Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics

Cho, Jae Yeong; Kim, Kye Hun; Lee, Sang Eun; Cho, Hyun‐Jai; Lee, Hae Young; Choi, Jin-Oh; Jeon, Eun‐Seok; Kim, Minseok; Kim, Jae‐Joong; Hwang, Kyung‐Kuk; Chae, Shung Chull; Baek, Sang Hong; Kang, Seok Min; Choi, Dong‐Ju; Yoo, Byung‐Su; Ahn, Youngkeun; Park, Hyun-Young; Cho, Myeong Chan; Oh, Byung‐Hee

doi:10.3390/jcm9010149

Cited by 20 publications

(20 citation statements)

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“…16 Previous studies defined normoglycaemia as no previous history of DM and HbA1c < 6.4% or 6.5%. 13 , 17 Previous report demonstrated that the ethnic differences in the relationship between insulin sensitivity and insulin response and the genetic background of East Asians are susceptible to diabetes than Caucasians. 18 That is the reason why abnormal glucose metabolism is likely to occur even if the value of HbA1c is normally high in East Asians.…”

Section: Methodsmentioning

confidence: 99%

“… 10 , 11 , 12 In nondiabetic patients with acute heart failure, admission hyperglycaemia was an independent predictor of one‐year mortality, despite diabetes mellitus (DM) itself not carrying this prognosis. 13 The association between admission hyperglycaemia and clinical outcome in nondiabetic HFpEF patients has not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Impact of admission hyperglycaemia on clinical outcomes in non‐diabetic heart failure with preserved ejection fraction

et al. 2021

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Aims At present, the clinical significance of admission hyperglycaemia in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. This study was designed to evaluate the relationship between admission hyperglycaemia and clinical outcome in HFpEF patients, especially in non‐diabetic patients. Methods and results We enrolled 486 non‐diabetic HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT‐HFpEF registry, a prospective, multicentre observational study. We divided non‐diabetic patients into two groups, an admission hyperglycaemia group whose blood glucose on admission was ≥7.0 mmol/L (148 patients) and a normoglycaemic group whose blood glucose on admission was <7.0 mmol/L (338 patients). The primary endpoint was all‐cause mortality, and the secondary endpoints were heart failure death and other causes of cardiac death. During a mean follow‐up period of 400 ± 335 days, all‐cause mortality was 69 patients. Twenty‐five patients suffered cardiac death. All‐cause mortality ( P = 0.002), cardiac death ( P = 0.009), and heart failure death ( P = 0.001) were significantly more frequent in the admission hyperglycaemia group than in the normoglycaemic group. Admission hyperglycaemia was independently and significantly associated with all‐cause mortality and cardiac death (HR 2.01, 95% CI 1.20–3.34, P = 0.008 and HR 3.03, 95% CI 1.35–6.96, P = 0.007, respectively). Conclusions Non‐diabetic HFpEF patients with admission hyperglycaemia when hospitalized for heart failure had poorer clinical outcomes than normoglycaemic patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of admission hyperglycaemia on clinical outcomes in non‐diabetic heart failure with preserved ejection fraction

et al. 2021

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“…Indeed, both diabetes and hyperglycemia directly in uence atherosclerotic plaque formation and progression and may induce microvascular dysfunction and microangiopathy. Therefore, the resulting vicious circle might affect the macrovascular and microvascular beds, leading to an adverse long-term prognosis in both MIOCA and MINOCA patients [33][34][35] .…”

Section: Hyperglycemia and Long-termoutcomesmentioning

confidence: 99%

Impact of Admission Hyperglycemia on Short and Long-Term Prognosis in Acute Myocardial Infarction: MINOCA versus MIOCA

Paolisso

Foà

Bergamaschi

et al. 2021

Preprint

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BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial Registrationdata were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

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“…T2D is closely associated with those 2 phenotypes of cardiomyopathy in humans [ 18 ]. Recent studies have shown that poor glycemic control correlates with increased risk of HF in diabetic patients, and the myocardial changes in those patients are believed to be induced by hyperglycemia [ 19 , 20 ]. T2D was known to be one of the main risk factors and determinants of HFrEF.…”

Section: Introductionmentioning

confidence: 99%

A Role of Glucose Overload in Diabetic Cardiomyopathy in Nonhuman Primates

Xiu

Jin

2021

Journal of Diabetes Research

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Type 2 diabetes (T2D) plays a major role in the development of heart failure. Patients with T2D have an increased risk to develop HF than healthy subjects, and they always have very poor outcomes and survival rates. However, the underlying mechanisms for this are still unclear. To help develop new therapeutic interventions, well-characterized animal models for preclinical and translational investigations in T2D and HF are urgently needed. Although studies in rodents are more often used, the research findings in rodents have often failed to be translated into humans due to the significant metabolic differences between rodents and humans. Nonhuman primates (NHPs) serve as valuable translational models between basic studies in rodent models and clinical studies in humans. NHPs can recapitulate the natural progress of these diseases in humans and study the underlying mechanism due to their genetic similarity and comparable spontaneous T2D rates to humans. In this review, we discuss the importance of using NHPs models in understanding diabetic cardiomyopathy (DCM) in humans with aspects of correlations between hyperglycemia and cardiac dysfunction progression, glucose overload, and altered glucose metabolism promoting cardiac oxidative stress and mitochondria dysfunction, glucose, and its effect on cardiac resynchronization therapy with defibrillator (CRT-d), the currently available diabetic NHPs models and the limitations involved in the use of NHP models.

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Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics

Cited by 20 publications

References 27 publications

Impact of admission hyperglycaemia on clinical outcomes in non‐diabetic heart failure with preserved ejection fraction

Impact of admission hyperglycaemia on clinical outcomes in non‐diabetic heart failure with preserved ejection fraction

Impact of Admission Hyperglycemia on Short and Long-Term Prognosis in Acute Myocardial Infarction: MINOCA versus MIOCA

A Role of Glucose Overload in Diabetic Cardiomyopathy in Nonhuman Primates

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