Type 2 diabetes in patients with heart failure and depressed systolic function was associated with a more pronounced inverted U-shaped LVEF trajectory and marked decline after 9 years compared to non-diabetic patients.
Cohort (n=1,160)
No
Does the presence of type 2 diabetes worsen long-term LVEF trajectories in patients with heart failure and depressed systolic function?
In patients with heart failure and depressed LVEF, the presence of type 2 diabetes is associated with a more pronounced long-term decline in LVEF after an initial recovery, particularly in those with ischemic etiology.
p-value: p=0.009
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Julián et al. (Mon,) conducted a cohort in Heart failure with reduced ejection fraction and Type 2 Diabetes (n=1,160). Type 2 Diabetes (Exposure) vs. Non-diabetic patients was evaluated on LVEF trajectory over time (p=0.009). Type 2 diabetes in patients with heart failure and depressed systolic function was associated with a more pronounced inverted U-shaped LVEF trajectory and marked decline after 9 years compared to non-diabetic patients.