Glycaemic Variability and Hyperglycaemia as Prognostic Markers of Major Cardiovascular Events in Diabetic Patients Hospitalised in Cardiology Intensive Care Unit for Acute Heart Failure.

Edouard Gerbaud,Pierre Coste,Thomas Baudinet,Michel Montaudon,Bogdan Catargi,Rémi Kabore,Alexandre Ouattara,Fritz-Line Vélayoudom,Marie-Christine Beauvieux,Pierre Domingues-Dos-Santos,Benjamin Seguy,Ambroise Bouchard De La Poterie,Anne-Iris Lemaître,Laura Cetran,François Picard

doi:10.3390/jcm11061549

Abstract

(1) Background: Hyperglycaemia and hypoglycaemia are both emerging risk factors for cardiovascular disease. Nevertheless, the potential effect of glycaemic variability (GV) on mid-term major cardiovascular events (MACE) in diabetic patients presenting with acute heart failure (AHF) remains unclear. This study investigates the prognostic value of GV in diabetic patients presenting with acute heart failure (AHF). (2) Methods: this was an observational study including consecutive patients with diabetes and AHF between January 2015 and November 2016. GV was calculated using standard deviation of glycaemia values during initial hospitalisation in the intensive cardiac care unit. MACE, including recurrent AHF, new-onset myocardial infarction, ischaemic stroke and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analysed with respect to baseline characteristics and cardiac status. (3) Results: In total, 392 patients with diabetes and AHF were enrolled. During follow-up (median (interquartile range) 29 (6–51) months), MACE occurred in 227 patients (57.9%). In total, 92 patients died of cardiac causes (23.5%), 107 were hospitalised for heart failure (27.3%), 19 had new-onset myocardial infarction (4.8%) and 9 (2.3%) had an ischaemic stroke. Multivariable logistic regression analysis showed that GV > 50 mg/dL (2.70 mmol/L), age > 75 years, reduced left ventricular ejection fraction (LVEF < 30%) and female gender were independent predictors of MACE: hazard ratios (HR) of 3.16 (2.25–4.43; p < 0.001), 1.54 (1.14–2.08; p = 0.005), 1.47 (1.06–2.07; p = 0.02) and 1.43 (1.05–1.94; p = 0.03), respectively. (4) Conclusions: among other well-known factors of HF, a GV cut-off value of >50 mg/dL was the strongest independent predictive factor for mid-term MACE in patients with diabetes and AHF.

Highlights

Diabetes and chronic heart failure (CHF) are common comorbidities
This study explored the association between glycaemic variability (GV), well-known cardiovascular risk facstudy explored association between well-known cardiovascular riskAHF
This study explored the association between GV, well-known cardiovascular risk factors, established cardiac parameters and mid-term major cardiovascular events (MACE) in diabetic patients with acute heart failure (AHF)

Summary

Introduction

Diabetes and chronic heart failure (CHF) are common comorbidities. Around 40% of patients managed for acute heart failure (AHF) had diabetes [1]. Long-term control of diabetes, reflected by HbA1c , is an independent predictor of CHF [3]. A new concept, glycaemic variability (GV) [4,5], has emerged, and is associated with chronic diabetes complications such as microangiopathy [6] and macroangiopathy [7]. The mechanisms underlying the deleterious effects of GV involve short-term fluctuations, inducing endothelial dysfunction [9], apoptosis and oxidative stress [10]. Increasing GV may contribute to eye (i.e., development and progression of retinopathy), renal (risk of nephropathy and albuminuria) and cardiovascular complications (i.e., cardiac autonomic neuropathy, acute coronary syndrome and stroke functional outcome) [11–14]. Our previous study investigated the prognostic value of GV in patients with diabetes and acute coronary syndrome (ACS). Multivariable logistic regression analysis showed that GV > 2.70 mmol/L, a Synergy between PCI with

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