Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.
Cardiovasc Diabetol. 2024 Aug 1;23(1):280. doi: 10.1186/s12933-024-02360-6.
This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences.
Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients.
A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death.
In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml.
These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted.
本研究旨在评估指南推荐的诊断工具 NT-proBNP 和 NYHA 分级，并重点关注性别特异性差异。
患有 2 型糖尿病（T2D）的患者心力衰竭（HF）风险比没有 T2D 的患者高 4 倍，尤其是女性患者的风险比男性患者高两倍以上。尽管男性和女性之间存在明显的病理生理学差异，但目前针对糖尿病患者 HF 诊断算法尚无特异性性别推荐。
共纳入 2083 例 T2D 患者，主要终点为 5 年内住院期间发生心力衰竭。次要终点为全因死亡。
在女性患者中，与男性患者相比，NYHA II 级和 III 级之间在住院前或住院期间 HF 诊断的频率和死亡率没有显著差异。此外，仅在女性患者中，NT-proBNP 水平在 NYHA 阶段 II 和 III 之间没有明显差异。多变量回归分析表明，NYHA 分级不是女性 NT-proBNP 水平的预测因素，而仅在男性患者中是。多变量 Cox 回归分析表明，NYHA 评分在女性患者中也不是 HF 发生的显著危险因素。此外，男性患者中 NT-proBNP 水平在 125-400 pg/ml 之间与低于 125 pg/ml 的患者之间死亡率没有显著差异，而女性患者中 NT-proBNP 水平在 125-400 pg/ml 之间的死亡率明显高于低于 125 pg/ml 的患者。
这些发现表明，NYHA 分级可能不是评估 T2D 女性患者 HF 诊断的最适宜工具。此外，需要考虑为 T2D 女性患者进行更独立于症状的 HF 筛查，并重新评估当前指南，特别是针对性别特异性方面。
Zotero 插件
