{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:48:23Z","timestamp":1790772503377,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Compared with patients with hypertension only, those with hypertension and diabetes (HTN\/DM) have worse prognosis. We aimed to characterize morphological differences between hypertension and HTN\/DM using cardiovascular magnetic resonance; and compare differentially expressed proteins associated with myocardial fibrosis using high throughput multiplex assays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Asymptomatic patients underwent cardiovascular magnetic resonance: 438 patients with hypertension (60\u00b18 years; 59% males) and 167 age- and sex-matched patients with HTN\/DM (60\u00b110 years; 64% males). Replacement myocardial fibrosis was defined as nonischemic late gadolinium enhancement on cardiovascular magnetic resonance. Extracellular volume fraction was used as a marker of diffuse myocardial fibrosis. A total of 184 serum proteins (Olink Target Cardiovascular Disease II and III panels) were measured to identify unique signatures associated with myocardial fibrosis in all patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Despite similar left ventricular mass (\n                      <jats:italic>P<\/jats:italic>\n                      =0.344) and systolic blood pressure (\n                      <jats:italic>P<\/jats:italic>\n                      =0.086), patients with HTN\/DM had increased concentricity and worse multidirectional strain (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001 for comparison of all strain measures) compared to hypertension only. Replacement myocardial fibrosis was present in 28% of patients with HTN\/DM compared to 16% of those with hypertension (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). NT-proBNP (N-terminal pro-B-type natriuretic peptide) was the only protein differentially upregulated in hypertension patients with replacement myocardial fibrosis and independently associated with extracellular volume. In patients with HTN\/DM, GDF-15 (growth differentiation factor 15) was independently associated with replacement myocardial fibrosis and extracellular volume. Ingenuity Pathway Analysis demonstrated a strong association between increased inflammatory response\/immune cell trafficking and myocardial fibrosis in patients with HTN\/DM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Adverse cardiac remodeling was observed in patients with HTN\/DM. The novel proteomic signatures and associated biological activities of increased immune and inflammatory response may partly explain these observations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.123.015051","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T05:01:00Z","timestamp":1689051660000},"page":"545-553","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4683-3043","authenticated-orcid":true,"given":"Chee Jian","family":"Pua","sequence":"first","affiliation":[{"name":"National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7115-8038","authenticated-orcid":true,"given":"Germaine","family":"Loo","sequence":"additional","affiliation":[{"name":"Department of Cardiology (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Kui","sequence":"additional","affiliation":[{"name":"Department of Cardiology (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-9916","authenticated-orcid":true,"given":"Wai Lun","family":"Moy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Sengkang General Hospital, Singapore (W.L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2106-1876","authenticated-orcid":true,"given":"An-An","family":"Hii","sequence":"additional","affiliation":[{"name":"National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0447-9956","authenticated-orcid":true,"given":"Vivian","family":"Lee","sequence":"additional","affiliation":[{"name":"National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee-Tang","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Cardiology (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-7895","authenticated-orcid":true,"given":"Jennifer A.","family":"Bryant","sequence":"additional","affiliation":[{"name":"Department of Cardiology (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8001-9769","authenticated-orcid":true,"given":"Desiree-Faye","family":"Toh","sequence":"additional","affiliation":[{"name":"National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.), National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8777-2705","authenticated-orcid":true,"given":"Chi-Hang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, Singapore (C.-H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6628-194X","authenticated-orcid":true,"given":"Stuart A.","family":"Cook","sequence":"additional","affiliation":[{"name":"National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.), National Heart Centre Singapore, Singapore."},{"name":"Department of Cardiology (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.), National Heart Centre Singapore, Singapore."},{"name":"Cardiovascular &amp; Metabolic Disorders Program, Duke-NUS Medical School, Singapore (S.A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-8177","authenticated-orcid":true,"given":"A. 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