{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:48:40Z","timestamp":1790066920613,"version":"4.0.1"},"reference-count":58,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,2,19]]},"abstract":"\n Background<\/jats:title>\n \n Heterogeneity in the underlying processes that contribute to heart failure with preserved ejection fraction (\n HF<\/jats:styled-content>\n p\n EF<\/jats:styled-content>\n ) is increasingly recognized. Diabetes mellitus is a frequent comorbidity in\n HF<\/jats:styled-content>\n p\n EF<\/jats:styled-content>\n , but its impact on left ventricular and arterial structure and function in\n HF<\/jats:styled-content>\n p\n EF<\/jats:styled-content>\n is unknown.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We assessed the impact of diabetes mellitus on left ventricular cellular and interstitial hypertrophy (assessed with cardiac magnetic resonance imaging, including T1 mapping pregadolinium and postgadolinium administration), arterial stiffness (assessed with arterial tonometry), and pulsatile arterial hemodynamics (assessed with in\u2010office pressure\u2010flow analyses and 24\u2010hour ambulatory monitoring)\u00a0among 53 subjects with\n HF<\/jats:styled-content>\n p\n EF<\/jats:styled-content>\n (32 diabetic and 21 nondiabetic subjects). Despite few differences in clinical characteristics, diabetic subjects with HFpEF exhibited a markedly greater left ventricular mass index (78.1 [95%\n CI<\/jats:styled-content>\n , 70.4\u201385.9] g versus 63.6 [95%\n CI<\/jats:styled-content>\n , 55.8\u201371.3] g;\n P<\/jats:italic>\n =0.0093) and indexed extracellular volume (23.6 [95%\n CI<\/jats:styled-content>\n , 21.2\u201326.1] mL\/m\n 2<\/jats:sup>\n versus 16.2 [95%\n CI<\/jats:styled-content>\n , 13.1\u201319.4] mL\/m\n 2<\/jats:sup>\n ;\n P<\/jats:italic>\n =0.0008). Pronounced aortic stiffening was also observed in the diabetic group (carotid\u2010femoral pulse wave velocity, 11.86 [95%\n CI<\/jats:styled-content>\n , 10.4\u201313.1] m\/s versus 8.8 [95%\n CI<\/jats:styled-content>\n , 7.5\u201310.1] m\/s;\n P<\/jats:italic>\n =0.0027), with an adverse pulsatile hemodynamic profile characterized by increased oscillatory power (315 [95%\n CI<\/jats:styled-content>\n , 258\u2013373] mW versus 190 [95%\n CI<\/jats:styled-content>\n , 144\u2013236] mW;\n P<\/jats:italic>\n =0.0007), aortic characteristic impedance (0.154 [95%\n CI<\/jats:styled-content>\n , 0.124\u20130.183] mm Hg\/mL per second versus 0.096 [95%\n CI<\/jats:styled-content>\n , 0.072\u20130.121] mm\u00a0Hg\/mL per second;\n P<\/jats:italic>\n =0.0024), and forward (59.5 [95%\n CI<\/jats:styled-content>\n , 52.8\u201366.1] mm Hg versus 40.1 [95%\n CI<\/jats:styled-content>\n , 31.6\u201348.6] mm\u00a0Hg;\n P<\/jats:italic>\n =0.0010) and backward (19.6 [95%\n CI<\/jats:styled-content>\n , 16.2\u201322.9] mm Hg versus 14.1 [95%\n CI<\/jats:styled-content>\n , 10.9\u201317.3] mm\u00a0Hg;\n P<\/jats:italic>\n =0.0169) wave amplitude. Abnormal pulsatile hemodynamics were also evident in 24\u2010hour ambulatory monitoring, despite the absence of significant differences in 24\u2010hour systolic blood pressure between the groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Diabetes mellitus is a key determinant of left ventricular remodeling, arterial stiffness, adverse pulsatile hemodynamics, and ventricular\u2010arterial interactions in\n HF<\/jats:styled-content>\n p\n EF<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 01516346.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.011457","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T10:01:58Z","timestamp":1550224918000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Impact of Diabetes Mellitus on Ventricular Structure, Arterial Stiffness, and Pulsatile Hemodynamics in Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1161","volume":"8","author":[{"given":"Julio A.","family":"Chirinos","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA"},{"name":"Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA"},{"name":"Department of Radiology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupam","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA"},{"name":"Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Proto","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasad","family":"Konda","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Segers","sequence":"additional","affiliation":[{"name":"Biofluid, Tissue and Solid Mechanics for Medical Applications Ghent University Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott R.","family":"Akers","sequence":"additional","affiliation":[{"name":"Department of Radiology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond R.","family":"Townsend","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA"},{"name":"Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payman","family":"Zamani","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA"},{"name":"Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia 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