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

https://doi.org/10.15829/1728-8800-2026-4551

EDN: SGMBVX

Abstract

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<0,001), and proliferative potential of cardiomyocytes (p=0,049). The identified changes were accompanied by a significant decrease in blood oxytocin level (p<0,001) and high expression of oxytocin receptors (p<0,001) in the myocardium of patients with DP of HFpEF compared to the group without T2D.

Conclusion. A distinctive feature of the myocardial remodeling marker panel in patients with HFpEF in this study was a low blood oxytocin level and a high cardiomyocyte apoptosis index.

About the Authors

Anastasia D. Starchenko
Orenburg State Medical University Ministry of Health of Russia
Russian Federation

assistant of the Department of Internal Diseases

Orenburg


Yulia V. Liskova
N.I. Pirogov Russian National Research Medical University
Russian Federation

MD, Associate Professor, Professor of the Faculty Therapy Department

Moscow


Alexander A. Stadnikov
Orenburg State Medical University Ministry of Health of Russia
Russian Federation

Doctor of Biological Sciences, Professor, Professor of the Department of Embryology, Cytology and Histology

Orenburg


Vera A. Jargasova
Orenburg State Medical University Ministry of Health of Russia
Russian Federation

assistant of the Department of Internal Diseases

Orenburg


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What is already known about the subject?

  • Myocardial remodeling in most patients with the heart failure (HF) with preserved ejection fraction (HFpEF) phenotype is characterized by concentric hyper­trophy and progressive diastolic dysfunction, which are based on myocardial hypertrophy and dif­fuse fibrosis.
  • The main diagnostic/prognostic marker of HF is N-ter­minal pro-brain natriuretic peptide.

What might this study add?

  • Myocardial remodeling in patients with the diabetic phe­no­type of HFpEF against the background of co­ro­nary artery disease and hypertension is cha­rac­terized by the predominance of eccentric left ven­tri­cular hypertrophy, type 2 diastolic dys­func­tion with pro­nounced cardiomyocyte apop­to­sis, ac­ti­vation of proliferative potential and angio­ge­ne­sis in the myo­car­dium.
  • Low blood oxytocin levels are a distinctive fea­tu­re of the diabetic phenotype of HFpEF, with a com­parable increase in N-terminal pro-brain natri­ure­tic peptide in the general cohort of patients with HFpEF.

Review

For citations:

Starchenko A.D., Liskova Yu.V., Stadnikov A.A., Jargasova V.A. Clinical and morphological features of the diabetic phenotype of heart failure with preserved ejection fraction: focus on novel markers of myocardial remodeling. Cardiovascular Therapy and Prevention. 2026;25(1):4551. (In Russ.) https://doi.org/10.15829/1728-8800-2026-4551. EDN: SGMBVX

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ISSN 1728-8800 (Print)
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