Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Praha 4, Czech Republic.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Sci Rep. 2022 Jul 29;12(1):13038. doi: 10.1038/s41598-022-17327-4.
The role of metformin (MET) in the treatment of patients with advanced HFrEF and type 2 diabetes mellitus (DM) is not firmly established. We studied the impact of MET on metabolic profile, quality of life (QoL) and survival in these patients. A total of 847 stable patients with advanced HFrEF (57.4 ± 11.3 years, 67.7% NYHA III/IV, LVEF 23.6 ± 5.8%) underwent clinical and laboratory evaluation and were prospectively followed for a median of 1126 (IQRs 410; 1781) days for occurrence of death, urgent heart transplantation or mechanical circulatory support implantation. A subgroup of 380 patients (44.9%) had DM, 87 of DM patients (22.9%) were treated with MET. Despite worse insulin sensitivity and more severe DM (higher BMI, HbA1c, worse insulin resistance), MET-treated patients exhibited more stable HF marked by lower BNP level (400 vs. 642 ng/l), better LV and RV function, lower mitral and tricuspid regurgitation severity, were using smaller doses of diuretics (all p < 0.05). Further, they had higher eGFR (69.23 vs. 63.34 ml/min/1.73 m) and better QoL (MLHFQ: 36 vs. 48 points, p = 0.002). Compared to diabetics treated with other glucose-lowering agents, MET-treated patients had better event-free survival even after adjustment for BNP, BMI and eGFR (p = 0.035). Propensity score-matched analysis with 17 covariates yielded 81 pairs of patients and showed a significantly better survival for MET-treated subgroup (p = 0.01). MET treatment in patients with advanced HFrEF and DM is associated with improved outcome by mechanisms beyond the improvement of blood glucose control.
二甲双胍（MET）在治疗晚期射血分数降低的心力衰竭（HFrEF）合并 2 型糖尿病（DM）患者中的作用尚未确定。我们研究了 MET 对这些患者代谢谱、生活质量（QoL）和生存的影响。共 847 例稳定的晚期 HFrEF 患者（57.4±11.3 岁，67.7% NYHA III/IV，LVEF 23.6±5.8%）接受了临床和实验室评估，并前瞻性随访中位数为 1126（IQR 410；1781）天，以观察死亡、紧急心脏移植或机械循环支持植入的发生。其中 380 例（44.9%）患者合并 DM，87 例 DM 患者（22.9%）接受 MET 治疗。尽管 MET 治疗患者的胰岛素敏感性更差，且 DM 更严重（BMI、HbA1c、胰岛素抵抗更严重），但他们的 HF 更稳定，表现为 BNP 水平更低（400 vs. 642ng/l）、左心室和右心室功能更好、二尖瓣和三尖瓣反流程度更低、利尿剂用量更小（均 p<0.05）。此外，MET 治疗患者的 eGFR 更高（69.23 vs. 63.34ml/min/1.73m）、QoL 更好（MLHFQ：36 vs. 48 分，p=0.002）。与接受其他降糖药物治疗的糖尿病患者相比，即使在调整 BNP、BMI 和 eGFR 后，MET 治疗患者的无事件生存率仍更好（p=0.035）。采用 17 个协变量进行倾向评分匹配分析，得到 81 对患者，显示 MET 治疗亚组的生存率显著提高（p=0.01）。MET 治疗晚期 HFrEF 合并 DM 患者的疗效可能优于单纯改善血糖控制。
