Relationship Between Diabetes Mellitus and the Prognosis of Ischemic Heart Failure

Background: Ischemic heart failure (IHF) is an important type of heart failure (HF). The aim of this study is to analyze the clinical features of IHF, investigate the prognostic value of clinical risk factors, especially DM-related factors, on the IHF patients, so as to provide reference for the high-quality health management of IHF patients. Methods: A total of 430 IHF patients were divided into comorbid (IHF+ DM) group or IHF group according to whether they had DM in this cross sectional and prospective study. The patients were collected for their clinical information, and were followed up for 3.3 years to record the composite clinical endpoints including all-cause death, stroke, myocardial infarction and decompensated heart failure. The prognostic value of DM-related and other traditional risk factors with IHF were evaluated. Results: Among 430 patients with IHF, 176 had DM. Compared with the IHF group, the IHF + DM group had higher prevalence of hypertension and overweight, higher levels of FPG and HbA1c, higher proportion of patients in NYHA III – IV grade, larger left ventricular end diastolic diameter (LVEDD) in male group, higher Gensini score and shorter distance of 6-minute walk test (6-MWT). After a median follow-up of 3.3 years, a total of 156 patients (36.3%) had experienced clinical endpoint events. Kaplan Meier analysis showed that the IHF patients with DM history, and higher HbA1c or FPG level would significantly reduce the cumulative survival rates of composite clinical endpoints, as well as the cumulative survival rates of all-cause death and cardiovascular death (all P < 0.05). Cox regression analysis indicated that DM history and higher PFG or HbA1c levels were independently associated with the all-cause death, cardiovascular death, and composite endpoints (all P < 0.05). The incorporation of diabetes related factors (diabetes history, FPG and HbA1c) significantly increased the area under the receiver operating characteristic (ROC) curve of the risk model established by the traditional risk factors (0.803 vs. 0.775, P = 0.039). In addition to DM history, male sex, uric acid ≥ 400 μmol / L, creatinine ≥ 100 μmol / L, Gensini score > 80 and ACEF score were all independent risk factors for the occurrence of composite clinical endpoints in IHF patients. Conclusion: There existed a high incidence rate of DM in the IHF population. The diabetes related factors (diabetes history, FPG, HbA1c) significantly increased the predictive value of the risk model made by the basic risk factors in predicting the IHF outcomes. DM history, male, uric acid ≥ 400 μmol / L, creatinine ≥ 100 μmol / L, Gensini score > 80 and ACEF score were independent risk factors for the occurrence of composite clinical endpoints in IHF patients.