Long-term LVEF trajectories in patients with type 2 diabetes and heart failure

Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajectories. The ai...

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Detalles Bibliográficos
Autores: Julián, María Teresa|||0000-0003-2524-1823, Alonso Pedrol, Núria|||0000-0001-9687-8050, Lupón, Josep|||0000-0002-5601-9611, Gavidia-Bovadilla, Giovana, Ferrer, Elena|||0000-0001-5853-8207, de Antonio Ferrer, Marta|||0000-0002-4319-797X, López Ayerbe, Jorge|||0009-0008-8495-0877, Domingo, Mar|||0000-0002-2935-1272, Santiago Vacas, Evelyn|||0000-0001-7511-406X, Zamora, Elisabet|||0000-0001-5317-7481, Codina, Pau|||0000-0002-2469-5711, Moliner, P.|||0000-0002-5511-8597, Núñez, Julio|||0000-0003-1672-7119, Santesmases Ejarque, Javier|||0000-0002-1226-1617, Puig Domingo, Manuel|||0000-0002-6744-7195, Bayés-Genís, Antoni|||0000-0002-3044-197X
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:227715
Acceso en línea:https://ddd.uab.cat/record/227715
https://dx.doi.org/urn:doi:10.1186/s12933-020-01011-w
Access Level:acceso abierto
Palabra clave:Heart failure
Diabetes mellitus
Ejection fraction
Etiology
Long-term
Follow-up
Descripción
Sumario:Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajectories. The aim of this study was to prospectively assess very long-term (up to 15 years) LVEF trajectories in patients with and without T2D and underlying HF. Ambulatory patients admitted to a multidisciplinary HF clinic were prospectively evaluated by scheduled two-dimensional echocardiography at baseline, 1 year, and then every 2 years afterwards, up to 15 years. Statistical analyses of LVEF change with time were performed using the linear mixed effects (LME) models, and locally weighted error sum of squares (Loess) curves were plotted. Of the 1921 patients, 461 diabetic and 699 non-diabetic patients with LVEF < 50% were included in the study. The mean number of echocardiography measurements performed in diabetic patients was 3.3 ± 1.6. Early LVEF recovery was similar in diabetic and non-diabetic patients, but Loess curves showed a more pronounced inverted U shape in diabetics with a more pronounced decline after 9 years. LME analysis showed a statistical interaction between T2D and LVEF trajectory over time (p = 0.009), which was statistically significant in patients with ischemic etiologies (p < 0.001). Other variables that showed an interaction between LVEF trajectories and T2D were male sex (p = 0.04) and HF duration (p = 0.008). LVEF trajectories in T2D patients with depressed systolic function showed a pronounced inverted U shape with a marked decline after 9 years. Diabetic cardiomyopathy may underlie the functional decline observed.

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