Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical University, 510080, China; Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical University, 510080, China; Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Atherosclerosis. 2024 Jul;394:117306. doi: 10.1016/j.atherosclerosis.2023.117306. Epub 2023 Sep 28.
Secondary mitral regurgitation (sMR), a major valvular disease, is prevalent in patients with coronary artery disease (CAD), and is associated with higher incidence of heart failure (HF) and mortality when present in combination with abnormal glucose metabolism. We aimed to evaluate the relationship between stress hyperglycemia ratio (SHR) and worsening HF in CAD patients with significant (grade ≥2) sMR.
We performed a multi-center observational study of 874 participants with significant sMR following percutaneous coronary intervention (PCI) in the Cardiorenal Improvement-II (CIN-II) cohort. Patients with glucose and glycated hemoglobin (HbA1c) data at admission were included in the analysis, and categorized according to the SHR, the ratio of mmol/L blood glucose to % HbA1c, as quartiles: Q1: <0.74; Q2: 0.74-0.91; Q3: 0.91-1.14; and Q4: ≥1.14. The primary clinical endpoint was worsening HF and the secondary endpoint was major adverse cardiac events (MACE).
Of the 874 participants (64.1 ± 10.8 years, 80% male), 174 showed worsening HF and 226 developed MACE during a median follow-up of 3.7 years (interquartile range: 1.8-6.2 years). Compared to participants in the lowest quartile (Q1) of SHR, the highest quartile group (Q4) was at significantly higher risks of worsening HF (adjusted hazard ratio, 2.44; 95% confidence interval, 1.51-3.94; p< 0.001), while this was not associated with increased risk of MACE (p>0.05) after adjustment for potential covariates. For worsening HF, the results obtained for the normal glucose regulation subgroup may be more meaningful than those for the diabetes mellitus (DM) and pre-DM groups (p-interaction<0.001). For MACE, the acute myocardial infarction (AMI) (Q4 vs. Q1; HR: 0.65, 95%CI: 0.26-1.59) and non-AMI (Q4 vs. Q1; HR: 2.20, 95%CI: 1.36-3.54) subgroups differed significantly on MACE (p-interaction = 0.006).
Increasing SHR is associated with a higher risk of worsening of HF in patients with significant sMR, especially in those with normoglycemia.
继发性二尖瓣反流（sMR）是一种主要的瓣膜疾病，在冠状动脉疾病（CAD）患者中较为常见，当与异常葡萄糖代谢同时存在时，HF 的发生率更高，死亡率也更高。我们旨在评估在经皮冠状动脉介入治疗（PCI）后 sMR 严重程度（≥2 级）的 CAD 患者中，应激性高血糖比值（SHR）与 HF 恶化之间的关系。
我们对 Cardiorenal Improvement-II（CIN-II）队列中 874 例经 PCI 后 sMR 严重程度的患者进行了一项多中心观察性研究。纳入了入院时具有血糖和糖化血红蛋白（HbA1c）数据的患者，并根据 SHR（mmol/L 血糖与%HbA1c 的比值）进行四分位数分组：Q1：<0.74；Q2：0.74-0.91；Q3：0.91-1.14；Q4：≥1.14。主要临床终点为 HF 恶化，次要终点为主要不良心脏事件（MACE）。
在 874 名参与者中（64.1±10.8 岁，80%为男性），174 名出现 HF 恶化，226 名发生 MACE，中位随访时间为 3.7 年（四分位距：1.8-6.2 年）。与 SHR 最低四分位数组（Q1）相比，最高四分位数组（Q4）HF 恶化的风险显著更高（调整后的危险比，2.44；95%置信区间，1.51-3.94；p<0.001），而调整潜在协变量后，MACE 风险无显著增加（p>0.05）。对于 HF 恶化，在正常血糖调节亚组中得到的结果可能比糖尿病（DM）和 DM 前期亚组（p 交互作用<0.001）更有意义。对于 MACE，急性心肌梗死（AMI）（Q4 比 Q1；HR：0.65，95%CI：0.26-1.59）和非 AMI（Q4 比 Q1；HR：2.20，95%CI：1.36-3.54）亚组在 MACE 上有显著差异（p 交互作用=0.006）。
SHR 的升高与 sMR 严重程度的患者 HF 恶化的风险增加相关，尤其是在血糖正常的患者中。
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