HbA1c control linked to recovery of ejection fraction in hospitalized HF patients with diabetes

A substantial proportion of heart failure patients with reduced left ventricular ejection fraction (HFrEF) have experienced HFrecEF, defined as experienced partial or complete recovery of EF, and markedly improved clinical outcomes due to advances in medical treatment. Considering this, Chen Die Yang, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China, and colleagues aimed to examine the association between glycemic control and the incidence of HFrecEF in HFrEF patients with type 2 diabetes who are hospitalized.

For this purpose, the researchers consecutively enrolled 463 hospitalized T2DM patients with HFrEF. After about 12 months, an echocardiogram was performed. Patients with a definite EF improvement of≥10% and a second EF of> 40% were classified into HFrecEF. The patients who did not meet these criteria were labeled as having persistent HFrEF.

Based on HbA1c level tertiles, the patients were divided into three cohorts, and those with higher levels also had higher triglyceride levels, higher fasting glucose, and more frequent ischemic etiology. The cohorts were comparable for other characteristics and demographic (age, sex, blood pressure, cholesterol, and N-terminal pro-b-type natriuretic peptide levels, smoking, BMI, renal function, and history of hypertension).

The study led to the following findings:

· 44.5% of T2DM patients developed HFrecEF during the 12-month follow-up.

· HFrecEF patients had significantly lower HbA1c levels than those with persistent HFrEF (6.5% vs. 6.7%), especially in those with an ischemic etiology.

· HbA1c levels were inversely associated with changes in ejection fraction during follow-up.

· Every 1% increase in HbA1c led to a 17.4% lower likelihood of HFrecEF after multivariate adjustment.

· Patients with poor glycemic control having an HbA1c > 7.1% had a 52.0% reduced risk of HFrecEF versus patients with good glycemic control (HbA1c ≤ 6.2%).

Limitations of the study were that the data are from a single center and its retrospective design. Also, there was selection bias, and the sample size was underpowered.

Findings imply that the uncontrolled HbA1c level is linked with compromised HFrecEF development in T2DM patients with heart failure, particularly those with an ischemic etiology.

Reference:

Yang CD, Aihemaiti M, Quan JW, Chen JW, Shu XY, Ding FH, Shen WF, Lu L, Zhang RY, Pan WQ, Wang XQ. HbA1c level is associated with the development of heart failure with recovered ejection fraction in hospitalized heart failure patients with type 2 diabetes. Int J Cardiol. 2022 Sep 16:S0167-5273(22)01339-0.

doi: 10.1016/j.ijcard.2022.09.029

. Epub ahead of print. PMID: 36116615.