Karakteristike bolesnika i prognostičke implikacije dijabetesa melitusa tip 2 u srčanoj insuficijenciji sa očuvanom, umereno redukovanom i redukovanom ejekcionom frakcijom
Sažetak
Sažetak
Uvod: Tip 2 dijabetes melitusa (T2DM) je čest u srčanoj insuficijenciji (SI) i povezan sa povišenim morbiditetom i mortalitetom. Karakteristike i ishodi bolesnika sa i bez T2DM u zavisnosti od tipa SI, definisane kao: SI sa očuvanom ejekcionom frakcijom (EF) leve komore (heart failure with preserved EF, HFpEF), umereno redukovanom EF (midrange EF, HFmrEF) i redukovanom EF (reduced EF, HFrEF) nisu detaljno proučeni.
Cilj rada: da se kod bolesnika sa HFrEF, HFmrEF i HFpEF uporede kliničke karakteristike i jednogodišnji ukupni mortalitet, u zavisnosti od prisustva T2DM.
Materijal i metode: Sprovedena je prospektivna, opservaciona studija u koju su uključeni bolesnici sa SI lečeni u Klinici za kardiologiju Kliničkog centra Srbije, u Beogradu (novembar 2018 - januar 2019). Primarni cilj studije je ukupni mortalitet tokom 12 meseci praćenja.
Rezultati: Uključeno je 242 bolesnika (srednja starost 71±13, muškarci 57%). Učestalost T2DM je bila 31%. Nije registrovana razlika u učestalosti T2DM kod HFrEF, HFmrEF i HFpEF. Kod sve tri grupe, dijabetičari su bili stariji i češće su imali infarkt miokarda, drugi oblik koronarne bolesti, perifernu arterijsku bolest i hroničnu bubrežnu slabost (sve p-vrednosti <0,001). Bolesnici sa HFpEF i T2DM su češće bili ženskog pola i češće su imali hipertenziju i atrijalnu fibrilaciju (sve p-vrednosti <0,001). U sve tri grupe procenjena jednogodišnja stopa mortaliteta bila je značajno viša kod dijabetičara. T2DM je nezavisni prediktor povišenog rizika od smrti u HFrEF (HR; 1,33; 95%CI; 1,34–2,00), HFmrEF (HR; 1,13; 95%CI; 1,0 –1,24) i HFpEF (HR; 1,21; 95%CI; 1,09–1,56), sve p-vrednosti <0,05.
Zaključak: Bolesnici sa T2DM i SI su stariji, sa više komorbiditeta i većom stopom ukupnog mortaliteta u odnosu na osobe bez T2DM. T2DM je nezavisni prediktor povišenog ukupnog mortaliteta u HFrEF, HFmrEF i HFpEF. Obzirom na povišen rizik, T2DM zahteva revnosno dijagnostikovanje i savremeno lečenje kako bi se poboljšalo preživljavanje.
Ključne reči: srčana insuficijencija, ejekciona frakcija, dijabetes melitus, kliničke karakteristike, mortalitet.
Reference
1. Gevaert AB, Boen JRA, Segers VF, Van Craenenbroeck EM. Heart Failure With Preserved Ejection Fraction: A Review of Cardiac and Noncardiac Pathophysiology. Front Physiol. 2019;10:638.
2. Tanai E, Frantz S. Pathophysiology of Heart Failure. Compr Physiol. 2015;6:187–214.
3. Dauriz M, Targher G, Laroche C, Temporelli PL, Ferrari R, Anker SM., et al. Association Between Diabetes and 1-Year Adverse Clinical Outcomes in a Multinational Cohort of Ambulatory Patients With Chronic Heart Failure: Results From the ESC-HFA Heart Failure Long-Term Registry. Diabetes Care. 2017;40: 671-678.
4. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8:30–41.
5. Milinković I, Polovina M, Seferović PM. Age old problem: heart failure treatment in elderly. Eur J Prev Cardiol. 2019;26:1396–1398.
6. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Rev Esp Cardiol. 2016;69:1167.
7. Abebe TB, Gebreyohannes EA, Tefera YG, Abegaz TM. Patients with HFpEF and HFrEF have different clinical characteristics but similar prognosis: a retrospective cohort study. BMC Cardiovasc Disord. 2016;16:232.
8. Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19:1574–1585.
9. van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2014;16:103–111.
10. Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, Avogaro A, et al. Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure. JACC Heart Fail. 2015;3:136–145.
11. Seferović PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:853–872.
12. Pavlović A, Polovina M, Ristić A, Seferović JP, Veljić I, Simeunović D, et al. Long-term mortality is increased in patients with undetected prediabetes and type-2 diabetes hospitalized for worsening heart failure and reduced ejection fraction. Eur J Prev Cardiol. 2019;26:72–82.
13. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, 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;37:2129-200.
14. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018; 41:S13– S27.
15. Thomas MC. Type 2 Diabetes and Heart Failure: Challenges and Solutions. Curr Cardiol Rev. 2016;12:249–255.
16. Lehrke M, Marx N. Diabetes Mellitus and Heart Failure. Am J Cardiol. 2017;120:37–47.
17. Johansson I, Dahlström U, Edner M, Näsman P, Rydén L, Norhammar A. Type 2 diabetes and heart failure: Characteristics and prognosis in preserved, mid-range and reduced ventricular function. Diab Vasc Dis Res. 2018;15:494–503.
18. Zafrir B, Lund LH, Laroche C, Ruschitzka F, Crespo-Leiro MG, Coats AJS, et al. Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018;39:4277–4284.
19. Mesquita ET, Barbetta LMDS, Correia ETO. Heart Failure with Mid-Range Ejection Fraction - State of the Art. Arq Bras Cardiol. 2019;112:784–790.
20. Yoon S, Eom GH. Heart failure with preserved ejection fraction: present status and future directions. Exp Mol Med. 2019;51:161.
21. Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14:591–602.
22. van Deursen VM, Damman K, van der Meer P, Wijkstra PJ, Luijckx GJ, van Beek A, et al. Co-morbidities in heart failure. Heart Fail Rev. 2014;19:163–172.
23. Polovina M, Lund LH, Đikić D, Petrović-Đorđević I, Krljanac G, Milinković I, et al. Type 2 diabetes increases the long-term risk of heart failure and mortality in patients with atrial fibrillation. Eur J Heart Fail. 2020;22:113–125.
24. Seferović PM, Coats AJS, Ponikowski P, Filippatos G, Huelsmann M, Jhund PS, et al. European Society of Cardiology/Heart Failure Association position paper on the role and safety of new glucose-lowering drugs in patients with heart failure. Eur J Heart Fail. 2019;10.1002/1673.