Diabetes mellitus and hemodynamics in advanced heart failure.
Diabetes mellitus
Heart failure
Hemodynamics
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 05 2023
15 05 2023
Historique:
received:
30
01
2023
revised:
24
02
2023
accepted:
05
03
2023
medline:
11
4
2023
pubmed:
13
3
2023
entrez:
12
3
2023
Statut:
ppublish
Résumé
The presence of diabetes in patients with heart failure (HF) is associated with a worse prognosis. It is unclear if hemodynamics in HF patients with DM differ from those of non-diabetic patients and how this might influence outcome. This study aims to discover the impact of DM on hemodynamics in HF patients. Consecutive patients (n = 598) with HF and reduced ejection fraction (LVEF ≤40%) undergoing invasive hemodynamic evaluation were included (non-DM: n = 473, DM: n = 125). Hemodynamic parameters included pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP). Mean follow-up was 9.5 ± 5.1 years. Patients with DM (82.7% male, mean age 57.1 ± 10.1 years, mean HbA1c 60 ± 21 mmol/mol) had higher PCWP, mPAP, CVP and higher MAP. Adjusted analysis demonstrated that DM patients had higher PCWP and CVP. Increasing HbA1c-values were correlated with higher PCWP (p = 0.017) and CVP (p = 0.043). Patients with DM, especially those with poor glycemic control, have higher filling pressures. This may be a feature of diabetic cardiomyopathy, however, other unknown mechanisms beyond hemodynamic factors are likely to explain the increased mortality associated with diabetes in HF.
Sections du résumé
BACKGROUND
The presence of diabetes in patients with heart failure (HF) is associated with a worse prognosis. It is unclear if hemodynamics in HF patients with DM differ from those of non-diabetic patients and how this might influence outcome. This study aims to discover the impact of DM on hemodynamics in HF patients.
METHODS
Consecutive patients (n = 598) with HF and reduced ejection fraction (LVEF ≤40%) undergoing invasive hemodynamic evaluation were included (non-DM: n = 473, DM: n = 125). Hemodynamic parameters included pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP). Mean follow-up was 9.5 ± 5.1 years.
RESULTS
Patients with DM (82.7% male, mean age 57.1 ± 10.1 years, mean HbA1c 60 ± 21 mmol/mol) had higher PCWP, mPAP, CVP and higher MAP. Adjusted analysis demonstrated that DM patients had higher PCWP and CVP. Increasing HbA1c-values were correlated with higher PCWP (p = 0.017) and CVP (p = 0.043).
CONCLUSION
Patients with DM, especially those with poor glycemic control, have higher filling pressures. This may be a feature of diabetic cardiomyopathy, however, other unknown mechanisms beyond hemodynamic factors are likely to explain the increased mortality associated with diabetes in HF.
Identifiants
pubmed: 36907448
pii: S0167-5273(23)00341-8
doi: 10.1016/j.ijcard.2023.03.015
pii:
doi:
Substances chimiques
Glycated Hemoglobin
0
Types de publication
Journal Article
Comment
Langues
eng
Sous-ensembles de citation
IM
Pagination
60-65Commentaires et corrections
Type : CommentOn
Informations de copyright
Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest BH and TD: Nothing to declare. KR: Advisor: Abbott, Boehringer Ingelheim and NovoNordisk. Speaker's fee: Astra-Zeneca, Orion Pharma, Novartis, Vifor Pharm. ME: Speaker's fee: Orion Pharma. CK: Advisor: Amicus, Sanofi Genozyme, Astra Zeneca, Boehringer Ingelheim. Speakers fee: Astra Zeneca, Amicus, Sanofi Genozyme, Boehringer Ingelheim, Novo Nordisk. FG: Advisor: Abbott, Ionis, Alnylam, Astra-Zeneca, Pfizer; Research grants. Pfizer. Speaker's fee: Novartis, Vifor Pharma