Li X, Jiang R, Kong H, Shu Y, Li Q, Hua W
Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for -Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Exp Clin Endocrinol Diabetes. 2014 Sep;122(8):457-62. doi: 10.1055/s-0034-1376966. Epub 2014 Jun 11.
Recent data have suggested that impaired fasting glucose (IFG) is an independent risk factor for mortality in patients with heart failure. However, the prognostic indicator of elevated fasting blood glucose (FBG) such as IFG in dilated cardiomyopathy (DCM) was not well understood. The purpose of this study was to examine the association between IFG at admission and survival in hospitalized patients with DCM.
A retrospective cohort study was undertaken in 1 089 hospitalized patients with DCM in Fuwai Hospital from November 2003 to September 2 011 (female 26.5%, 51.4±14.6 years old). Standard demographics, echocardiography and routine blood samples were obtained shortly after admission. The outcomes were assessed using all-cause mortality at a mean follow-up of 3.5±2.3 years and were analyzed using Kaplan-Meier survival curve (log-rank test) and Cox regression.
The cohort consisted of 1 089 patients with DCM, 835 patients with normal fasting glucose (NFG, FBG<6.1 mmol/L, 76.7%), 113 patients with IFG (FBG 6.1-6.9 mmol/L, 10.4%), and 141 patients with FBG≥7.0 mmol/L (12.9%). Among the 1 089 patients studied, 252 (23.1%) died over a mean follow-up period of 3.5±2.3 years. All-cause mortality rates were highest in patients with FBG≥7.0 mmol/L (31.2%), intermediate in those with IFG (24.8%), and lowest in those with NFG (21.6%); a significant difference in all-cause mortality rate was found among the 3 groups (log-rank χ(2)=6.715, P=0.035). After adjustment for baseline variables, New York Heart Association (NYHA) functional class, QRS duration, left atrium diameter, systolic blood pressure, FBG≥7.0 mmol/L, not IFG, and circulating creatinine levels were the variables that remained as predictors of all-cause mortality.
In the present study, all-cause mortality was higher in patients with FBG≥7.0 mmol/L compared to the patients with NFG, and FBG≥ 7.0 mmol/L, not IFG, was one of predictors of all-cause mortality in DCM patients.
近期数据表明，空腹血糖受损（IFG）是心力衰竭患者死亡的独立危险因素。然而，在扩张型心肌病（DCM）中，空腹血糖升高（FBG）如IFG的预后指标尚未得到充分了解。本研究的目的是探讨DCM住院患者入院时IFG与生存之间的关系。
对2003年11月至2011年9月在阜外医院住院的1089例DCM患者进行回顾性队列研究（女性占26.5%，年龄51.4±14.6岁）。入院后不久获取标准人口统计学资料、超声心动图和常规血液样本。在平均随访3.5±2.3年时使用全因死亡率评估结局，并使用Kaplan-Meier生存曲线（对数秩检验）和Cox回归进行分析。
该队列包括1089例DCM患者，835例空腹血糖正常（NFG，FBG<6.1 mmol/L，占76.7%），113例IFG患者（FBG 6.1 - 6.9 mmol/L，占10.4%），以及141例FBG≥7.0 mmol/L的患者（占12.9%）。在研究的1089例患者中，252例（23.1%）在平均随访3.5±2.3年期间死亡。全因死亡率在FBG≥7.0 mmol/L的患者中最高（31.2%），IFG患者中次之（24.8%），NFG患者中最低（21.6%）；三组间全因死亡率存在显著差异（对数秩χ(2)=6.715，P = 0.035）。在对基线变量、纽约心脏协会（NYHA）功能分级、QRS时限、左心房直径、收缩压、FBG≥7.0 mmol/L而非IFG以及循环肌酐水平进行调整后，这些变量仍是全因死亡率的预测因素。
在本研究中，FBG≥7.0 mmol/L的患者全因死亡率高于NFG患者，且FBG≥7.0 mmol/L而非IFG是DCM患者全因死亡率的预测因素之一。
