Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2023 Sep 20;14:1211954. doi: 10.3389/fendo.2023.1211954. eCollection 2023.
A substantial portion of heart failure (HF) patients adherent to guideline-directed medical therapies have experienced improved ejection fraction (EF), termed HFimpEF. Glycemic variability (GV) has emerged as a critical cardiometabolic factor. However, the relation between long-term GV and the incidence of HFimpEF is still unclear.
A total of 591 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) admitted from January 2013 to December 2020 were consecutively enrolled. Repeat echocardiograms were performed at baseline and after around 12 months. The incidence of HFimpEF, defined as (1) an absolute EF improvement ≥10% and (2) a second EF > 40% and its association with long-term fasting plasma glucose (FPG) variability were analyzed.
During a mean follow-up of 12.2 ± 0.6 months, 218 (42.0%) patients developed HFimpEF. Multivariate analysis showed FPG variability was independently associated with the incidence of HFimpEF after adjustment for baseline HbA1c, mean FPG during follow-up and other traditional risk factors (odds ratio [OR] for highest vs. lowest quartile of CV of FPG: 0.487 [95% CI 0.257~0.910]). Evaluation of GV by alternative measures yielded similar results. Subgroup analysis revealed that long-term GV was associated with HFimpEF irrespective of glycemic levels and diabetic conditions.
This study reveals that greater FPG variability is associated with compromised development of HFimpEF. A more stable control of glycemic levels might provide favorable effects on myocardial functional recovery in HF patients even without diabetes.
相当一部分遵循指南指导的医学治疗的心力衰竭（HF）患者射血分数（EF）得到改善，称为 HFimpEF。血糖变异性（GV）已成为一个关键的心脏代谢因素。然而，长期 GV 与 HFimpEF 发生率之间的关系尚不清楚。
共连续纳入 2013 年 1 月至 2020 年 12 月期间因射血分数降低（HFrEF，EF≤40%）住院的 591 例 HF 患者。在基线和大约 12 个月后进行重复超声心动图检查。HFimpEF 的发生率，定义为（1）绝对 EF 改善≥10%和（2）第二次 EF>40%，并分析其与长期空腹血糖（FPG）变异性的关系。
在平均 12.2±0.6 个月的随访期间，218 例（42.0%）患者发生 HFimpEF。多变量分析显示，在校正基线 HbA1c、随访期间平均 FPG 和其他传统危险因素后，FPG 变异与 HFimpEF 的发生独立相关（FPG 变异系数最高与最低四分位数的比值[OR]：0.487 [95%CI 0.257~0.910]）。用替代指标评估 GV 也得出了类似的结果。亚组分析表明，无论血糖水平和糖尿病状况如何，长期 GV 与 HFimpEF 相关。
这项研究表明，更大的 FPG 变异性与 HFimpEF 的发生有关。即使没有糖尿病，血糖水平更稳定的控制可能对 HF 患者的心肌功能恢复产生有利影响。
