Abstract
Introduction: Glycosylated hemoglobin (Hb A1c) is an index of metabolic control in diabetes (D). Recent studies suggest that poor glycemic control in diabetic patients (pts) indicated by elevated Hb A1c levels (>7.0%) may be associated with increased risk of heart failure (HF). Our goal was to investigate the association between Hb A1c level and severity of HF in advanced HF pts with D. Methods: Among 180 pts referred for cardiac transplantation, 35 consecutive patients with advanced HF and D underwent evaluation with serum glucose, serum creatinine, Hb A1c, B-type natriuretic peptide (BNP), cardiopulmonary exercise testing and right heart catheterizaton. Pts were divided into two groups based on Hb A1c7% (Group A, mean Hb A1c=5.9±0.8) and Hb A1c >7% (Group B, mean Hb A1c=10.1±2.4). Results:∗Parameter (mean value)Hb A1c ≤7% (Group A: n=19)Hb A1c >7% (Group B: n=16)p valueAge (years)53.9±13.149.6±13.30.34Gender (male %)79690.70NYHA Class2.9±0.83.9±0.90.43Peak Oxygen Consumption (V02) ml/kg/minute16.2±2.214.5±3.40.25BNP (pg/ml)399.6±281.1754.8±696.40.05∗Pulmonary capillary wedge (PCW) pressure (mm Hg)22.2±8.026.2±8.50.24Glucose (mg/dl)141±75217±1190.03∗Creatinine (mg/dl)1.4±0.51.4±0.40.88BMI26.5±7.927.9±6.30.57% on Insulin9130.09∗p ≤ 0.05 Conclusion: BNP level was significantly elevated in diabetic pts with Hb A1c >7% (Group B). Glucose level was significantly higher in Group B. In Group B pts compared to Group A there was also a trend towards increased severity of symptoms demonstrated by worse NYHA class, lower peak VO2 and higher PCW pressure. Poor glycemic control in HF pts appears to have negative impact on functional capacity and severity of symptoms. Persistent glucose intolerance as shown by elevated Hb A1c>7% may be contributing to increased fluid retention reflected by higher PCW pressure and significantly higher BNP level in Group B compared to Group A pts. The effect of improved glycemic control on clinical outcomes such as frequency of hospitalization and survival in advanced HF pts with D deserves further study.
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