Visit-to-visit glycemic variability is associated with the incidence of heart failure with improved ejection fraction

Abstract

Abstract Background With advanced guideline-directed therapies, a substantial portion of heart failure (HF) patients have experienced improvement of ejection fraction (EF), termed HFimpEF. Purpose In the present study, we sought to investigate the association between visit-to-visit glycemic variability (GV) and the incidence of HFimpEF. Methods From January 2013 to December 2020, 951 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) were consecutively enrolled and followed up for around 12 months. The incidence of HFimpEF, defined as (1) an absolute EF improvement ≥10% and (2) a second EF > 40% and its relationship with visit-to-visit fasting plasma glucose (FPG) variability were analyzed. Results A total of 519 HFrEF patients were finally enrolled. During a mean follow-up of 12.2 ± 0.6 months, 218 (42.0%) patients developed HFimpEF. Multivariate analysis showed visit-to-visit FPG variability was independently associated with incidence of HFimpEF after adjustment for baseline HBA1c, mean FPG during follow-up and other traditional risk factors (odds ratio [OR] for highest vs. lowest quartile of CV of FPG: 0.487 [95% CI 0.257∼0.910]). Assessing FPG variability by alternative measures yielded similar results. Subgroup analysis revealed the relationship between GV and HFimpEF was only observed in HF of ischemic etiology and the association persisted significant irrespective of glycemic levels and diabetic conditions. Conclusions This study reveals that greater visit-to-visit FPG variability is associated with compromised development of HFimpEF independent of mean glycemic levels and diabetic conditions. Therapies targeted at improving GV might provide favorable effects on myocardial recovery in HF patients even without diabetes.Fig 1Fig 2