Liu Zhican, Hu Hailong, Zeng Jianping, Jiang Mingyan
Department of Pulmonary and Critical Care Medicine, Xiangtan Central Hospital, The Affiliated Hospital of Hunan University, Xiangtan, 411100, China.
Department of Cardiology, Xiangtan Central Hospital, The Affiliated Hospital of Hunan University, Xiangtan, 411100, China.
Diabetol Metab Syndr. 2025 Apr 4;17(1):115. doi: 10.1186/s13098-025-01627-6.
Type 2 diabetes mellitus (T2DM) is known to worsen the prognosis of heart failure (HF), but its specific impact on patients with ischemic versus non-ischemic heart failure with mildly reduced ejection fraction (HFmrEF) remains unclear due to limited research and conflicting evidence.
We conducted a retrospective study of 1,691 HFmrEF patients at Xiangtan Central Hospital. Participants were divided into four groups: ischemic with T2DM (467 patients), ischemic without T2DM (856 patients), non-ischemic with T2DM (87 patients), and non-ischemic without T2DM (281 patients). We utilized the Cox proportional hazards model to analyze differences in all-cause mortality and cardiovascular events among the groups.
After adjusting for multiple confounding factors using the Cox proportional hazards model, the ischemic heart disease and T2DM group had a significantly higher risk of all-cause mortality compared to the ischemic group without T2DM (HR = 1.5, 95% CI = 1.2-1.9, P = 0.001). The risk of cardiovascular events was also significantly increased (HR = 1.3, 95% CI = 1.1-1.5, P = 0.001). In non-ischemic HFmrEF patients, T2DM was not associated with a significantly increased risk of all-cause mortality (HR = 1.0, 95% CI = 0.6-1.7, P = 0.957) or cardiovascular events (HR = 1.3, 95% CI = 0.9-1.9, P = 0.113).
T2DM significantly increases the risk of all-cause mortality and cardiovascular events in ischemic HFmrEF patients, while its impact on non-ischemic HFmrEF patients is limited. These findings underscore the importance of managing T2DM in patients with ischemic HFmrEF.
2型糖尿病（T2DM）已知会使心力衰竭（HF）的预后恶化，但由于研究有限且证据相互矛盾，其对射血分数轻度降低的缺血性与非缺血性心力衰竭（HFmrEF）患者的具体影响仍不清楚。
我们对湘潭市中心医院的1691例HFmrEF患者进行了一项回顾性研究。参与者被分为四组：缺血性合并T2DM（467例患者）、缺血性不合并T2DM（856例患者）、非缺血性合并T2DM（87例患者）和非缺血性不合并T2DM（281例患者）。我们使用Cox比例风险模型分析各组全因死亡率和心血管事件的差异。
使用Cox比例风险模型调整多个混杂因素后，缺血性心脏病合并T2DM组的全因死亡率风险显著高于不合并T2DM的缺血组（HR = 1.5，95%CI = 1.2 - 1.9，P = 0.001）。心血管事件风险也显著增加（HR = 1.3，95%CI = 1.1 - 1.5，P = 0.001）。在非缺血性HFmrEF患者中，T2DM与全因死亡率风险显著增加无关（HR = 1.0，95%CI = 0.6 - 1.7，P = 0.957）或心血管事件无关（HR = 1.3，95%CI = 0.9 - 1.9，P = 0.113）。
T2DM显著增加缺血性HFmrEF患者的全因死亡率和心血管事件风险，而其对非缺血性HFmrEF患者的影响有限。这些发现强调了在缺血性HFmrEF患者中管理T2DM的重要性。
