The Impact of HbA1c level on heart failure with recovered rjection fraction in patients with Type 2 Diabetes

Abstract

\n \n \n Heart failure (HF) with improved or recovered ejection fraction (EF, HFrecEF) has been recognized as a new type of HF with different underlying clinical phenotype, pathophysiology and prognosis. However, few studies have analyzed the relationship between type 2 diabetes and HFrecEF, and the impact of glycemic level on myocardial function recovery.\n \n \n \n In the present study, we sought to investigate the relation between HbA1c level and HFrecEF in patients with type 2 diabetes.\n \n \n \n A total of 796 HF patients with reduced left-ventricular ejection fraction (LVEF, <40%) and type 2 diabetes were consecutively enrolled from August 2012 to July 2020. During follow-up for up to 24 months, patients were classified into HFrecEF for whom developed recovered LVEF (≥40% and absolute increase ≥5%) and HFrEF for whose LVEF was persistently reduced (<40%). The relation between HbA1c and the recovery of LV function was analyzed.\n \n \n \n HF patients with type 2 diabetes had significantly lower rates of LVEF recovery when having higher versus lower HbA1c levels in the baseline (the lowest tertile: 62.4%, intermediate tertile: 50.4%, the highest tertile: 46.8%; P<0.001). There were stepwise decreases in changes of LVEF (P<0.001) and increases in changes of LV end-systolic diameter (LVESD; P=0.093) with increasing tertiles of LVEF during follow-up. In the subgroup analysis, the impact of HbA1c on LVEF recovery was more prominent in patients with ischemic heart disease (P<0.001) than those with dilated cardiomyopathy (P=0.536). A significant interaction term was present between HbA1c and etiology of heart failure with regard to LVEF recovery (P=0.012). After multivariate adjustment of conventional confounding factors, high HbA1c level remained to be an independent risk factor lower incidence of HFrecEF in patients type 2 diabetes.\n \n \n \n Our study suggests that optimal glycemic control is an independent predictor for incidence of HFrecEF in patients with type 2 diabetes.\n \n \n \n Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China, Shanghai Municipal Commission of Health and Family Planning\n