Diabetes mellitus in stable chronic heart failure and the combination with humoral activation, their association, and prediction of 2-year adverse outcomes. Data from the FAR NHL registry

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Pub Date : 2024-09-12 DOI:10.1111/1753-0407.13605

Karel Labr, Jindrich Spinar, Jiri Parenica, Lenka Spinarova, Jan Krejci, Filip Malek, Petr Ostadal, Ondrej Ludka, Jiri Jarkovsky, Klara Benesova, Ruzena Labrova, Monika Spinarova

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Abstract

Background/Aim

The study aims to describe the role of diabetes in patients with heart failure.

Methods

In all, 1052 chronic heart failure patients were included in the FARmacology and NeuroHumoral Activation (FAR NHL) multicenter prospective registry. They had ejection fraction below 50% and were on stable medication for at least 1 month.

Results

More than one-third (38.9%) of the patients had diabetes mellitus (DM). Diabetic patients (N = 409) were older (median 67 vs. 64, p < 0.001), had higher body mass index (BMI) (30 vs. 28 kg/m², p < 0.001), much more frequently had ischemic heart disease (71 vs. 47%, p < 0.001), hypertension (80 vs. 67%, p < 0.001), dyslipidemia (89 vs. 69%, p < 0.001), worse renal function (estimated glomerular filtration rate [eGFR] median 63 vs. 73 mL/min/1.73 m², p < 0.001), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) (median 681 vs. 463 pg/mL, p = 0.003). All-cause death, left ventricle assist device implantation, and orthotopic heart transplantation were set as the combined primary end point, which was present in 15.5% (163 patients) within the 2-year follow-up. In the 2-year follow-up, 81.0% of patients with diabetes survived without a primary end point, while 85.4% of the patients without diabetes survived, the difference being on the verge of statistical significance (p = 0.089). DM is a statistically significant predictor of NT-proBNP value in univariate analysis, but it is not an independent predictor in a multivariate analysis. When the NT-proBNP level was high, the presence of DM did not influence the prognosis.

Conclusion

The combination of diabetes and NT-proBNP levels may better stratify the prognosis of patients with chronic heart failure.

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稳定型慢性心力衰竭患者的糖尿病及其与体液激活的结合、两者之间的关联以及两年不良预后的预测。来自 FAR NHL 登记处的数据

背景/目的该研究旨在描述糖尿病在心力衰竭患者中的作用。方法 FARmacology and NeuroHumoral Activation（FAR NHL）多中心前瞻性登记共纳入了 1052 名慢性心力衰竭患者。这些患者的射血分数低于 50%，且服用稳定药物至少 1 个月。结果超过三分之一（38.9%）的患者患有糖尿病（DM）。糖尿病患者（N = 409）年龄较大（中位数为 67 岁对 64 岁，P < 0.001），体重指数（BMI）较高（30 kg/m2 对 28 kg/m2，P < 0.001），患有缺血性心脏病（71% 对 47%，P < 0.001）、高血压（80% 对 67%，P < 0.001）、血脂异常（89% 对 69%，p <0.001）、肾功能较差（估计肾小球滤过率[eGFR]中位数为 63 对 73 mL/min/1.73 m2，p <0.001）以及 N 端脑钠肽原（NT-proBNP）较高（中位数为 681 对 463 pg/mL，p = 0.003）。全因死亡、左心室辅助装置植入和正位心脏移植被设定为合并的主要终点，在2年的随访中，15.5%的患者（163例）出现了这一情况。在2年的随访中，81.0%的糖尿病患者在未出现主要终点的情况下存活了下来，而85.4%的非糖尿病患者存活了下来，差异接近统计学意义（P = 0.089）。在单变量分析中，DM 对 NT-proBNP 值的预测具有统计学意义，但在多变量分析中，DM 并非独立的预测因素。当 NT-proBNP 水平较高时，DM 的存在并不影响预后。结论糖尿病和 NT-proBNP 水平的结合可更好地对慢性心力衰竭患者的预后进行分层。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.