Effect of type 2 diabetes mellitus on the prognosis of patients with coronary heart disease complicated with heart failure with preserved ejection fraction_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Rong ¹ , YU Zixiang ¹ , LI Qian ² , DONG Jiajia ³ , YALIQIN Nazila ¹ , GUAN Lina ⁴ , LI Xiaomei ¹ ,  MA Yitong ⁵

1. First Department of Coronary Heart Disease, Heart Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;
2. Cardiology Department of Pingmei Shenma Medical Group General Hospital, Pingdingshan 467000, P. R. China;
3. Cardiology Department of Xingjiang Bozhou People’s Hospital, Bole 833400, P. R. China;
4. Cardiac Ultrasound Diagnosis Department of the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;
5. Heart Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding?author：

MA Yitong, Email: myt-xj@163.com

Keywords：

Type 2 diabetes mellitus; Heart failure with preserved ejection fraction; Coronary atherosclerotic heart disease; Prognosis

DOI：

10.7507/1672-2531.202112041

Video：

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Objective To investigate the effect of type 2 diabetes mellitus on the prognosis of coronary heart disease patients who had a complication of heart failure with preserved ejection fraction. Metohds A retrospective study was performed with 393 coronary heart disease patients who were complicated with heart failure with preserved ejection fraction. The diagnosis was based on the results of echocardiography and coronary angiography at the heart center of the First Affiliated Hospital of Xinjiang Medical University assessed from January 2017 to December 2017. The patients were divided into diabetic group and non-diabetic group. The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. In addition, the incidence of MACE was compared between the complete revascularization group and the incomplete revascularization group. Multivariate Cox regression analysis was used to analyze the effect of the risk factors on prognosis. Results The prevalence of hypertension and the use of ACEi/ARB in the diabetic group were higher than those in the non-diabetic group (P<0.05), and the level of high-density lipoprotein in the diabetic group was lower than that in the non-diabetic group (P<0.05). The incidence of MACE in the diabetic group (35.8%) was higher than that in non-diabetic group (25%, P=0.027). Complete revascularization improved the prognosis and reduced the incidence of MACE in both the diabetic group and non-diabetic group (P<0.05). Multivariate Cox regression analysis showed that a history of myocardial infarction (HR=0.44, 95%CI 0.20 to 1.00, P=0.049), incomplete revascularization (HR=17.28, 95%CI 2.34 to 127.43, P=0.005), and ejection fraction (HR=0.90, 95%CI 0.82 to 1.00, P=0.046) were associated with the occurrence of MACE in patients with coronary heart disease complicated with heart failure with preserved ejection fraction. Conclusion Type 2 diabetes mellitus affects the prognosis of coronary heart disease patients who have complication of heart failure with preserved ejection fraction. Complete revascularization can improve the prognosis of type 2 diabetic patients with coronary heart disease who have complications of heart failure with preserved ejection fraction.

Citation： CHEN Rong, YU Zixiang, LI Qian, DONG Jiajia, YALIQIN Nazila, GUAN Lina, LI Xiaomei, MA Yitong. Effect of type 2 diabetes mellitus on the prognosis of patients with coronary heart disease complicated with heart failure with preserved ejection fraction. Chinese Journal of Evidence-Based Medicine, 2022, 22(5): 517-523. doi: 10.7507/1672-2531.202112041 Copy

1.	Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis, 2005, 47(5): 320-332.
2.	Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol, 2004, 43(3): 317-327.
3.	Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355(3): 251-259.
4.	Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J, 2011, 32(6): 670-679.
5.	Ather S, Chan W, Bozkurt B, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol, 2012, 59(11): 998-1005.
6.	Shah SJ, Gheorghiade M. Heart failure with preserved ejection fraction: treat now by treating comorbidities. JAMA, 2008, 300(4): 431-433.
7.	Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2013, 128(16): e240-327.
8.	Lee DS, Gona P, Vasan RS, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation, 2009, 119(24): 3070-3077.
9.	中華醫學會心血管病學分會心力衰竭學組, 中國醫師協會心力衰竭專業委員會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南2018. 中華心血管病雜志, 2018, 46(10): 760-789.
10.	Hwang SJ, Melenovsky V, Borlaug BA. Implications of coronary artery disease in heart failure with preserved ejection fraction. J Am Coll Cardiol, 2014, 63(25 Pt A): 2817-2827.
11.	高血壓聯盟, 中華醫學會心血管病學分會, 中國醫師協會高血壓專業委員會, 等. 中國高血壓防治指南2018年修訂版. 心腦血管病防治, 2019, 19(1): 1-44.
12.	中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2017年版). 中國實用內科雜志, 2018, 38(4): 292-344.
13.	Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol, 2018, 72(18): 2231-2264.
14.	Massie BM, Carson PE, McMurray JJ, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med, 2008, 359(23): 2456-2467.
15.	Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA, 2019, 322(13): 1271-1282.
16.	Reddy YN, Borlaug BA. Heart failure with preserved ejection fraction. Curr Probl Cardiol, 2016, 41(4): 145-188.
17.	Cenkerova K, Dubrava J, Pokorna V, et al. Prognostic value of echocardiography and ECG in heart failure with preserved ejection fraction. Bratisl Lek Listy, 2016, 117(7): 407-412.
18.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
19.	Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol, 2019, 7(6): 452-461.
20.	Lindman BR, Dávila-Román VG, Mann DL, et al. Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study. J Am Coll Cardiol, 2014, 64(6): 541-549.
21.	MacDonald MR, Petrie MC, Varyani F, et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J, 2008, 29(11): 1377-1385.
22.	McHugh K, DeVore AD, Wu J, et al. Heart failure with preserved ejection fraction and diabetes: JACC state-of-the-art review. J Am Coll Cardiol, 2019, 73(5): 602-611.
23.	Figtree GA, R?dholm K, Barrett TD, et al. Effects of canagliflozin on heart failure outcomes associated with preserved and reduced ejection fraction in type 2 diabetes mellitus. Circulation, 2019, 139(22): 2591-2593.
24.	Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation, 2001, 103(22): 2668-2673.
25.	佟威威, 佟廣輝, 秦曉松, 等. 2型糖尿病患者血脂水平與心腦血管并發癥的相關性分析. 現代生物醫學進展, 2013, 13(28): 5505-5507, 5510.
26.	Hao K, Takahashi J, Sakata Y, et al. Prognostic impact of residual stenosis after percutaneous coronary intervention in patients with ischemic heart failure-a report from the CHART-2 study. Int J Cardiol, 2019, 278: 22-27.
27.	Ho JE, Enserro D, Brouwers FP, et al. Predicting heart failure with preserved and reduced ejection fraction: the International Collaboration on Heart Failure Subtypes. Circ Heart Fail, 2016, 9(6): e003116.
28.	Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol, 2017, 70(20): 2476-2486.
29.	Dunlay SM, Roger VL, Weston SA, et al. Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail, 2012, 5(6): 720-726.
30.	Zile MR, Gottdiener JS, Hetzel SJ, et al. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation, 2011, 124(23): 2491-2501.
31.	Persson H, Lonn E, Edner M, et al. Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence: results from the CHARM Echocardiographic Substudy-CHARMES. J Am Coll Cardiol, 2007, 49(6): 687-694.

1. Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis, 2005, 47(5): 320-332.
2. Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol, 2004, 43(3): 317-327.
3. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355(3): 251-259.
4. Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J, 2011, 32(6): 670-679.
5. Ather S, Chan W, Bozkurt B, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol, 2012, 59(11): 998-1005.
6. Shah SJ, Gheorghiade M. Heart failure with preserved ejection fraction: treat now by treating comorbidities. JAMA, 2008, 300(4): 431-433.
7. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2013, 128(16): e240-327.
8. Lee DS, Gona P, Vasan RS, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation, 2009, 119(24): 3070-3077.
9. 中華醫學會心血管病學分會心力衰竭學組, 中國醫師協會心力衰竭專業委員會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南2018. 中華心血管病雜志, 2018, 46(10): 760-789.
10. Hwang SJ, Melenovsky V, Borlaug BA. Implications of coronary artery disease in heart failure with preserved ejection fraction. J Am Coll Cardiol, 2014, 63(25 Pt A): 2817-2827.
11. 高血壓聯盟, 中華醫學會心血管病學分會, 中國醫師協會高血壓專業委員會, 等. 中國高血壓防治指南2018年修訂版. 心腦血管病防治, 2019, 19(1): 1-44.
12. 中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2017年版). 中國實用內科雜志, 2018, 38(4): 292-344.
13. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol, 2018, 72(18): 2231-2264.
14. Massie BM, Carson PE, McMurray JJ, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med, 2008, 359(23): 2456-2467.
15. Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA, 2019, 322(13): 1271-1282.
16. Reddy YN, Borlaug BA. Heart failure with preserved ejection fraction. Curr Probl Cardiol, 2016, 41(4): 145-188.
17. Cenkerova K, Dubrava J, Pokorna V, et al. Prognostic value of echocardiography and ECG in heart failure with preserved ejection fraction. Bratisl Lek Listy, 2016, 117(7): 407-412.
18. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
19. Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol, 2019, 7(6): 452-461.
20. Lindman BR, Dávila-Román VG, Mann DL, et al. Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study. J Am Coll Cardiol, 2014, 64(6): 541-549.
21. MacDonald MR, Petrie MC, Varyani F, et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J, 2008, 29(11): 1377-1385.
22. McHugh K, DeVore AD, Wu J, et al. Heart failure with preserved ejection fraction and diabetes: JACC state-of-the-art review. J Am Coll Cardiol, 2019, 73(5): 602-611.
23. Figtree GA, R?dholm K, Barrett TD, et al. Effects of canagliflozin on heart failure outcomes associated with preserved and reduced ejection fraction in type 2 diabetes mellitus. Circulation, 2019, 139(22): 2591-2593.
24. Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation, 2001, 103(22): 2668-2673.
25. 佟威威, 佟廣輝, 秦曉松, 等. 2型糖尿病患者血脂水平與心腦血管并發癥的相關性分析. 現代生物醫學進展, 2013, 13(28): 5505-5507, 5510.
26. Hao K, Takahashi J, Sakata Y, et al. Prognostic impact of residual stenosis after percutaneous coronary intervention in patients with ischemic heart failure-a report from the CHART-2 study. Int J Cardiol, 2019, 278: 22-27.
27. Ho JE, Enserro D, Brouwers FP, et al. Predicting heart failure with preserved and reduced ejection fraction: the International Collaboration on Heart Failure Subtypes. Circ Heart Fail, 2016, 9(6): e003116.
28. Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol, 2017, 70(20): 2476-2486.
29. Dunlay SM, Roger VL, Weston SA, et al. Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail, 2012, 5(6): 720-726.
30. Zile MR, Gottdiener JS, Hetzel SJ, et al. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation, 2011, 124(23): 2491-2501.
31. Persson H, Lonn E, Edner M, et al. Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence: results from the CHARM Echocardiographic Substudy-CHARMES. J Am Coll Cardiol, 2007, 49(6): 687-694.

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