Association of hemoglobin A1c variability and the incidence of heart failure with preserved ejection fraction in patients with type 2 diabetes mellitus and arterial hypertension
Association of hemoglobin A1c variability and the incidence of heart failure with preserved ejection fraction in patients with type 2 diabetes mellitus and arterial hypertension
复制标题
2 型糖尿病和动脉高血压患者血红蛋白 A1c 变异性与射血分数保留的心力衰竭发生率之间的关系。
DOI：
10.1016/j.hjc.2017.08.001
复制
发表时间：
2018-03-01
影响因子：
4.1
通讯作者：
Wang, Chang-Qian
中科院分区：
文献类型：
--
作者：
Gu, Jun;Fan, Yu-Qi;Wang, Chang-Qian
背景资料：本研究旨在探讨2型糖尿病（T2 DM）合并高血压患者血红蛋白A1 c（HbA 1c）变异性、左心室（LV）舒张功能和射血分数保留性症状性心力衰竭（HFpEF）发生率之间的关系。对我院符合条件的T2 DM合并高血压且无心力衰竭临床体征或症状的患者进行了回顾性队列研究病历数据库通过标准差（SD）和变异系数（CV）测量HbA 1c的变异性。采用多变量考克斯回归分析评估新发症状性HFpEF的风险。结果：共201例受试者根据HbA 1c变异指标的中位数进行分类。在中位随访7.3年期间，HbA 1c-SD水平较高（5/105 vs. 13/96，P=0.029）和HbA 1c-CV水平较高（5/101 vs. 13/100，P=0.046）的受试者中新发症状性HFpEF的受试者百分比较高。多变量考克斯回归分析也显示，HbA 1c变异性[HbA 1c-SD（HR 1.754，95% CI：1.003-3.104，P=0.049）或HbA1c-CV（HR 1.604 95% CI：1.064-2.419，P=0.024）]与T2 DM和高血压患者新发症状性HFpEF的存在相关，与HbA 1c平均水平无关。此外，较低的HbA 1c变异性产生了更显着的改善，左室舒张功能（E/E 0）在follow-up.Conclusions：HbA 1c变异性可能提供额外的有价值的信息作为一个潜在的预测HFpEF在T2 DM和高血压患者的进展。(C)2018年希腊心脏病学会。出版社：Elsevier B. V.
Background: This study aimed to investigate the association between variability in hemoglobin A1c (HbA1c)and left ventricular (LV) diastolic function and incidence of symptomatic heart failure with preserved ejection fraction (HFpEF) in patients with type 2 diabetes mellitus (T2DM) and arterial hypertension.Methods: A retrospective cohort study was conducted on eligible patients with T2DM and hypertension and without clinical signs or symptoms of heart failure in our hospital medical record database. Variability in HbA1c was measured by standard deviation (SD) and coefficient of variation (CV). Risk of new onset of symptomatic HFpEF was evaluated by multivariable cox regression analysis.Results: A total of 201 subjects were categorized according to the median value of HbA1c variability indicators. Over a median follow-up of 7.3 years, the percentage of subjects who had new incidence of symptomatic HFpEF was higher in those with higher HbA1c-SD level (5/105 vs. 13/96, P=0.029) and higher HbA1c-CV level (5/101 vs. 13/100, P=0.046). Multivariable cox regression analysis also showed that higher HbA1c variability [HbA1c-SD (HR 1.754, 95% CI: 1.003-3.104, P=0.049) or HbA1c-CV (HR 1.604 95% CI: 1.064-2.419, P=0.024)] was associated with the presence of new-onset symptomatic HFpEF, independent of HbA1c-mean level, in T2DM and hypertensive patients. Moreover, lower HbA1c variability generated more prominent improvement in LV diastolic function (E/E 0) during the follow-up.Conclusions: HbA1c variability may provide additional valuable information as a potential predictor of the progression of HFpEF in T2DM and hypertensive patients. (C) 2018 Hellenic Society of Cardiology. Publishing services by Elsevier B.V.