Clinical and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction depending on the presence of type II diabetes mellitus
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Abstract
The aim – to compare clinical and instrumental parameters in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) depending on the presence of type II diabetes mellitus.
Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. The study group included mainly patients with coronary heart disease (CHD) in combination with hypertension – 403 (82.2 %) patients, with isolated CHD – 55 (11.2 %) and with hypertension – 32 (6.6 %) patients. Most patients (278 (56.7 %)) had a permanent form of atrial fibrillation. Among the subjects were 373 (76.1 %) men and 117 (23.9 %) women. Patients were included in the study in the phase of clinical compensation, i.e. in the euvolemic state. All patients were divided into two groups: group I included 338 (69 %) patients with CHF and reduced LVEF without diabetes; group II consisted of 152 (31 %) patients with CHF and reduced LVEF with type II diabetes.
Results and discussion. The analysis revealed no significant differences among patients in the study groups by age, general hemodynamic parameters, mean daily heart rate, NYHA functional class, concomitant chronic obstructive pulmonary disease and the duration of CHF. A lower percentage of patients with atrial fibrillation in group II, a higher BMI in patients in group I, Е/е´ and left ventricular myocardial mass index were higher in patients without concomitant diabetes. In the study, we obtained a significantly higher uric acid level in patients with concomitant diabetes mellitus 2 and did not receive statistical differences in oxidative stress and proinflammatory markers, NT-proBNP and insulin. There was also no significant difference in the values of flow-dependent endothelial dysfunction. The combination of coronary heart disease and diabetes mellitus 2 has been shown to be a major factor of high mortality in patients with CHF. However, we did not find a difference in the life expectancy of patients with CHF and reduced LVEF with and without diabetes. We also had a significantly worse survival of patients with HbA1с above 7.4 %.
Conclusions. The 5-year survival of patients with CHF with reduced LVEF with and without diabetes mellitus 2 does not differ significantly, while among the general group of patients the worst 5-year survival was demonstrated by those with HbA1с higher than 7.4 %.
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