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Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

BACKGROUND: Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajecto...

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Autores principales: Julián, María Teresa, Alonso, Núria, Lupón, Josep, Gavidia-Bovadilla, Giovana, Ferrer, Elena, de Antonio, Marta, López-Ayerbe, Jorge, Domingo, Mar, Santiago-Vacas, Evelyn, Zamora, Elisabet, Codina, Pau, Moliner, Pedro, Núñez, Julio, Santesmases, Javier, Puig-Domingo, Manel, Bayes-Genis, Antoni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092450/
https://www.ncbi.nlm.nih.gov/pubmed/32293458
http://dx.doi.org/10.1186/s12933-020-01011-w
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author Julián, María Teresa
Alonso, Núria
Lupón, Josep
Gavidia-Bovadilla, Giovana
Ferrer, Elena
de Antonio, Marta
López-Ayerbe, Jorge
Domingo, Mar
Santiago-Vacas, Evelyn
Zamora, Elisabet
Codina, Pau
Moliner, Pedro
Núñez, Julio
Santesmases, Javier
Puig-Domingo, Manel
Bayes-Genis, Antoni
author_facet Julián, María Teresa
Alonso, Núria
Lupón, Josep
Gavidia-Bovadilla, Giovana
Ferrer, Elena
de Antonio, Marta
López-Ayerbe, Jorge
Domingo, Mar
Santiago-Vacas, Evelyn
Zamora, Elisabet
Codina, Pau
Moliner, Pedro
Núñez, Julio
Santesmases, Javier
Puig-Domingo, Manel
Bayes-Genis, Antoni
author_sort Julián, María Teresa
collection PubMed
description BACKGROUND: Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajectories. The aim of this study was to prospectively assess very long-term (up to 15 years) LVEF trajectories in patients with and without T2D and underlying HF. METHODS: Ambulatory patients admitted to a multidisciplinary HF clinic were prospectively evaluated by scheduled two-dimensional echocardiography at baseline, 1 year, and then every 2 years afterwards, up to 15 years. Statistical analyses of LVEF change with time were performed using the linear mixed effects (LME) models, and locally weighted error sum of squares (Loess) curves were plotted. RESULTS: Of the 1921 patients, 461 diabetic and 699 non-diabetic patients with LVEF < 50% were included in the study. The mean number of echocardiography measurements performed in diabetic patients was 3.3 ± 1.6. Early LVEF recovery was similar in diabetic and non-diabetic patients, but Loess curves showed a more pronounced inverted U shape in diabetics with a more pronounced decline after 9 years. LME analysis showed a statistical interaction between T2D and LVEF trajectory over time (p = 0.009), which was statistically significant in patients with ischemic etiologies (p < 0.001). Other variables that showed an interaction between LVEF trajectories and T2D were male sex (p = 0.04) and HF duration (p = 0.008). CONCLUSIONS: LVEF trajectories in T2D patients with depressed systolic function showed a pronounced inverted U shape with a marked decline after 9 years. Diabetic cardiomyopathy may underlie the functional decline observed.
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spelling pubmed-70924502020-03-24 Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline Julián, María Teresa Alonso, Núria Lupón, Josep Gavidia-Bovadilla, Giovana Ferrer, Elena de Antonio, Marta López-Ayerbe, Jorge Domingo, Mar Santiago-Vacas, Evelyn Zamora, Elisabet Codina, Pau Moliner, Pedro Núñez, Julio Santesmases, Javier Puig-Domingo, Manel Bayes-Genis, Antoni Cardiovasc Diabetol Original Investigation BACKGROUND: Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajectories. The aim of this study was to prospectively assess very long-term (up to 15 years) LVEF trajectories in patients with and without T2D and underlying HF. METHODS: Ambulatory patients admitted to a multidisciplinary HF clinic were prospectively evaluated by scheduled two-dimensional echocardiography at baseline, 1 year, and then every 2 years afterwards, up to 15 years. Statistical analyses of LVEF change with time were performed using the linear mixed effects (LME) models, and locally weighted error sum of squares (Loess) curves were plotted. RESULTS: Of the 1921 patients, 461 diabetic and 699 non-diabetic patients with LVEF < 50% were included in the study. The mean number of echocardiography measurements performed in diabetic patients was 3.3 ± 1.6. Early LVEF recovery was similar in diabetic and non-diabetic patients, but Loess curves showed a more pronounced inverted U shape in diabetics with a more pronounced decline after 9 years. LME analysis showed a statistical interaction between T2D and LVEF trajectory over time (p = 0.009), which was statistically significant in patients with ischemic etiologies (p < 0.001). Other variables that showed an interaction between LVEF trajectories and T2D were male sex (p = 0.04) and HF duration (p = 0.008). CONCLUSIONS: LVEF trajectories in T2D patients with depressed systolic function showed a pronounced inverted U shape with a marked decline after 9 years. Diabetic cardiomyopathy may underlie the functional decline observed. BioMed Central 2020-03-23 /pmc/articles/PMC7092450/ /pubmed/32293458 http://dx.doi.org/10.1186/s12933-020-01011-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Investigation
Julián, María Teresa
Alonso, Núria
Lupón, Josep
Gavidia-Bovadilla, Giovana
Ferrer, Elena
de Antonio, Marta
López-Ayerbe, Jorge
Domingo, Mar
Santiago-Vacas, Evelyn
Zamora, Elisabet
Codina, Pau
Moliner, Pedro
Núñez, Julio
Santesmases, Javier
Puig-Domingo, Manel
Bayes-Genis, Antoni
Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
title Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
title_full Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
title_fullStr Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
title_full_unstemmed Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
title_short Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
title_sort long-term lvef trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092450/
https://www.ncbi.nlm.nih.gov/pubmed/32293458
http://dx.doi.org/10.1186/s12933-020-01011-w
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