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Microvascular disease in patients with diabetes with heart failure and reduced ejection versus preserved ejection fraction
Tromp, Jasper Lim, Shir Lynn Tay, Wan Ting Teng, Tiew-Hwa Katherine Chandramouli, Chanchal Ouwerkerk, Wouter Wander, Gupreet S. Sawhney, Jitendra P. S. Yap, Jonathan MacDonald, Michael R.
Tromp, Jasper
Lim, Shir Lynn
Tay, Wan Ting
Teng, Tiew-Hwa Katherine
Chandramouli, Chanchal
Ouwerkerk, Wouter
Wander, Gupreet S.
Sawhney, Jitendra P. S.
Yap, Jonathan
MacDonald, Michael R.
Abstract
OBJECTIVE Microvascular complications are common among patients with diabetes mellitus (DM). The presence of heart failure (HF) is presumed to be due to macrovascular disease (typically HF with reduced ejection fraction [HFrEF] following myocardial infarction). We hypothesized that HF with preserved ejection fraction (HFpEF) in patients with DM may be a manifestation of microvascular disease compared with HFrEF. The objective of this study was to examine the prevalence and association with clinical outcome of microvascular complications in patients with HF and DM. RESEARCH DESIGN AND METHODS We investigated the prevalence, association with clinical outcome, and cardiac structure and function of microvascular (neuropathy, nephropathy, and retinopathy) complications of DM in 2,800 prospectively enrolled participants with HF and DM (561 with HFpEF) from the Asian Sudden Cardiac Death In Heart Failure (ASIAN-HF) registry. RESULTS A total of 601 (21.5%) participants with DM had microvascular complications. Participants with DM and any (one or more) microvascular complications were more likely to have HFpEF (odds ratio 1.70 [95% CI 1.15–2.50]; P = 0.008). Furthermore, the likelihood of having HFpEF increased with an increasing number of microvascular complications (Ptrend < 0.001). Microvascular complications were associated with more left ventricular (LV) hypertrophy and a greater reduction in quality of life in HFpEF than HFrEF (Pinteraction < 0.001 for all). Compared with participants with DM and without microvascular complications, the adjusted hazard ratio for the composite outcome of all-cause death or HF hospitalization was 1.35 (95% CI 1.04–1.76) for participants with DM and microvascular complications regardless of HF type (Pinteraction = 0.112). CONCLUSIONS Diabetic microvascular disease is more common, and related to greater LV remodeling, more impairment of quality in life, and similar adverse outcomes, in participants with HFpEF compared with HFrEF. HFpEF may be a clinical manifestation of microvascular disease in DM.
Keywords
Date
2019
Type
Journal article
Journal
Diabetes Care
Book
Volume
42
Issue
9
Page Range
1792-1799
Article Number
ACU Department
Collections
Relation URI
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Event URL
Open Access Status
License
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Controlled