Data di Pubblicazione:
2019
Citazione:
Prognostic role of diabetes and of medium-term glycemic control in heart failure / S. Paolillo, E. Salvioni, M. Mapelli, A. Bonomi, C. Vignati, G. Cattadori, F. De Martino, G. Sinagra, M. Piepoli, U. Corra, R. La Gioia, G. Limongelli, R. Badagliacca, P. Perrone Filardi, P. Agostoni. ((Intervento presentato al convegno European Society of Cardiology (ESC) Heart Failure tenutosi a Athene nel 2019.
Abstract:
Background: Diabetes mellitus (DM) is common in heart failure (HF) patients and seems to adversely influence long-term morbidity and mortality. However, many variables affect HF prognosis and the exact role of DM and of glycemic control in presence of other well-known prognostic indicators is not clear. Aim of the present analysis was to assess in a large HF population the prognostic role of DM, the prognostic effect of insulin treatment, and the relationship among glycated hemoglobin (HbA1c) and prognosis over time and in presence of other prognostic predictors.
Methods: Data from HF patients with reduced ejection (HFrEF) fraction enrolled in the MECKI score database were retrospectively analyzed. In a first step analysis we compared the 10-year prognosis of diabetic and non-diabetic patients; then we compared the prognosis at 10 years of diabetic insulin and non-insulin dependent patients; last we compared the 10-year prognosis of diabetics according to HbA1c values (<7%, 7-8%, >8%). All the survival analyses were made at baseline and after correction for the variables included in the MECKI score (EF, Hb, Na, peakVO2, VE/VCO2 slope, MDRD). The primary endpoint was a composite of cardiovascular death, urgent heart transplantation and ventricular assist device implantation.
Results: Data from 3927 HFrEF patients (79% M, 61.7±13.2 years) were included in the present analysis; 897 patients (23%) presented a definite diagnosis of DM at baseline. Not-adjusted Kaplan-Meier analysis showed a worst prognosis in diabetic compared to non-diabetics as regards the primary study endpoint (Log Rank p=0.04), however after correction for the MECKI score variables no further prognostic differences were observed (Log Rank p=ns) (Figure 1A). The comparison between insulin (n=304) and non-insulin (n=567) diabetics showed an increased occurrence of the primary endpoint in patients on insulin (Log Rank p=0.05), however this difference disappeared after correction for the MECKI score variables (Log Rank p=ns). Last, the three groups of HbA1c showed significant survival differences (Log Rang p<0.001), having patients with HbA1c >8% (n=149) a worst prognosis, with comparable survival in patients with HbA1c <7% (n=266) and between 7-8% (n=133). These differences persisted even after correction for the MECKI score variables (Log Rank p=0.005) (Figure 1B). Conclusion: DM is a prognostic predictor in HFrEF patients, however its role may be mitigated by the presence of other important prognostic indicators. Differently, impaired medium-term glycemic control, expressed by elevated HbA1c, maintains over time its prognostic role independently from the presence of other well-known prognostic indicators. Thus, our efforts in diabetic patients needs to be concentrated on glycemic homeostasis stability over time.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
S. Paolillo, E. Salvioni, M. Mapelli, A. Bonomi, C. Vignati, G. Cattadori, F. De Martino, G. Sinagra, M. Piepoli, U. Corra, R. La Gioia, G. Limongelli, R. Badagliacca, P. Perrone Filardi, P. Agostoni
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