Walker Andrew Mn, Patel Peysh A, Rajwani Adil, Groves David, Denby Christine, Kearney Lorraine, Sapsford Robert J, Witte Klaus K, Kearney Mark T, Cubbon Richard M
LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Department of Medical Physics and Clinical Engineering, The Royal Liverpool University Hospital, Liverpool, UK Department of Physics, University of Liverpool, Liverpool, UK.
Diab Vasc Dis Res. 2016 Sep;13(5):331-40. doi: 10.1177/1479164116653342. Epub 2016 Jun 22.
Diabetes mellitus is associated with an increased risk of death and hospitalisation in patients with chronic heart failure. Better understanding of potential underlying mechanisms may aid the development of diabetes mellitus-specific chronic heart failure therapeutic strategies.
Prospective observational cohort study of 628 patients with chronic heart failure associated with left ventricular systolic dysfunction receiving contemporary evidence-based therapy. Indices of cardiac structure and function, along with symptoms and biochemical parameters, were compared in patients with and without diabetes mellitus at study recruitment and 1 year later.
Patients with diabetes mellitus (24.2%) experienced higher rates of all-cause [hazard ratio, 2.3 (95% confidence interval, 1.8-3.0)] and chronic heart failure-specific mortality and hospitalisation despite comparable pharmacological and device-based therapies. At study recruitment, patients with diabetes mellitus were more symptomatic, required greater diuretic doses and more frequently had radiologic evidence of pulmonary oedema, despite higher left ventricular ejection fraction. They also exhibited echocardiographic evidence of increased left ventricular wall thickness and pulmonary arterial pressure. Diabetes mellitus was associated with reduced indices of heart rate variability and increased heart rate turbulence. During follow-up, patients with diabetes mellitus experienced less beneficial left ventricular remodelling and greater deterioration in renal function.
Diabetes mellitus is associated with features of adverse structural and functional cardiac remodelling in patients with chronic heart failure.
糖尿病与慢性心力衰竭患者的死亡和住院风险增加相关。更好地了解潜在的潜在机制可能有助于制定针对糖尿病的慢性心力衰竭治疗策略。
对628例伴有左心室收缩功能障碍的慢性心力衰竭患者进行前瞻性观察队列研究，这些患者接受当代基于证据的治疗。在研究入组时和1年后，比较了糖尿病患者和非糖尿病患者的心脏结构和功能指标，以及症状和生化参数。
尽管接受了类似的药物和器械治疗，但糖尿病患者（24.2%）的全因死亡[风险比，2.3（95%置信区间，1.8-3.0）]、慢性心力衰竭特异性死亡率和住院率更高。在研究入组时，糖尿病患者症状更明显，需要更大剂量的利尿剂，尽管左心室射血分数较高，但更频繁地有肺水肿的影像学证据。他们还表现出超声心动图证据显示左心室壁厚度增加和肺动脉压升高。糖尿病与心率变异性降低和心率震荡增加有关。在随访期间，糖尿病患者的左心室重构益处较少，肾功能恶化更严重。
糖尿病与慢性心力衰竭患者不良的心脏结构和功能重构特征相关。
