Microvascular Disease in Patients With Diabetes With Heart Failure and Reduced Ejection Versus Preserved Ejection Fraction
Article Figures & Tables
Figures
- Figure 1
OR adjusted for age, sex, history of CAD, previous stroke, peripheral artery disease, hypertension, atrial fibrillation, ethnicity, NYHA class, duration of HF, BMI, usage of β-blockers, ACEi/ARB, insulin, oral antidiabetes medications, creatinine, hemoglobin. A and B: Forest plot with ORs and 95% CI for having HFpEF stratified according to microvascular complication (A) and number of microvascular complications (B). C: Percentage of participants with cardiac hypertrophy stratified according to number of microvascular complications and HF subtype.
- Figure 2
A–C: Kaplan-Meier curves according to microvascular status for the combined outcome of all-cause mortality or HF hospitalization for the total population (A), HFrEF only (B), and HFpEF only (C). D: Box plot of quality of life status (KCCQ overall scores) stratified according to HF type and microvascular complication (MC) status.
Tables
- Table 1
Baseline characteristics according to complication status
DM without microvascular complications (N = 2,199) DM with microvascular complications (N = 601) P value Age (years) 63.0 (11.4) 64.3 (10.8) 0.012 Women 586 (26.6) 175 (29.1) 0.23 Ethnicity <0.001 Chinese 767 (34.9) 180 (30.0) Indian 673 (30.6) 182 (30.3) Malaysian 415 (18.9) 119 (19.8) Japanese 145 (6.6) 73 (12.1) Korean 103 (4.7) 10 (1.7) Thai 43 (2.0) 27 (4.5) Filipino 12 (0.5) 5 (0.8) Indigenous SEA 34 (1.5) 4 (0.7) Others 6 (0.3) 1 (0.2) NYHA class <0.001 I 289 (14.9) 50 (9.0) II 1,035 (53.4) 286 (51.6) III 523 (27.0) 195 (35.2) IV 93 (4.8) 23 (4.2) Systolic BP (mmHg) 122.6 (20.9) 127.1 (22.6) <0.001 Diastolic BP (mmHg) 72.4 (12.4) 71.1 (12.0) 0.019 BMI (kg/m2) 26.0 (5.1) 26.3 (5.7) 0.16 Heart rate (bpm) 80.1 (16.1) 78.1 (13.9) <0.001 eGFR (mL/min/1.73 m2) 63.6 (27.4) 46.7 (25.5) <0.001 LVEF (%) 33.8 (14.9) 35.9 (15.5) 0.002 HFpEF (%) 411 (18.7) 150 (24.9) 0.001 Ischemic etiology 1,202 (58.5) 372 (64.4) 0.011 Duration of HF, years 0.02 <1 988 (47.1) 229 (40.2) 1–5 621 (29.3) 196 (34.4) >5–10 317 (14.9) 97 (17.0) ≥10 185 (8.7) 48 (8.4) Signs and symptoms Shortness of breath on exertion 1,531 (69.7) 470 (78.2) <0.001 Angina 266 (12.1) 56 (9.3) 0.058 Elevated JVP 359 (16.3) 132 (22.0) 0.001 Peripheral edema 636 (28.9) 224 (37.3) <0.001 Pulmonary rales 391 (17.8) 165 (27.5) <0.001 Medical history Obese 380 (18.7) 115 (20.6) 0.329 CAD 1,263 (57.5) 383 (63.7) 0.006 CKD (eGFR <60 mL/min/1.73 m2) 877 (48.7) 375 (75.0) <0.001 Prior stroke 166 (7.6) 67 (11.1) 0.005 Atrial fibrillation/flutter 399 (18.2) 104 (17.3) 0.63 Hypertension 1,532 (69.7) 448 (74.5) 0.022 Type of DM 0.214 Type 1 60 (2.7) 11 (1.8) Type 2 2,139 (97.3) 590 (98.2) Duration of DM (years), median (IQR) 7 (3, 12) 11 (6, 20) <0.001 Peripheral arterial disease 73 (3.3) 63 (10.5) <0.001 Medication and device use ACEi or ARB 1,560 (73.2) 392 (66.4) 0.001 β-Blockers 1,616 (75.8) 457 (77.5) 0.41 MRA 1,078 (50.6) 206 (34.9) <0.001 Any diuretics 1,771 (83.1) 489 (82.9) 0.9 Any oral antidiabetes medication 1,291 (60.6) 320 (54.6) 0.008 Insulin 335 (15.7) 139 (23.7) <0.001 Device use 0.372 None 1,932 (88.0) 539 (89.7) ICD/CRT-D 177 (8.0) 45 (7.5) Pacer/pacemaker 87 (4.0) 17 (2.8) Laboratory, median (IQR) Potassium (mmol/L) 4.2 (3.8, 4.6) 4.3 (3.9, 4.6) 0.008 Sodium (mmol/L) 138.0 (136.0, 140.0) 138.0 (136.0, 141.0) 0.88 Creatinine (mg/dL) 1.1 (0.9, 1.5) 1.5 (1.2, 2.2) <0.001 Data are n (%) or median (interquartile range [IQR]). BP, blood pressure; CKD, chronic kidney disease; CRT-D, cardiac resynchronization therapy defibrillator; HR, heart rate; ICD, implantable cardioverter defibrillator; JVP, jugular venous pressure; MRA, mineralocorticoid receptor antagonist; SEA, Southeast Asia.
- Table 2
Crude and adjusted associations of microvascular complications with 1-year outcomes
Composite outcome All-cause mortality HF hospitalizations No. at risk No. of events (%) No. at risk No. of events (%) No. at risk No. of events (%) DM without microvascular complications (referent for HR) 2,024 437 (21.6) 2,024 209 (10.3) 2,024 271 (13.4) DM with microvascular complications 543 172 (31.7) 543 76 (14.0) 543 114 (21.0) HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Univariable 1.55 (1.32–1.94) <0.001 1.39 (1.07–1.81) 0.014 1.63 (1.31–2.02) <0.001 Model 1 1.60 (1.34–1.92) <0.001 1.42 (1.08–1.88) 0.012 1.59 (1.24–2.04) <0.001 Model 2 1.52 (1.25–1.86) <0.001 1.43 (1.07–1.91) 0.015 1.46 (1.13–1.90) 0.004 Model 3 1.34 (1.06–1.69) 0.015 1.12 (0.78–1.60) 0.536 1.43 (1.06–1.93) 0.019 Model 4 1.35 (1.04–1.76) 0.024 1.16 (0.78–1.73) 0.456 1.49 (1.06–2.09) 0.020 Model 1: age, sex, ethnicity, NYHA class, HF subtype (HFrEF/HFpEF), duration of HF. Model 2: model 1 + BMI, history of hypertension, atrial fibrillation, CAD, usage of insulins, and oral DM drugs. Model 3: model 2 + usage of ACEi/ARB, β-blockers, mineralocorticoid receptor antagonist, creatinine levels, hemoglobin levels, type of DM. Model 4: model 3 + duration of DM.
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