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

Abstract

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.

Stress hyperglycemia ratio as a prognostic indicator for long-term adverse outcomes in heart failure with preserved ejection fraction

“…Stress hyperglycemia is linked to inflammation, oxidative stress, microvascular injury, endothelial dysfunction, and prothrombotic state, contributing to impaired myocardial blood flow, and diminished cardiac function [ 31 ]. In HFpEF patients, stress hyperglycemia was identified as a robust predictor of all-cause and cardiac mortality, specifically in those without diabetes [ 17 ]. While stress hyperglycemia may not potentially distinguish among diverse causes of absolute hyperglycemia, SHR is a combined measure of a patient’s acute-phase and chronic glycemia values, it reflects the true stress hyperglycemia state and has been found to be a potential determinant of adverse risk in multiple cardiovascular diseases [ 32 ].…”

“…Stress hyperglycemia, a temporary rise in blood glucose levels due to physiological stressors, is often seen in acute clinical settings, including in patients with acute HF [ 11 – 14 ]. Elevated admission glucose levels, indicating stress hyperglycemia, independently predict adverse outcomes in individuals with potential cardiovascular diseases, including those with HFpEF [ 12 , 15 – 17 ]. Nevertheless, stress hyperglycemia at admission can stem from either chronic hyperglycemia or an acute stress response and may not precisely indicate true acute glycemia.…”

Association of admission hyperglycemia and all-cause mortality in acute myocardial infarction with percutaneous coronary intervention: A dose–response meta-analysis

“…In addition, the accumulation of excess free fatty acids can lead to reduced myocardial contractility, thereby increasing the risk of pump failure and arrhythmias ( 55 ). AH also induces an increase in inflammatory cytokines with concomitant endothelial dysfunction, which leads to poorer clinical outcomes ( 58 , 59 ). Therefore, in the setting of hyperglycemia and insulin resistance, a metabolic crisis may ensue as the energy efficiency of the hypoxic myocardium was reduced.…”