Clinical and instrumental characteristics and five-year survival of men and women 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 and cumulative survival of women and men with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LV EF), depending on the presence of type II diabetes mellitus.
Materials and methods. A retrospective analysis of 490 case histories of patients observed in the heart failure department in the period from 2011 to 2018, with CHF, II–IV NYHA functional class, LVEF ≤ 40 %, 40–80 years of age (median (quartiles)) – 64 (56.00; 69.00) years). The study group included mainly patients with coronary heart disease in combination with hypertension – 403 (82.2 %) patients, with isolated coronary heart disease – 55 (11.2 %) and with isolated hypertension – 32 (6.6 %). 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. Comparisons were performed in populations of men and women depending on the presence of type 2 diabetes. Patients were included in the study in the phase of clinical compensation, in the euvolemic state.
Results and discussion. The analysis revealed that the prevalence of type 2 diabetes mellitus in the population of men with CHF and reduced LV EF is significantly lower than in the female population. There were no significant differences between the study groups by etiology, the NYHA class, as well as the structure of comorbid conditions. Also there were no significant differences in age, mean daily heart rate, systolic and diastolic blood pressure. Despite expectations, insulin levels in both male and female cohorts did not differ significantly in patients with and without concomitant diabetes. In the cohort of men with CHF and reduced LV EF with concomitant diabetes the body mass index, anteroposterior left atrial size, GFR values were significantly higher, whereas the level of circulating citrulline and urea nitrogen were significantly lower compared to women. Women with CHF with reduced LV EF and concomitant diabetes compared to women without diabetes had lower LV EF and left atrial size, higher circulating citrulline levels, and E/е´ ratios. Analysis of the kidneys functional state showed deterioration of nitrogen excretory function in all study groups in the presence of type 2 diabetes mellitus. The five-year survival of men with CHF and reduced LV EF did not differ depending on the presence of type 2 diabetes mellitus. Instead, when analyzing the effect of type 2 diabetes mellitus on life expectancy in women with CHF and reduced LV EF, we observed a significantly worse prognosis.
Conclusions. Woman with CHF and reduced LV EF with concomitant type 2 diabetes mellitus is characterized by a worse clinical course of the disease, which is combined with signs of more pronounced damage to target organs (heart, kidneys). At the same time, in women with diabetes, compared with men, the nitrogen-excreting renal function is significantly lower. Cumulative 5-year survival in the male cohort depending on presence of diabetes did not differ, while women with diabetes were characterized by significantly lower 5-year survival compared to women without diabetes.
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