Osteoprotegerin Is Associated With Subclinical Left Ventricular Systolic Dysfunction in Diabetic Hypertensive Patients: A Speckle Tracking Study

doi:10.1016/j.cjca.2014.08.018

Canadian Journal of Cardiology

Volume 30, Issue 12, December 2014, Pages 1529-1534

https://doi.org/10.1016/j.cjca.2014.08.018 Get rights and content

Abstract

Background

Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction.

Methods

The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography.

Results

Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients (P = 0.009, P = 0.049, P < 0.001, P = 0.004, and P < 0.001, respectively). Diabetic hypertensive patients were divided into 2 groups according to median GLS value (> 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P < 0.001), and hemoglobin A1c (%; P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS (P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5.

Conclusions

Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.

Résumé

Introduction

Récemment, le rôle de l'ostéoprotégérine (OPG) dans la pathogenèse de l'insuffisance cardiaque par le biais de ses divers mécanismes a fait l'objet d'une grande attention. La quantification de la déformation myocardique peut déterminer les modifications subcliniques de la fonction du ventricule gauche (VG), mais la déformation longitudinale globale (DLG) prédit mieux les résultats que la fraction d'éjection. Nous avons posé l'hypothèse que l'augmentation des concentrations de l'OPG peut prédire la dysfonction systolique subclinique du VG des patients hypertendus diabétiques traités ayant une fraction d'éjection VG préservée.

Méthodes

L'étude était composée de 86 patients hypertendus diabétiques et de 30 patients hypertendus non diabétiques. Tous les patients ont subi une échocardiographie et un prélèvement d'échantillons de sang par ponction veineuse pour déterminer l'OPG. La relation entre les concentrations d'OPG et la DLG du VG a été étudiée par échocardiographie bidimensionnelle Speckle Tracking (suivi de pixel).

Résultats

Les patients hypertendus diabétiques avaient une vélocité tissulaire diastolique précoce maximale/une vélocité tissulaire diastolique précoce plus élevées et une vélocité tissulaire systolique, une DLG, un taux de DLG durant la systole et un taux DLG durant la diastole précoce plus faibles que les patients hypertendus non diabétiques (P = 0,009, P = 0,049, P< 0,001, P = 0,004, et P< 0,001, respectivement). Les patients hypertendus diabétiques ont été divisés en 2 groupes selon la valeur médiane de la DLG (> 18,5 et ≤ 18,5). Les patients ayant une DLG ≤ 18,5 avaient des valeurs de pression artérielle diastolique (mm Hg; P = 0,048), d'OPG (pmol/l; P< 0,001) et d'hémoglobine A1c (%; P = 0,042) plus élevées que ceux ayant une DLG > 18,5. Dans l'analyse de régression logistique multivariée, l'OPG s'était avérée un prédicteur indépendant de la détérioration de la DLG (P = 0,001). L'analyse de la courbe caractéristique d'efficacité du récepteur révélait que des valeurs d'OPG > 6,45 (pmol/l) déterminaient les patients ayant une DLG ≤ 18,5.

Conclusions

Les valeurs plasmatiques de l'OPG pourraient prédire la dysfonction systolique subclinique du VG des patients hypertendus diabétiques.

Section snippets

Study population

From September 2012 to June 2013, we conducted a single-centre cross-sectional study including 86 consecutive diabetic hypertensive patients and 30 consecutive nondiabetic hypertensive patients. All patients were receiving antihypertensive and/or antidiabetic treatment for at least 1 year. Exclusion criteria were echocardiographic evidence of either regional or global wall motion abnormalities, LV EF < 50%, history of significant coronary artery disease (CAD) and coronary artery bypass graft

Results

The study population consisted of 86 (55.8% female) diabetic hypertensive and 30 (73.3% female) nondiabetic hypertensive patients. The clinical, biochemical, and echocardiographic characteristics of the study population are presented in Supplemental Table S1. Diabetic hypertensive patients had lower eGFR (86.40 ± 16.20 mL/min vs 92.00 ± 9.40 mL/min; P = 0.024) and higher microalbumin (1.1 [2.87] mg/dL vs 0.5 [0.64] mg/dL; P = 0.001), carotid intima media thickness (CIMT; 0.8 [0.3] mm vs 0.5

Discussion

To our knowledge we showed for the first time in this study, that plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients who were receiving medical treatment and had no previous history of CVD. A cutoff value > 6.45 pmol/L was able to identify the patients with subclinical LV systolic dysfunction.

Diabetes is known to be associated with the development of HF even without the presence of coexisting CAD.9, 18 In addition, the clinical and morphologic

Conclusion

Our study shows the emerging role of OPG as an indicator of subclinical LV systolic dysfunction in diabetic hypertensive patients. It is evidently crucial to establish biochemical markers of increased risk for CVD events. These markers could be used in the clinical setting for the early diagnosis of subclinical LV systolic dysfunction, which would allow for strategies to be designed to reduce the cardiovascular event rate in those patients. Further studies are needed to establish whether

Disclosures

The authors have no conflicts of interest to disclose.

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Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients with acute coronary syndromes and chronic heart failure. Its prognostic value in acute heart failure (AHF) is unknown. The aim of this study was to assess the prognostic value provided by serum OPG levels at discharge after an admission for AHF.
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L’ostéoprotégérine (OPG) s’avère prometteuse comme prédicteur de pronostic défavorable chez les patients souffrant de syndromes coronariens aigus et d’insuffisance cardiaque chronique. On ignore sa valeur pronostique dans l’insuffisance cardiaque aiguë (ICA). Le but de cette étude était d’évaluer la valeur pronostique des concentrations sériques d’OPG au congé après une admission pour une ICA.
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Les concentrations sériques d’OPG étaient directement associées à une probabilité plus élevée de décès ou de réadmission pour une ICA dans les 6 mois, quels que soient les autres marqueurs pronostiques connus. Cela était vrai tant pour la fraction d’éjection préservée que pour la fraction d’éjection réduite.
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: See editorial by Putko et al., on pages 1492-1495 of this issue.

: See page 1533 for disclosure information.

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Clinical ResearchOsteoprotegerin Is Associated With Subclinical Left Ventricular Systolic Dysfunction in Diabetic Hypertensive Patients: A Speckle Tracking Study

Abstract

Background

Methods

Results

Conclusions

Résumé

Introduction

Méthodes

Résultats

Conclusions

Section snippets

Study population

Results

Discussion

Conclusion

Disclosures

Heart Fail Clin

Can J Cardiol

Am J Kidney Dis

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

Am J Cardiol

Plasma osteoprotegerin levels in the general population: relation to indices of left ventricular structure and function

Hypertension

TNF revisited: osteoprotegerin and TNF-related molecules in heart failure

Curr Heart Fail Rep

Osteoprotegerin as a marker of atherosclerosis in diabetic patients

Int J Endocrinol

Increased plasma concentrations of osteoprotegerin in type 2 diabetic patients with microvascular complications

Eur J Endocrinol

Osteoprotegerin and mortality in type 2 diabetic patients

Diabetes Care

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPD 38

BMJ

Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring

Circ Cardiovasc Imaging

Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration

Eur J Echocardiogr

Evaluation of right ventricle functions and serotonin levels during headache attacks in migraine patients with aura

Int J Cardiovasc Imaging

Clinical Research
Osteoprotegerin Is Associated With Subclinical Left Ventricular Systolic Dysfunction in Diabetic Hypertensive Patients: A Speckle Tracking Study