Impact of Aortic Valve Replacement on Glycemic Control in Diabetes Mellitus

  • Peter Michael Rodgers-Fischl University of Kentucky Medical Center
Keywords: Aortic Valve Replacement, Diabetes Mellitus

Abstract

Introduction: The Framingham Studies revealed diabetes mellitus (DM) predisposed subjects to a 2-8 fold increase in risk in developing heart failure (HF). Much less information is available about the reverse issue; namely is there an increased risk of developing DM in patients with HF.  We sought to determine if reversal/partial reversal of HF through aortic valve replacement would improve glycemic control in patients with DM at our institution.

            Methods: Electronic medical records of 57 consecutive diabetic patients who underwent aortic valve replacement (AVR) at a medium sized academic medical center from May 2005 through May 2015 and had glycated hemoglobin (HbA1C) measuredbefore and after the procedure were retrospectively analyzed. Variables of interest included  HbA1C  and echocardiographic parameters such as left ventricular ejection fraction (LVEF), tricuspid regurgitation velocity (TRV), and right ventricular systolic pressure (RVSP) before and after valve replacement.

            Results: HbA1C decreased significantly during the first year after replacement, from 7.1% (range 4.4-13.0%) before surgery to 6.5% in the first year (p < .05). Also, calculated RVSP decreased from 44 mmHg (20-79 mmHg) to 37 (p<0.05 from the preoperative value). LVEF and TRV did not change significantly.   Reductions in HbA1C and RVSP during the first year were greater in patients who experienced an increase of 5% or more in EF at their first postoperative measurement.  Patients with higher baseline HbA1C had a greater decline in glycated Hb during the first year (p < 0.01).

            Conclusion: AVR was associated with a reduction of HbA1C and decrease of pulmonary artery systolic pressure within one year of the procedure.

Keywords: Aortic Valve Replacement, Glycemic Control, Heart Failure

Author Biography

Peter Michael Rodgers-Fischl, University of Kentucky Medical Center
Cardiothoracic Surgery - Resident Physician

References

Nichols GA, Moler EJ. Cardiovascular disease, heart failure, chronic kidney disease and depression independently increase the risk of incident diabetes. Diabetologia. 2011;54(3):523-6.

Uriel N, Naka Y, Colombo PC, et al. Improved diabetic control in advanced heart failure patients treated with left ventricular assist devices. Eur J Heart Fail. 2011;13(2):195-9.

Guglin M, Villafranca A, Morrison A. Cardiogenic diabetes. Heart Fail Rev. 2014;19(5):595-602.

Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57–e185.

Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease: Cardiovascular Health Study. J Am Coll Cardiol 1997; 29:630–634.

R.O. Bonow, E. Lakatos, B.J. Maron, S.E. Epstein, Serial long-term assessment of the

natural history of asymptomatic patients with chronic aortic regurgitation and nor-

mal left ventricular systolic function, Circulation 84 (1991) 1625 – 1635.

M.P. Tornos, M. Olona, G. Permanyer-Miralda, M.P. Herrejon, M. Camprecios, A.

Evangelista, et al., Clinical outcome of severe asymptomatic chronic aortic regurgitation:

a long-term prospective follow-up study, Am. Heart J. 130 (1995) 333–339.

K.S. Dujardin,M. Enriquez-Sarano, H.V. Schaff, K.R. Bailey, J.B. Seward, A.J. Tajik,Mortality

and morbidity of aortic regurgitation in clinical practice. A long-term followup

study, Circulation 99 (1999) 1851–1857.

D. Siemienczuk, B. Greenberg, C. Morris, B. Massie, R.A. Wilson, N. Topic, et al.,

Chronic aortic insufficiency: factors associated with progression to aortic valve replacement, Ann. Intern. Med. 110 (1989) 587–592.

Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34:29.

Nichols GA, Hillier TA, Erbey JR, Brown JB. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care 2001; 24:1614.

Bertoni AG, Hundley WG, Massing MW, et al. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care 2004; 27:699.

Amato L, Paolisso G, Cacciatore F, Ferrara N, Ferrara P, Canonico S, Varricchio M, Rengo F. Congestive heart failure predicts the development of non-insulin-dependent diabetes mellitus in the elderly. The Osservatorio Geriatrico Regione Campania Group. Diabetes Metab 1997;23:213–218.

Andersson C, Norgaard ML, Hansen PR, Fosbol EL, Schmiegelow M, Weeke P, Olesen JB, Raunso J, Jorgensen CH, Vaag A, Kober L, Torp-Pedersen C, Gislason GH. Heart failure severity, as determined by loop diuretic dosages, predicts the risk of developing diabetes after myocardial infarction: a nationwide cohort study. Eur J Heart Fail 2010;12:1333–1338.

AlZadjali MA, Godfrey V, Khan F, Choy A, Doney AS, Wong AK, Petrie JR, Struthers AD, Lang CC. Insulin resistance is highly prevalent and is associated with reduced exercise tolerance in nondiabetic patients with heart failure. J Am Coll Cardiol. 2009;53:747–753.

Mohamedali B, Yost G, Bhat G. Mechanical circulatory support improves diabetic control in patients with advanced heart failure. Eur J Heart Fail. 2014;16(10):1120-4.

Choudhary N, Chen L, Kotyra L, Wittlin SD, Alexis JD. Improvement in glycemic control after left ventricular assist device implantation in advanced heart failure patients with diabetes mellitus. ASAIO J. 2014;60(6):675-80.

Heck PM, Dutka DP. Insulin resistance and heart failure. Curr Heart Fail Rep 2009;6:89–94.

James KB, McCarthy PM, Thomas JD, Vargo R, Hobbs RE, Sapps S, Bravo E. Effect of the implantable left ventricular assist device on neuroendocrine activation in heart failure. Circulation 1995;92(9 Suppl):II191–II195.

Torre-Amione G, Stetson SJ, Youker KA, Durand JB, Radovancevic B, Delgado RM, Frazier OH, Entman ML, Noon GP. Decreased expression of tumor necrosis factor-alpha in failing human myocardium after mechanical circulatory support: a potential mechanism for cardiac recovery. Circulation 1999;100:1189–1193.

Andraws R, Brown DL. Effect of inhibition of the renin-angiotensin system on development of type 2 diabetes mellitus (meta-analysis of randomized trials). Am J Cardiol. 2007;99(7):1006-12.

Koerner MM, El-Banayosy A, Eleuteri K, Kline C, Stephenson E 3rd, Pae W, Ghosizad A. Neurohormonal regulation and improvement in blood glucose control: reduction of insulin requirement in patients with a nonpulsatile ventricular assist device. Heart Surg Forum 2014;17:E98–E102.

Long T, Lopez BM, Berberian C, Cunningham MJ, Starnes VA, Cohen RG. Exercise Hemodynamics and Quality of Life after Aortic Valve Replacement for Aortic Stenosis in the Elderly Using the Hancock II Bioprosthesis. Cardiol Res Pract. 2014;2014:151282.

Published
2018-07-12
Section
Articles