Das Sandeep R, Drazner Mark H, Yancy Clyde W, Stevenson Lynne W, Gersh Bernard J, Dries Daniel L
Donald W. Reynolds Cardiovascular Clinical Research Center, Division of Cardiology, University of Texas Southwestern Medical School, Dallas, Tex, USA.
Am Heart J. 2004 Nov;148(5):883-8. doi: 10.1016/j.ahj.2004.04.019.
Emerging data suggest that diabetes mellitus is a risk factor for the progression of established heart failure only in those patients with ischemic cardiomyopathy. Whether diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular systolic dysfunction to symptomatic heart failure in patients with left ventricular dysfunction of an ischemic cause is not known.
We performed a retrospective analysis of 2821 patients with asymptomatic left ventricular systolic dysfunction from the Studies of Left Ventricular Dysfunction (SOLVD) Prevention trial. We used adjusted survival analysis to examine the effects of ischemic heart disease and diabetes mellitus on 3 prespecified study end points: (1) development of heart failure (HF) symptoms, (2) HF hospitalization, and (3) death or development of symptoms.
There is a statistically significant interaction between the cause of left ventricular systolic dysfunction and diabetes mellitus on the risk of development of heart failure symptoms (P = .020). Patients with ischemic cardiomyopathy and diabetes had an increased risk of progression to symptomatic heart failure (HR = 1.56, P < .001), hospitalization for heart failure (HR = 2.16, P < .001), and death or development of symptoms (HR = 1.50, P < .001), compared with patients with ischemic cardiomyopathy without diabetes. In contrast, diabetes was not associated with an increased risk of reaching these end points in patients with nonischemic cardiomyopathy.
Diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular systolic dysfunction to symptomatic heart failure, but this risk appears to be confined to those patients with ischemic cardiomyopathy.
新出现的数据表明，糖尿病仅在患有缺血性心肌病的患者中才是已确诊心力衰竭进展的危险因素。糖尿病是否是缺血性病因导致的左心室功能障碍患者从无症状左心室收缩功能障碍进展为有症状心力衰竭的危险因素尚不清楚。
我们对来自左心室功能障碍研究（SOLVD）预防试验的2821例无症状左心室收缩功能障碍患者进行了回顾性分析。我们使用校正生存分析来检验缺血性心脏病和糖尿病对3个预先设定的研究终点的影响：（1）心力衰竭（HF）症状的出现，（2）因HF住院，以及（3）死亡或症状出现。
左心室收缩功能障碍的病因与糖尿病之间在发生心力衰竭症状的风险上存在统计学显著的交互作用（P = 0.020）。与无糖尿病的缺血性心肌病患者相比，患有缺血性心肌病和糖尿病的患者进展为有症状心力衰竭（HR = 1.56，P < 0.001）、因心力衰竭住院（HR = 2.16，P < 0.001）以及死亡或症状出现（HR = 1.50，P < 0.001）的风险增加。相比之下，糖尿病与非缺血性心肌病患者达到这些终点的风险增加无关。
糖尿病是从无症状左心室收缩功能障碍进展为有症状心力衰竭的危险因素，但这种风险似乎仅限于那些患有缺血性心肌病的患者。
