Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction Insights from the MECKI Score database

被引：16

作者：

Paolillo, Stefania

Salvioni, Elisabetta

Filardi, Pasquale Perrone

Bonomi, Alice

Sinagra, Gianfranco

Gentile, Piero

Gargiulo, Paola

Scoccia, Alessandra

Cosentino, Nicola

Gugliandolo, Paola

Badagliacca, Roberto

Lagioia, Rocco

Correale, Michele

Frigerio, Maria

Perna, Enrico

Piepoli, Massimo

Re, Federica

Raimondo, Rosa

Mina, Chiara

Clemenza, Francesco

Bussotti, Maurizio

Limongelli, Giuseppe

Gravino, Rita

Passantino, Andrea

Magri, Damiano

Parati, Gianfranco

Caravita, Sergio

Scardovi, Angela B.

Arcari, Luca

Vignati, Carlo

Mapelli, Massimo

Cattadori, Gaia

Cavaliere, Carlo

Corra, Ugo

Agostoni, Piergiuseppe

机构：

[1] Department of Advanced Biomedical Sciences, Federico II University of Naples

[2] Mediterranea Cardiocentro, Naples

[3] Centro Cardiologico Monzino, IRCCS, Milano

[4] Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste

[5] Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, “Sapienza”, Rome University, Rome

[6] Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Bari

[7] Department of Cardiology, University of Foggia, Foggia

[8] Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Milano

[9] UOC Cardiologia, G da Saliceto Hospital, Piacenza

[10] Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma

[11] Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate

[12] Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS – ISMETT, Palermo

[13] Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano

[14] Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli

[15] Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, “Sapienza” Università degli Studi di Roma, Roma

[16] Department of Medicine and Surgery, University of Milano-Bicocca, Milan

[17] San Luca Hospital, Istituto Auxologico Italiano, Milan

[18] Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG)

[19] Cardiology Division, Santo Spirito Hospital, Roma

[20] Department of Clinical Sciences and Community health, Cardiovascular Section, University of Milano, Milano

[21] IRCCS SDN, Napoli

[22] Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2020年 / 317卷

关键词：

Heart failure; Diabetes mellitus; Glycated hemoglobin; Prognosis; AMBULATORY PATIENTS; ESC GUIDELINES; EXERCISE TEST; MORTALITY; SURVIVAL; OUTCOMES; DYSFUNCTION; MORBIDITY; PERFORM;

D O I：

10.1016/j.ijcard.2020.04.079

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population. Methods: 3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1-8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death. Results: For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis. Conclusion: In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control. (c) 2020 Elsevier B.V. All rights reserved.

引用

页码：103 / 110

页数：8

共 29 条

[1] Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation [J].

Aaronson, KD ;

Schwartz, JS ;

Chen, TM ;

Wong, KL ;

Goin, JE ;

Mancini, DM .

CIRCULATION, 1997, 95 (12) :2660-2667

[2] Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique: A new tool for heart failure evaluation [J].

Agostoni, P ;

Cattadori, G ;

Apostolo, A ;

Contini, M ;

Palermo, P ;

Marenzi, G ;

Wasserman, K .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 46 (09) :1779-1781

[3] Exercise hyperpnea in chronic heart failure: relationships to lung stiffness and expiratory flow limitation [J].

Agostoni, P ;

Pellegrino, R ;

Conca, C ;

Rodarte, JR ;

Brusasco, V .

JOURNAL OF APPLIED PHYSIOLOGY, 2002, 92 (04) :1409-1416

[4] How to perform and report a cardiopulmonary exercise test in patients with chronic heart failure [J].

Agostoni, Piergiuseppe ;

Dumitrescu, Daniel .

INTERNATIONAL JOURNAL OF CARDIOLOGY, 2019, 288 :107-113

[5] Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison [J].

Agostoni, Piergiuseppe ;

Paolillo, Stefania ;

Mapelli, Massimo ;

Gentile, Piero ;

Salvioni, Elisabetta ;

Veglia, Fabrizio ;

Bonomi, Alice ;

Corra, Ugo ;

Lagioia, Rocco ;

Limongelli, Giuseppe ;

Sinagra, Gianfranco ;

Cattadori, Gaia ;

Scardovi, Angela B. ;

Metra, Marco ;

Carubelli, Valentina ;

Scrutinio, Domenico ;

Raimondo, Rosa ;

Emdin, Michele ;

Piepoli, Massimo ;

Magri, Damiano ;

Parati, Gianfranco ;

Caravita, Sergio ;

Re, Federica ;

Cicoira, Mariantonietta ;

Mina, Chiara ;

Correale, Michele ;

Frigerio, Maria ;

Bussotti, Maurizio ;

Oliva, Fabrizio ;

Battaia, Elisa ;

Belardinelli, Romualdo ;

Mezzani, Alessandro ;

Pastormerlo, Luigi ;

Guazzi, Marco ;

Badagliacca, Roberto ;

Di Lenarda, Andrea ;

Passino, Claudio ;

Sciomer, Susanna ;

Zambon, Elena ;

Pacileo, Giuseppe ;

Ricci, Roberto ;

Apostolo, Anna ;

Palermo, Pietro ;

Contini, Mauro ;

Clemenza, Francesco ;

Marchese, Giovanni ;

Gargiulo, Paola ;

Binno, Simone ;

Lombardi, Carlo ;

Passantino, Andrea .

EUROPEAN JOURNAL OF HEART FAILURE, 2018, 20 (04) :700-710

[6] Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: A multiparametric approach to heart failure prognosis [J].

Agostoni, Piergiuseppe ;

Corra, Ugo ;

Cattadori, Gaia ;

Veglia, Fabrizio ;

La Gioia, Rocco ;

Scardovi, Angela B. ;

Emdin, Michele ;

Metra, Marco ;

Sinagra, Gianfranco ;

Limongelli, Giuseppe ;

Raimondo, Rossella ;

Re, Federica ;

Guazzi, Marco ;

Belardinelli, Romualdo ;

Parati, Gianfranco ;

Magri, Damiano ;

Fiorentini, Cesare ;

Mezzani, Alessandro ;

Salvioni, Elisabetta ;

Scrutinio, Domenico ;

Ricci, Renato ;

Bettari, Luca ;

Di Lenarda, Andrea ;

Pastormerlo, Luigi E. ;

Pacileo, Giuseppe ;

Vaninetti, Raffaella ;

Apostolo, Anna ;

Iorio, AnnaMaria ;

Paolillo, Stefania ;

Palermo, Pietro ;

Contini, Mauro ;

Confalonieri, Marco ;

Giannuzzi, Pantaleo ;

Passantino, Andrea ;

Dei Cas, Livio ;

Piepoli, Massimo F. ;

Passino, Claudio .

INTERNATIONAL JOURNAL OF CARDIOLOGY, 2013, 167 (06) :2710-2718

[7] Relationship of Hemoglobin A1C and Mortality in Heart Failure Patients With Diabetes [J].

Aguilar, David ;

Bozkurt, Biykem ;

Ramasubbu, Kumudha ;

Deswal, Anita .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (05) :422-428

[8] Executive Summary: Standards of Medical Care in Diabetes-2014 [J].

不详 .

DIABETES CARE, 2014, 37 :S5-S13

[9] 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD [J].

Cosentino, Francesco ;

Grant, Peter J. ;

Aboyans, Victor ;

Bailey, Clifford J. ;

Ceriello, Antonio ;

Delgado, Victoria ;

Federici, Massimo ;

Filippatos, Gerasimos ;

Grobbee, Diederick E. ;

Hansen, Tina Birgitte ;

Huikuri, Heikki, V ;

Johansson, Isabelle ;

Juni, Peter ;

Lettino, Maddalena ;

Marx, Nikolaus ;

Mellbin, Linda G. ;

Ostgren, Carl J. ;

Rocca, Bianca ;

Roffi, Marco ;

Sattar, Naveed ;

Seferovic, Petar M. ;

Sousa-Uva, Miguel ;

Valensi, Paul ;

Wheeler, David C. ;

Piepoli, Massimo Francesco ;

Birkeland, Kare, I ;

Adamopoulos, Stamatis ;

Ajjan, Ramzi ;

Avogaro, Angelo ;

Baigent, Colin ;

Brodmann, Marianne ;

Bueno, Hector ;

Ceconi, Claudio ;

Chioncel, Ovidiu ;

Coats, Andrew ;

Collet, Jean-Philippe ;

Collins, Peter ;

Cosyns, Bernard ;

Di Mario, Carlo ;

Fisher, Miles ;

Fitzsimons, Donna ;

Halvorsen, Sigrun ;

Hansen, Dominique ;

Hoes, Arno ;

Holt, Richard I. G. ;

Home, Philip ;

Katus, Hugo A. ;

Khunti, Kamlesh ;

Komajda, Michel ;

Lambrinou, Ekaterini .

EUROPEAN HEART JOURNAL, 2020, 41 (02) :255-323

[10] Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes [J].

Cosmi, Franco ;

Shen, Li ;

Magnoli, Michela ;

Abraham, William T. ;

Anand, Inder S. ;

Cleland, John G. ;

Cohn, Jay N. ;

Cosmi, Deborah ;

De Berardis, Giorgia ;

Dickstein, Kenneth ;

Franzosi, Maria Grazia ;

Gullestad, Lars ;

Jhund, Pardeep S. ;

Kjekshus, John ;

Kober, Lars ;

Lepore, Vito ;

Lucisano, Giuseppe ;

Maggioni, Aldo P. ;

Masson, Serge ;

McMurray, John J. V. ;

Nicolucci, Antonio ;

Petrarolo, Vito ;

Robusto, Fabio ;

Staszewsky, Lidia ;

Tavazzi, Luigi ;

Teli, Roberto ;

Tognoni, Gianni ;

Wikstrand, John ;

Latini, Roberto .

EUROPEAN JOURNAL OF HEART FAILURE, 2018, 20 (05) :888-895

← 1 2 3 →