controls: stress myocardial blood flow (MBF) before AVR/baseline: 1.25 [1.10, 1.41] vs 1.54 [1.41, 1.66]
AS-T2D vs T2D controls: PCr/ATP after AVR/follow-up: 1.44 [1.30, 1.60] vs 1.51 [1.34, 1.53]
AS-T2D vs T2D controls: stress MBF after AVR/follow-up: 1.48 [1.29, 1.66] vs 1.60 [1.34, 1.86]

Global longitudinal strain, 6-minute walk distance, NT-proBNP · after AVR

Improved after AVR in AS-noT2D; no improvement in AS-T2D

Original publication

Association Between Type 2 Diabetes and Changes in Myocardial Structure, Contractile Function, Energetics, and Blood Flow Before and After Aortic Valve Replacement in Patients With Severe Aortic Stenosis. Circulation. Published 25 September 2023. doi:10.1161/circulationaha.122.063444

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