根据心力衰竭和射血分数保留患者的糖尿病状态的临床和超声心动图特征和心血管结局：来自 I-Preserve 试验（伊贝沙坦治疗射血分数保留心力衰竭）的报告。
Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction).
机构信息
From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
出版信息
Circulation. 2017 Feb 21;135(8):724-735. doi: 10.1161/CIRCULATIONAHA.116.024593. Epub 2017 Jan 4.
BACKGROUND
In patients with heart failure and preserved ejection fraction, little is known about the characteristics of, and outcomes in, those with and without diabetes mellitus.
METHODS
We examined clinical and echocardiographic characteristics and outcomes in the I-Preserve trial (Irbesartan in Heart Failure With Preserved Ejection Fraction) according to history of diabetes mellitus. Cox regression models were used to estimate hazard ratios for cardiovascular outcomes adjusted for known predictors, including age, sex, natriuretic peptides, and comorbidity. Echocardiographic data were available in 745 patients and were additionally adjusted for in supplementary analyses.
RESULTS
Overall, 1134 of 4128 patients (27%) had diabetes mellitus. Compared with those without diabetes mellitus, they were more likely to have a history of myocardial infarction (28% versus 22%), higher body mass index (31 versus 29 kg/m), worse Minnesota Living With Heart Failure score (48 versus 40), higher median N-terminal pro-B-type natriuretic peptide concentration (403 versus 320 pg/mL; all <0.01), more signs of congestion, but no significant difference in left ventricular ejection fraction. Patients with diabetes mellitus had a greater left ventricular mass and left atrial area than patients without diabetes mellitus. Doppler E-wave velocity (86 versus 76 cm/s; <0.0001) and the E/e' ratio (11.7 versus 10.4; =0.010) were higher in patients with diabetes mellitus. Over a median follow-up of 4.1 years, cardiovascular death or heart failure hospitalization occurred in 34% of patients with diabetes mellitus versus 22% of those without diabetes mellitus (adjusted hazard ratio, 1.75; 95% confidence interval, 1.49-2.05), and 28% versus 19% of patients with and without diabetes mellitus died (adjusted hazard ratio, 1.59; confidence interval, 1.33-1.91).
CONCLUSIONS
In heart failure with preserved ejection fraction, patients with diabetes mellitus have more signs of congestion, worse quality of life, higher N-terminal pro-B-type natriuretic peptide levels, and a poorer prognosis. They also display greater structural and functional echocardiographic abnormalities. Further investigation is needed to determine the mediators of the adverse impact of diabetes mellitus on outcomes in heart failure with preserved ejection fraction and whether they are modifiable.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00095238.
背景
在射血分数保留的心力衰竭患者中，关于伴有和不伴有糖尿病患者的特征和结局知之甚少。
方法
我们根据糖尿病病史，检查了 I-Preserve 试验（Irbesartan 在射血分数保留的心力衰竭中的应用）中的临床和超声心动图特征及结局。使用 Cox 回归模型，根据年龄、性别、利钠肽和合并症等已知预测因素，估算心血管结局的危险比。在补充分析中，还对 745 例患者的超声心动图数据进行了调整。
结果
4128 例患者中，1134 例（27%）有糖尿病。与无糖尿病患者相比，他们更有可能有心肌梗死病史（28%比 22%）、更高的体重指数（31 比 29kg/m）、更差的明尼苏达心力衰竭生活质量评分（48 比 40）、更高的中位 N 末端 B 型利钠肽浓度（403 比 320pg/ml；均<0.01）、更多充血体征，但左心室射血分数无显著差异。有糖尿病的患者左心室质量和左心房面积大于无糖尿病的患者。有糖尿病的患者的多普勒 E 波速度（86 比 76cm/s；<0.0001）和 E/e'比值（11.7 比 10.4；=0.010）更高。在中位随访 4.1 年后，有糖尿病的患者中，心血管死亡或心力衰竭住院的发生率为 34%，而无糖尿病的患者为 22%（调整后的危险比，1.75；95%置信区间，1.49-2.05），有和无糖尿病的患者中，28%的患者死亡（调整后的危险比，1.59；置信区间，1.33-1.91）。
结论
在射血分数保留的心力衰竭中，有糖尿病的患者有更多的充血体征、更差的生活质量、更高的 N 末端 B 型利钠肽水平和更差的预后。他们还表现出更大的结构性和功能性超声心动图异常。需要进一步研究以确定糖尿病对射血分数保留的心力衰竭患者结局的不良影响的介质，以及这些介质是否可以改变。
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