The influence of dipeptidyl peptidase-4 inhibitor on the progression of type B intramural hematoma

Qu Chen; Dandan Jiang; Zhonggui Shan

doi:10.3389/fcvm.2022.969357

The influence of dipeptidyl peptidase-4 inhibitor on the progression of type B intramural hematoma

Front Cardiovasc Med. 2022 Oct 18:9:969357. doi: 10.3389/fcvm.2022.969357. eCollection 2022.

Authors

Qu Chen¹, Dandan Jiang², Zhonggui Shan¹

Affiliations

¹ Department of Cardiovascular Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
² Department of Respiratory Medicine, Xinglin Branch of the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.

Abstract

Objectives: Investigating whether dipeptidyl peptidase-4 inhibitors (DPP4i) could influence the progression of type B intramural hematoma (IMHB) in patients with diabetes mellitus (DM).

Materials and methods: Uncomplicated IMHB patients were matched by age, sex, and body mass index. Cox proportional hazard models were constructed to identify risk factors. A Kaplan-Meier survival analysis was used to estimate all-cause and aorta-related mortality.

Results: Ninety-six matched IMHB patients were divided into Group A (n = 32, IMHB patients without DM), Group B (n = 32, IMHB patients with DMreceiving oral antidiabetic drugs [without DPP4i]) and Group C (n = 32, IMHB patients with DM receiving oral antidiabetic drugs [with DPP4i]). Group C had the lowest rate of aorta-related adverse events (3.1%), aorta-related mortality (0.0%) and reintervention (3.1%). Cox proportional hazard models revealed that a lower eosinophil count (per 0.1, HR, 0.48; 95% CI, 0.29-0.79, P = 0.004) and a higher neutrophil to lymphocyte ratio (NLR) (HR, 1.13; 95% CI, 1.05-1.21, P = 0.001) were associated with higher occurrences of aorta-related adverse events. A lower eosinophil count (per 0.1, HR, 0.40; 95% CI, 0.18-0.89, P = 0.025) and a higher NLR (HR, 1.19; 95% CI, 1.08-1.32, P = 0.001) were also associated with increased aorta-related mortality.

Conclusion: DPP4i administration in DM patients with IMHB was associated with lower aorta-related mortality and more benign progression than in those who did not receive DPP4i or those without DM. Furthermore, a higher eosinophil count and a lower NLR ratio are potential protective factors that may explain the potential therapeutic benefit of DPP4i.

Keywords: diabetes mellitus; dipeptidyl peptidase-4 inhibitor; eosinophil; intramural hematoma; outcome.