在BEST试验中，糖尿病对晚期心力衰竭患者预后的影响。

The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial.

作者信息

Domanski Michael, Krause-Steinrauf Heidi, Deedwania Prakash, Follmann Dean, Ghali Jalal K, Gilbert Edward, Haffner Steven, Katz Richard, Lindenfeld JoAnn, Lowes Brian D, Martin Wade, McGrew Frank, Bristow Michael R

机构信息

Clinical Trials Group, National Heart, Lung, and Blood Institute/NIH, 6701 Rockledge Drive, Bethesda, MD 20892, USA.

出版信息

J Am Coll Cardiol. 2003 Sep 3;42(5):914-22. doi: 10.1016/s0735-1097(03)00856-8.

DOI:10.1016/s0735-1097(03)00856-8

PMID:12957443

Abstract

OBJECTIVES

This was a retrospective analysis to determine the effect of diabetes on outcome in patients with advanced heart failure (HF), and to determine the effect of beta-blockade in patients with HF with and without diabetes mellitus.

BACKGROUND

In chronic HF the impact on clinical outcomes and therapeutic response of the prevalent comorbid condition diabetes mellitus has not been extensively investigated.

METHODS

We assessed the impact of diabetes on prognosis and effectiveness of beta-blocker therapy with bucindolol in patients with HF enrolled in the Beta-Blocker Evaluation of Survival Trial (BEST). We conducted a retrospective analysis to examine the prognosis of patients with advanced HF with and without diabetes, and the effect of beta-blocker therapy on mortality and HF progression or myocardial infarction (MI). The database was the 2,708 patients with advanced HF (36% with diabetes and 64% without diabetes) who were randomized to the beta-blocker bucindolol or placebo in BEST and followed for mortality, hospitalization, and MI for an average of two years.

RESULTS

Patients with diabetes had more severe chronic HF and more coronary risk factors than patients without diabetes. Diabetes was independently associated with increased mortality in patients with ischemic cardiomyopathy (adjusted hazard ratio 1.33, 95% confidence interval 1.12 to 1.58, p = 0.001), but not in those with a nonischemic etiology (adjusted hazard ratio 0.98, 95% confidence interval 0.74 to 1.30, p = 0.89). Compared with patients without diabetes, in diabetic patients beta-blocker therapy was at least as effective in reducing death or HF hospitalizations, total hospitalizations, HF hospitalizations, and MI. Ventricular function and physiologic responses to beta-blockade were similar in patients with and without diabetes.

CONCLUSIONS

Diabetes worsens prognosis in patients with advanced HF, but this worsening appears to be limited to patients with ischemic cardiomyopathy. In advanced HF beta-blockade is effective in reducing major clinical end points in patients with and without diabetes.

摘要

目的

本研究为回顾性分析，旨在确定糖尿病对晚期心力衰竭（HF）患者预后的影响，以及β受体阻滞剂对合并或不合并糖尿病的HF患者的影响。

背景

在慢性HF中，常见的合并症糖尿病对临床结局和治疗反应的影响尚未得到广泛研究。

方法

我们评估了糖尿病对参加β受体阻滞剂生存试验（BEST）的HF患者使用布新洛尔进行β受体阻滞剂治疗的预后和有效性的影响。我们进行了一项回顾性分析，以检查合并或不合并糖尿病的晚期HF患者的预后，以及β受体阻滞剂治疗对死亡率、HF进展或心肌梗死（MI）的影响。数据库为2708例晚期HF患者（36%患有糖尿病，64%未患糖尿病），他们在BEST中被随机分配接受β受体阻滞剂布新洛尔或安慰剂治疗，并平均随访两年，观察死亡率、住院情况和MI。

结果

与未患糖尿病的患者相比，患糖尿病的患者慢性HF更严重，冠状动脉危险因素更多。糖尿病与缺血性心肌病患者死亡率增加独立相关（校正风险比1.33，95%置信区间1.12至1.58，p = 0.001），但在非缺血性病因患者中并非如此（校正风险比0.98，95%置信区间0.74至1.30，p = 0.89）。与未患糖尿病的患者相比，在糖尿病患者中，β受体阻滞剂治疗在降低死亡或HF住院、总住院、HF住院和MI方面至少同样有效。合并或不合并糖尿病的患者对β受体阻滞剂的心室功能和生理反应相似。