Long-term glycemic variability predicts compromised development of heart failure with improved ejection fraction: a cohort study

Chen Die Yang; Jia Wei Chen; Jin Wei Quan; Xin Yi Shu; Shuo Feng; Muladili Aihemaiti; Feng Hua Ding; Wei Feng Shen; Lin Lu; Rui Yan Zhang; Xiao Qun Wang

doi:10.3389/fendo.2023.1211954

Long-term glycemic variability predicts compromised development of heart failure with improved ejection fraction: a cohort study

Front Endocrinol (Lausanne). 2023 Sep 20:14:1211954. doi: 10.3389/fendo.2023.1211954. eCollection 2023.

Authors

Chen Die Yang¹, Jia Wei Chen², Jin Wei Quan², Xin Yi Shu², Shuo Feng¹, Muladili Aihemaiti², Feng Hua Ding¹, Wei Feng Shen^{1

2}, Lin Lu^{1

2}, Rui Yan Zhang¹, Xiao Qun Wang^{1

2}

Affiliations

¹ Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
² Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.

Abstract

Background: A substantial portion of heart failure (HF) patients adherent to guideline-directed medical therapies have experienced improved ejection fraction (EF), termed HFimpEF. Glycemic variability (GV) has emerged as a critical cardiometabolic factor. However, the relation between long-term GV and the incidence of HFimpEF is still unclear.

Methods: A total of 591 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) admitted from January 2013 to December 2020 were consecutively enrolled. Repeat echocardiograms were performed at baseline and after around 12 months. The incidence of HFimpEF, defined as (1) an absolute EF improvement ≥10% and (2) a second EF > 40% and its association with long-term fasting plasma glucose (FPG) variability were analyzed.

Results: During a mean follow-up of 12.2 ± 0.6 months, 218 (42.0%) patients developed HFimpEF. Multivariate analysis showed FPG variability was independently associated with the 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]). Evaluation of GV by alternative measures yielded similar results. Subgroup analysis revealed that long-term GV was associated with HFimpEF irrespective of glycemic levels and diabetic conditions.

Conclusions: This study reveals that greater FPG variability is associated with compromised development of HFimpEF. A more stable control of glycemic levels might provide favorable effects on myocardial functional recovery in HF patients even without diabetes.

Keywords: fasting plasma glucose; glycemic variability; heart failure with improved ejection fraction; heart failure with reduced ejection fraction; myocardial recovery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Diabetes Mellitus*
Heart Failure*
Humans
Risk Factors
Stroke Volume

Grants and funding

This work was supported by National Natural Science Foundation of China (Grant No. 81870179, 82000369, 82170423), Shanghai Municipal Commission of Health and Family Planning (Grant No. 20194Y0042), Technology Transfer Project of Shanghai Jiao Tong University School of Medicine (Grant No. ZT202103).