慢性心力衰竭患者的血糖水平与预后——使用重复教育和心力衰竭门诊患者遵医行为监测（REMADHE）试验的 6 个月间隔长期前瞻性随机对照研究的亚组分析。

Glycemia and prognosis of patients with chronic heart failure--subanalysis of the Long-term Prospective Randomized Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients (REMADHE) trial.

机构信息

Heart Failure Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.

出版信息

Am Heart J. 2010 Jan;159(1):90-7. doi: 10.1016/j.ahj.2009.10.027.

DOI:10.1016/j.ahj.2009.10.027

PMID:20102872

Abstract

BACKGROUND

Heart failure and diabetes often occur simultaneously in patients, but the prognostic value of glycemia in chronic heart failure is debatable. We evaluated the role of glycemia on prognosis of heart failure.

METHODS

Outpatients with chronic heart failure from the Long-term Prospective Randomized Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients (REMADHE) trial were grouped according to the presence of diabetes and level of glycemia. All-cause mortality/heart transplantation and unplanned hospital admission were evaluated.

RESULTS

Four hundred fifty-six patients were included (135 [29.5%] female, 124 [27.2%] with diabetes mellitus, age of 50.2 +/- 11.4 years, and left-ventricle ejection fraction of 34.7% +/- 10.5%). During follow-up (3.6 +/- 2.2 years), 27 (5.9%) patients were submitted to heart transplantation and 202 (44.2%) died; survival was similar in patients with and without diabetes mellitus. When patients with and without diabetes were categorized according to glucose range (glycemia < or = 100 mg/dL [5.5 mmol/L]), as well as when distributed in quintiles of glucose, the survival was significantly worse among patients with lower levels of glycemia. This finding persisted in Cox proportional hazards regression model that included gender, etiology, left ventricle ejection fraction, left ventricle diastolic diameter, creatinine level and beta-blocker therapy, and functional status (hazard ratio 1.45, 95% CI 1.09-1.69, P = .039). No difference regarding unplanned hospital admission was found.

CONCLUSION

We report on an inverse association between glycemia and mortality in outpatients with chronic heart failure. These results point to a new pathophysiologic understanding of the interactions between diabetes mellitus, hyperglycemia, and heart disease.

摘要

背景

心力衰竭和糖尿病常同时发生在患者身上，但血糖在慢性心力衰竭中的预后价值仍存在争议。我们评估了血糖对心力衰竭预后的影响。

方法

根据是否存在糖尿病和血糖水平，将来自长期前瞻性随机对照研究使用每六个月重复教育和监测心力衰竭门诊患者依从性（REMADHE）试验的慢性心力衰竭门诊患者进行分组。评估全因死亡率/心脏移植和非计划住院入院情况。

结果

共纳入 456 例患者（135 例[29.5%]为女性，124 例[27.2%]患有糖尿病，年龄 50.2+/-11.4 岁，左心室射血分数为 34.7+/-10.5%）。在随访期间（3.6+/-2.2 年），27 例（5.9%）患者接受了心脏移植，202 例（44.2%）死亡；有或无糖尿病的患者生存情况相似。当根据血糖范围（血糖<或=100mg/dL[5.5mmol/L]）将有和无糖尿病的患者分类，以及将患者按血糖五分位数分布时，血糖水平较低的患者生存状况明显较差。这种发现持续存在于包括性别、病因、左心室射血分数、左心室舒张直径、肌酐水平和β受体阻滞剂治疗以及功能状态的 Cox 比例风险回归模型中（风险比 1.45，95%可信区间 1.09-1.69，P=0.039）。未发现非计划住院入院率的差异。