Impact of diabetes in patients with pulmonary hypertension.


Diabetes complicates management in a number of disease states and adversely impacts survival; how diabetes affects patients with pulmonary hypertension (PH) has not been well characterized. With insulin resistance having recently been demonstrated in PH, we sought to examine the impact of diabetes in these patients. Demographic characteristics, echo data, and invasive hemodynamic data were prospectively collected for 261 patients with PH referred for initial hemodynamic assessment. Diabetes was defined as documented insulin resistance or treatment with antidiabetic medications. Fifty-five patients (21%) had diabetes, and compared with nondiabetic patients, they were older (mean years ± SD, 61 ± 13 vs. 56 ± 16; [Formula: see text]), more likely to be black (29% vs. 14%; [Formula: see text]) and hypertensive (71% vs. 30%; [Formula: see text]), and had higher mean (±SD) serum creatinine levels (1.1 ± 0.5 vs. 1.0 ± 0.4; [Formula: see text]). Diabetic patients had similar World Health Organization functional class at presentation but were more likely to have pulmonary venous etiology of PH (24% vs. 10%; [Formula: see text]). Echo findings, including biventricular function, tricuspid regurgitation, and pressure estimates were similar. Invasive pulmonary pressures and cardiac output were similar, but right atrial pressure was appreciably higher (14 ± 8 mmHg vs. 10 ± 5 mmHg; [Formula: see text]). Despite similar management, survival was markedly worse and remained so after statistical adjustment. In summary, diabetic patients referred for assessment of PH were more likely to have pulmonary venous disease than nondiabetic patients with PH, with hemodynamics suggesting greater right-sided diastolic dysfunction. The markedly worse survival in these patients merits further study.





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Publication Info

Abernethy, Abraham D, Kathryn Stackhouse, Stephen Hart, Ganesh Devendra, Thomas M Bashore, Raed Dweik and Richard A Krasuski (2015). Impact of diabetes in patients with pulmonary hypertension. Pulmonary circulation, 5(1). pp. 117–123. 10.1086/679705 Retrieved from

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Thomas Michael Bashore

Professor Emeritus of Medicine

The major areas of research involve mostly hemodynamic and imaging research:
1. Valvular heart disease.
2. Adult congenital heart disease.
3. Pulmonary Hypertension.
4. Complex cardiovascular problems.

The Valvular Disease Program and Adult Congenital Program are nationally recognized, and many trainees have gone on to academic careers at a number of universities. Dr. Bashore is now or recently has been on the Editorial Boards of Circulation, the American Journal of Cardiology, Cardiac Catheterization and Intervention, the Journal of Heart Valve Disease, the American Heart Journal, Cardiology Today, the Journal of Invasive Cardiology and the Journal of the American College of Cardiology. He was formerly director of the Diagnostic Cardiac Catheterization Laboratories for 10 years, and then the Director of the Cardiology Fellowship Training Program for 12 years. He is currently the Clinical Chief of the Division of Cardiology. He is a member and/or chairman of numerous committees of the American College of Cardiology and author of over 250 manuscripts, over 70 book chapters and reviews and 3 books. Dr. J. Kevin Harrison, Dr. Andrew Wang, Dr. Tom Gehrig, Dr. Todd Kiefer, Dr. Michael Sketch and Dr. Cary Ward complement the research team along with a variety of research personnel. Currently research is focused on the percutaneous treatment of structural heart disease and adult congenital heart disease.


Richard Andrew Krasuski

Professor of Medicine

Dr. Richard Krasuski is Director of the Adult Congenital Heart Center at Duke University Medical Center, the Director of Hemodynamic Research, and the Medical Director of the CTEPH Program. He is considered a thought leader in the fields of pulmonary hypertension and congenital heart disease. His research focus is in epidemiologic and clinical studies involving patients with pulmonary hypertension and patients with congenital heart disease. He is involved in multiple multicenter studies through the Alliance for Adult Research in Congenital Cardiology (AARCC). He has also helped to develop multiple research databases in these patient populations. He is Co-PI in the upcoming EPIPHANY Study examining the impact of medical and transcatheter interventions on RV-PA coupling in patients with chronic thromboembolic pulmonary hypertension. Over his career he has mentored over 80 students, residents and fellows and has published over 300 peer reviewed publications, book chapters and meeting abstracts. He is also the Chief Editor of Advances in Pulmonary Hypertension and on the editorial boards of several leading medical journals.

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