Clinical and morphological features of the diabetic phenotype of heart failure with preserved ejection fraction: focus on novel markers of myocardial remodeling

Aim . To study novel biomarkers, as well as clinical and morphological features of myocardial remodeling, in patients with the diabetic phenotype (DP) of heart failure with preserved ejection fraction (HFpEF) hospitalized for elective coronary artery bypass grafting. Material and methods. A total of 120 patients of both sexes with stage I-IIA, class I-III HFpEF (60+60) (with or without type 2 diabetes (T2D)), and underlying coronary artery disease and hypertension were studied. In addition to standard examinations, blood levels of N-terminal pro-brain natriuretic peptide and oxytocin were measured, along with assessment of left ventricular (LV) myocardial remodeling and diastolic dysfunction types. The global LV function index was calculated, and general histological and immunohistochemical (caspase-3, bcl-2, ki- 67, and oxytocin receptors) investigations of right atrial appendage myocardial biopsies were performed. Results . Myocardial remodeling in DP of HFpEF was characterized by the predominance of eccentric hypertrophy (43%), type 2 diastolic dysfunction (p=0,028), lower LV ejection fraction (p=0,002), and lower LV global function index (p=0,042) compared to patients without T2D. The morphological profile of the myocardium in DP of HFpEF demonstrated significant activation of angiogenesis (p=0,006), apoptosis (p