Impact of Type 2 Diabetes Mellitus on the Epidemiological-Clinical and Paraclinical Characteristics of Acute Heart Failure Seen at the Soavinandriana Hospital Center, Antananarivo Madagascar

Background: The association diabetes mellitus - acute heart failure (AHF) is frequent and a source of significant morbidity and mortality. Objective: The present study aimed to determine the impact of type 2 diabetes (T2DM) on the epidemiological-clinical and paraclinical characteristics of acute heart failure (AHF). Methods: This was a retrospective cross-sectional study, carried out over a period of 2 years. The diagnosis of diabetes mellitus was made according to the criteria of the American Diabetes Association. The diagnosis of AHF is established by the signs and symptoms of heart failure; increased levels of brain natriuretic peptide (BNP); and systolic and/or diastolic dysfunction on echocardiography. Results: 63 T2DM and 120 non-T2DM consecutive patients were selected. Age (≥ 50 years in men and ≥ 60 years in women) (OR=2.08 [1.31– 5.14]), dyslipidemia (OR=3.95 [1.82– 8.75]), microalbuminuria (OR=6.06 [1.69– 27.3]) and overweight/obesity (OR=3.32 [1.33– 13.5]) were more frequent in T2DM. The clinical profile of T2DM was marked by the rise in mean systolic arterial pressure (p=0.0368), arterial oxygen desaturation (p=0.0214), New York Heart Association (NYHA) IV breathlessness (OR=2.06 [1.04– 4.08]); and paraclinical by left ventricular hypertrophy (OR=2.67 [1.24– 5.77]), segmental kinetic disorder (OR=1.96 [1.04– 3.67]) and ischemic heart disease (OR=1.98 [1.09– 3.92]). Diabetics received more statin (OR=2.06 [1.05– 4.03]) and less spironolactone (OR=0.29 [0.13– 0.64]). Conclusion: T2DM is associated with poor profile of AHF. Adequate management of cardiovascular risk factors, including diabetes, could thus minimize the occurrence of AHF and improve this profile.