Paolillo Stefania, Salvioni Elisabetta, Perrone Filardi Pasquale, Bonomi Alice, Sinagra Gianfranco, Gentile Piero, Gargiulo Paola, Scoccia Alessandra, Cosentino Nicola, Gugliandolo Paola, Badagliacca Roberto, Lagioia Rocco, Correale Michele, Frigerio Maria, Perna Enrico, Piepoli Massimo, Re Federica, Raimondo Rosa, Minà Chiara, Clemenza Francesco, Bussotti Maurizio, Limongelli Giuseppe, Gravino Rita, Passantino Andrea, Magrì Damiano, Parati Gianfranco, Caravita Sergio, Scardovi Angela B, Arcari Luca, Vignati Carlo, Mapelli Massimo, Cattadori Gaia, Cavaliere Carlo, Corrà Ugo, Agostoni Piergiuseppe
Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Mediterranea Cardiocentro, Naples, Italy.
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Int J Cardiol. 2020 Oct 15;317:103-110. doi: 10.1016/j.ijcard.2020.04.079. Epub 2020 Apr 29.
The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population.
3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1-8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death.
For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis.
In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.
糖尿病（DM）在心力衰竭（HF）患者中的预后作用尚不明确，因为在考虑混杂因素时，糖尿病被几个与糖尿病相关的变量所掩盖。我们确定了糖尿病、治疗方法和血糖控制在实际心力衰竭人群中的预后作用。
对纳入代谢运动心脏肾脏指数（MECKI）评分数据库的3927例心力衰竭患者进行评估，中位随访时间为3.66年（四分位间距1.70 - 6.67）。数据分析考虑了糖尿病患者（n = 897）与非糖尿病患者（n = 3030）之间的生存率，以及糖尿病患者中胰岛素治疗组（n = 304）、口服降糖药治疗组（n = 479）和仅饮食治疗组（n = 88）之间的生存率。根据糖化血红蛋白（HbA1c）对糖尿病患者进行分组，评估血糖控制的作用：HbA1c<7%（n = 266）、7.1 - 8%（n = 133）、>8%（n = 149）。所有分析均对射血分数、肾功能、血红蛋白、钠、运动峰值摄氧量和通气/二氧化碳关系斜率进行了校正。研究的主要终点是心血管死亡、紧急心脏移植或左心室辅助装置植入的复合终点。次要终点是心血管死亡和全因死亡。
对于所有终点，在对混杂因素进行校正后，与非糖尿病患者和口服降糖药治疗的患者相比，糖尿病状态以及胰岛素治疗或饮食方案与不良长期预后均无显著相关性。即使在校正混杂因素后，HbA1c>8%的患者预后更差（对数秩检验p<0.001）。所有结果通过风险比分析得到了重复验证。
在心力衰竭患者中，糖尿病、胰岛素治疗和饮食方案不是不良结局的预测因素。考虑到潜在的混杂因素，唯一与长期预后相关的情况是血糖控制不佳。
