2型糖尿病对射血分数轻度降低的心力衰竭患者的预后影响
Prognostic Implications of Type 2 Diabetes Mellitus in Heart Failure with Mildly Reduced Ejection Fraction.
作者信息
Schupp Tobias, Abumayyaleh Mohammad, Weidner Kathrin, Lau Felix, Reinhardt Marielen, Abel Noah, Schmitt Alexander, Forner Jan, Ayasse Niklas, Bertsch Thomas, Akin Muharrem, Akin Ibrahim, Behnes Michael
机构信息
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Rheumatology, Pneumology), Transplant Center Mannheim, Medical Faculty Mannheim, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany.
出版信息
J Clin Med. 2024 Jan 27;13(3):742. doi: 10.3390/jcm13030742.
BACKGROUND
Data regarding the characterization and outcomes of diabetics with heart failure with a mildly reduced ejection fraction (HFmrEF) is scarce. This study investigates the prevalence and prognostic impact of type 2 diabetes in patients with HFmrEF.
METHODS
Consecutive patients with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Patients with type 2 diabetes (dia-betics) were compared to patients without (i.e., non-diabetics). The primary endpoint was all-cause mortality at 30 months. Statistical analyses included Kaplan-Meier, multivariable Cox regression analyses and propensity score matching.
RESULTS
A total of 2169 patients with HFmrEF were included. The overall prevalence of type 2 diabetes was 36%. Diabetics had an increased risk of 30-months all-cause mortality (35.8% vs. 28.6%; HR = 1.273; 95% CI 1.092-1.483; = 0.002), which was confirmed after multivariable adjustment (HR = 1.234; 95% CI 1.030-1.479; = 0.022) and propensity score matching (HR = 1.265; 95% CI 1.018-1.572; = 0.034). Diabetics had a higher risk of HF-related rehospitalization (17.8% vs. 10.7%; HR = 1.714; 95% CI 1.355-2.169; = 0.001). Finally, the risk of all-cause mortality was increased in diabetics treated with insulin (40.7% vs. 33.1%; log-rank = 0.029), whereas other anti-diabetic pharmacotherapies had no prognostic impact in HFmrEF.
CONCLUSIONS
Type 2 diabetes is common and independently associated with adverse long-term prognosis in patients with HFmrEF.
背景
关于射血分数轻度降低的心力衰竭（HFmrEF）糖尿病患者的特征和预后的数据很少。本研究调查2型糖尿病在HFmrEF患者中的患病率及其对预后的影响。
方法
对2016年至2022年在一家机构连续纳入的HFmrEF患者（即左心室射血分数41%-49%且有HF体征和/或症状）进行回顾性研究。将2型糖尿病患者（糖尿病患者）与无糖尿病患者（即非糖尿病患者）进行比较。主要终点是30个月时的全因死亡率。统计分析包括Kaplan-Meier分析、多变量Cox回归分析和倾向评分匹配。
结果
共纳入2169例HFmrEF患者。2型糖尿病的总体患病率为36%。糖尿病患者30个月全因死亡率风险增加（35.8%对28.6%；HR = 1.273；95%CI 1.092-1.483；P = 0.002），多变量调整后得到证实（HR = 1.234；95%CI 1.030-1.479；P = 0.022），倾向评分匹配后也得到证实（HR = 1.265；95%CI 1.018-1.572；P = 0.034）。糖尿病患者因心力衰竭再次住院的风险更高（17.8%对10.7%；HR = 1.714；95%CI 1.355-2.169；P = 0.001）。最后，接受胰岛素治疗的糖尿病患者全因死亡率风险增加（40.7%对33.1%；log-rank P = 0.029），而其他抗糖尿病药物治疗对HFmrEF患者的预后无影响。
结论
2型糖尿病在HFmrEF患者中很常见，且与不良的长期预后独立相关。
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