Liang Yuan-Feng, Song Feier, Liu Huixia, Liu Jian, Zhang Yu-Yuan, Lin Wei-Dong, Liao Hong-Tao, Guo Hui-Ming, Tse Gary, Liu Fang-Zhou, Lin Zhanyi
Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Cardiol Res Pract. 2021 Oct 27;2021:2558639. doi: 10.1155/2021/2558639. eCollection 2021.
Diabetes mellitus (DM) is a prognostic marker in elderly patients with cardiovascular diseases, but its predictive value in elderly valvular heart disease (VHD) patients is unclear. This study aimed to investigate the effect of DM on the long-term outcome of elderly VHD patients.
This single-center, observational study enrolled patients aged 65 and older consecutively with confirmed VHD using echocardiography. Patients, divided into the DM group and non-DM group, were followed up for major adverse cardiac and cerebrovascular events (MACCEs), including all-cause death, ischemic stroke, and heart failure rehospitalization.
Our study consisted of 532 patients over a median follow-up of 52.9 months. Compared with the non-DM group ( = 377), the DM group ( = 155) had higher incidences of ischemic stroke (25.2% vs. 13.5%, =0.001), heart failure rehospitalization (37.4% vs. 20.7%, < 0.001), and MACCEs (60.0% vs. 35.8%, < 0.001). After adjustment of confounders by the multivariable cox regression, DM appeared as an independent predictor for MACCEs (adjusted hazard ratio, aHR: 1.88; 95% confidence interval 1.42-2.48; < 0.001). In the subgroup analysis of VHD etiology and functional style, conversely, DM was a protective factor for MACCEs in the patients with rheumatic VHD compared with those without rheumatic VHD (aHR: 0.43 vs. 2.27, =0.004).
DM was an independent predictor for ischemic stroke and heart failure rehospitalization in elderly VHD patients undergoing conservative treatment.
糖尿病（DM）是老年心血管疾病患者的一个预后标志物，但其在老年瓣膜性心脏病（VHD）患者中的预测价值尚不清楚。本研究旨在探讨DM对老年VHD患者长期预后的影响。
本单中心观察性研究连续纳入年龄≥65岁、经超声心动图确诊为VHD的患者。患者分为DM组和非DM组，随访主要不良心脑血管事件（MACCE），包括全因死亡、缺血性卒中和心力衰竭再次住院。
我们的研究包括532例患者，中位随访时间为52.9个月。与非DM组（n = 377）相比，DM组（n = 155）的缺血性卒中发生率更高（25.2%对13.5%，P = 0.001）、心力衰竭再次住院率更高（37.4%对20.7%，P < 0.001）以及MACCE发生率更高（60.0%对35.8%，P < 0.001）。经多变量cox回归调整混杂因素后，DM是MACCE的独立预测因素（调整后风险比，aHR：1.88；95%置信区间1.42 - 2.48；P < 0.001）。相反，在VHD病因和功能类型的亚组分析中，与非风湿性VHD患者相比，DM是风湿性VHD患者MACCE的保护因素（aHR：0.43对2.27，P = 0.004）。
DM是接受保守治疗的老年VHD患者缺血性卒中和心力衰竭再次住院的独立预测因素。
