{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:18:45Z","timestamp":1793132325408,"version":"4.5.0"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100021672","name":"NIHR Leicester Clinical Research Facility","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021672","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020013","name":"NIHR Leicester Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR-PDF 2011-04-5"],"award-info":[{"award-number":["NIHR-PDF 2011-04-5"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["RP-2017-08-ST2-007"],"award-info":[{"award-number":["RP-2017-08-ST2-007"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/CRTF\/20\/24069"],"award-info":[{"award-number":["FS\/CRTF\/20\/24069"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["PG\/07\/068\/2334"],"award-info":[{"award-number":["PG\/07\/068\/2334"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,8,4]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing and plasma biomarker analysis. Primary endpoint for survival analysis was a composite of cardiovascular mortality, myocardial infarction, hospitalisation with heart failure, syncope or arrhythmia. Secondary endpoint was all-cause death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Diabetes (n=56) and non-diabetes groups (n=198) were well matched for age, sex, ethnicity, blood pressure and severity of AS. The diabetes group had higher body mass index, lower estimated glomerular filtration rate and higher rates of hypertension, hyperlipidaemia and symptoms of AS. Biventricular volumes and systolic function were similar, but the diabetes group had higher extracellular volume fraction (25.9%\u00b13.1% vs 24.8%\u00b12.4%, p=0.020), lower myocardial perfusion reserve (2.02\u00b10.75 vs 2.34\u00b10.68, p=0.046) and lower percentage predicted peak oxygen consumption (68%\u00b121% vs 77%\u00b117%, p=0.002) compared with the non-diabetes group. Higher levels of renin (log\n                      <jats:sub>10<\/jats:sub>\n                      renin: 3.27\u00b10.59 vs 2.82\u00b10.69\u2009pg\/mL, p&lt;0.001) were found in diabetes. Multivariable Cox regression analysis showed diabetes was not associated with cardiovascular outcomes, but was independently associated with all-cause mortality (HR 2.04, 95%\u2009CI 1.05 to 4.00; p=0.037).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with moderate-to-severe AS, diabetes is associated with reduced exercise capacity, increased diffuse myocardial fibrosis and microvascular dysfunction, but not cardiovascular events despite a small increase in mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002441","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T13:27:59Z","timestamp":1692192479000},"page":"e002441","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of diabetes on remodelling, microvascular function and exercise capacity in aortic stenosis"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03883490","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7405-6056","authenticated-orcid":false,"given":"Abhishek","family":"Dattani","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emer M","family":"Brady","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aseel","family":"Alfuhied","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1740-9270","authenticated-orcid":false,"given":"Gaurav S","family":"Gulsin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D","family":"Steadman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"},{"name":"Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian L","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8370-186X","authenticated-orcid":false,"given":"Saadia","family":"Aslam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0017-6140","authenticated-orcid":false,"given":"Marko","family":"Banovic","sequence":"additional","affiliation":[{"name":"Cardiology Department, Clinical Centre of Serbia, Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Jerosch-Herold","sequence":"additional","affiliation":[{"name":"Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xue","sequence":"additional","affiliation":[{"name":"National 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