EMPA-REG OUTCOME: The Cardiologist's Point of View

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EMPA-REG OUTCOME: The Cardiologist's Point of View Son V. Pham, MD, Robert Chilton, DO The American Journal of Medicine Volume 130, Issue 6, Pages S57-S62 (June 2017) DOI: 10.1016/j.amjmed.2017.04.006 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Cardiometabolic relationships in diabetes. The loop shows pressure-volume changes during a single cardiac cycle. Diastolic dysfunction, a common occurrence in patients with T2DM, is manifest by elevated LVEDP, and results in the clinical manifestation of heart failure with a normal ejection fraction. Metabolic effects of diabetes adversely affect cardiac cellular function, as do diabetes-related structural abnormalities, via effects on diastolic filling. BP = blood pressure; LVEDP = left ventricular end-diastolic pressure; T2DM = type 2 diabetes mellitus. The American Journal of Medicine 2017 130, S57-S62DOI: (10.1016/j.amjmed.2017.04.006) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Mean coronary volumetric flow (A) and coronary flow velocity (B) data in patients with T2DM vs controls.38 The diameter of the proximal left anterior descending coronary artery was significantly smaller in patients with T2DM than in control subjects (2.6 ± 0.1 vs 3.0 ± 0.1 mm; P <.05). The baseline coronary flow velocity in T2DM patients showed a significant increase as compared with that in controls (27.0 ± 3.2 vs 14.9 ± 1.7 cm/s; P <.005), however, baseline coronary volumetric flow was similar. Although there was no significant difference in maximal hyperemic coronary flow velocity in the 2 groups, coronary volumetric flow during maximal hyperemia was significantly less in T2DM patients (98.7 ± 7.8 vs 121.7 ± 6.7 mL/min; P <.05). Consequently, coronary flow reserve was significantly lower in the patients with T2DM than in control subjects (2.7 ± 0.1 vs 3.8 ± 0.2; P = .0001). Percentage change in LVEF during dobutamine infusion (ΔLVEF) (C) was calculated and served as an index of myocardial contractile reserve; ΔLVEF was significantly lower in T2DM patients than in control subjects (9.3 ± 2.0 vs 15.1 ± 1.5; P <.01).38 aP <.05 vs controls; bP <.005 vs controls. LVEF = left ventricular ejection fraction; T2DM = type 2 diabetes mellitus. The American Journal of Medicine 2017 130, S57-S62DOI: (10.1016/j.amjmed.2017.04.006) Copyright © 2017 The Authors Terms and Conditions