Left ventricular systolic and diastolic function, remodelling, and clinical outcomes among patients with diabetes following myocardial infarction and the influence of direct renin inhibition with aliskiren
Journal article
Shah, Amil M., Shin, Sung Hee, Takeuchi, Madoka, Skali, Hicham, Desai, Akshay S., Kober, Lars, Maggioni, Aldo Pietro, Rouleau, Jean L., Kelly, Roxzana Y., Hester, Allen, Keefe, Deborah, McMurray, John J. V., Pfeffer, Marc A. and Solomon, Scott D.. (2012). Left ventricular systolic and diastolic function, remodelling, and clinical outcomes among patients with diabetes following myocardial infarction and the influence of direct renin inhibition with aliskiren. European Journal of Heart Failure. 14(2), pp. 185 - 192. https://doi.org/10.1093/eurjhf/hfr125
| Authors | Shah, Amil M., Shin, Sung Hee, Takeuchi, Madoka, Skali, Hicham, Desai, Akshay S., Kober, Lars, Maggioni, Aldo Pietro, Rouleau, Jean L., Kelly, Roxzana Y., Hester, Allen, Keefe, Deborah, McMurray, John J. V., Pfeffer, Marc A. and Solomon, Scott D. |
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| Abstract | Aims: We assessed the relationship between diabetes and cardiac structure and function following myocardial infarction (MI) and whether diabetes influences the effect of direct renin inhibition on change in left ventricular (LV) size. Methods and results: The ASPIRE trial enrolled 820 patients 2–8 weeks after MI with ejection fraction ≤45% and randomized them to the direct renin inhibitor aliskiren (n= 423) or placebo (n = 397) added to standard medical therapy. Echocardiography was performed at baseline and after 36 weeks in 672 patients with evaluable paired studies. Compared with non-diabetic patients, diabetic patients (n = 214) were at higher risk for a composite of cardiovascular (CV) death, heart failure hospitalization, recurrent MI, stroke, or aborted sudden death (14 vs. 7%; adjusted hazard ratio 1.63, 95% confidence interval 1.01–2.64, P= 0.045), despite similar left ventricular ejection fraction (37.9 ± 5.3 vs. 37.6 ± 5.2%, P= 0.48) and end-systolic volume (ESV) (84 ± 25 vs. 82 ± 28 mL, P= 0.46). Diabetic patients demonstrated greater concentric remodelling (relative wall thickness 0.38 ± 0.07 vs. 0.36 ± 0.07, P= 0.0002) and evidence of higher LV filling pressure (E/E′ 11.1 ± 5.3 vs. 9.1 ± 4.3, P= 0.0011). At 36 weeks, diabetic patients experienced similar per cent reduction in ESV overall (−4.9 ± 17.9 vs. −5.5 ± 16.9, P= 0.67) but tended to experience greater reduction in ESV than non-diabetic patients when treated with aliskiren (interaction P = 0.08). Conclusions: Compared with non-diabetic patients, diabetic patients are at increased risk of CV events post-MI despite no greater LV enlargement or reduction in systolic function. Diabetic patients demonstrate greater concentric remodelling and evidence of higher LV filling pressure, suggesting diastolic dysfunction as a potential mechanism for the higher risk observed among these patients. |
| Keywords | myocardial infarction; diabetes mellitus; heart failure; left ventricular function; echocardiography; direct renin inhibition |
| Year | 2012 |
| Journal | European Journal of Heart Failure |
| Journal citation | 14 (2), pp. 185 - 192 |
| Publisher | John Wiley & Sons Ltd |
| ISSN | 1388-9842 |
| Digital Object Identifier (DOI) | https://doi.org/10.1093/eurjhf/hfr125 |
| Scopus EID | 2-s2.0-84856142828 |
| Page range | 185 - 192 |
| Research Group | Mary MacKillop Institute for Health Research |
| Publisher's version | File Access Level Controlled |
| Place of publication | United Kingdom |
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