scholarly journals P4737Association between type-2 diabetes and 5-year heart failure outcomes in patients with atrial fibrillation

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
M Polovina ◽  
D Djikic ◽  
N Djuricic ◽  
I Milinkovic ◽  
P Seferovic
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes

3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Polovina ◽  
I Milinkovic ◽  
G Krljanac ◽  
I Veljic ◽  
I Petrovic-Djordjevic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
History Of ◽  
New Onset

Abstract Background Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised. Purpose In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up. Methods We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] <40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF. Results Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P<0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P<0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P<0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%). Conclusions T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.

scholarly journals Potential Effects of Bariatric Surgery on the Incidence of Heart Failure and Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus and Obesity and on Mortality in Patients With Preexisting Heart Failure: A Nationwide, Matched, Observational Cohort Study

2021 ◽  
Author(s):  
Gudrún Höskuldsdóttir ◽  
Naveed Sattar ◽  
Mervete Miftaraj ◽  
Ingmar Näslund ◽  
Johan Ottosson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery

Background Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM). Methods and Results In this register‐based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux‐en‐Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux‐en‐Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m 2 . The follow‐up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19–0.38), 41% for AF (HR, 0.59; CI, 0.44–0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12–0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12–0.43). Conclusions Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF.

Serum Magnesium Is Inversely Associated With Heart Failure, Atrial Fibrillation, and Microvascular Complications in Type 2 Diabetes

Diabetes Care ◽  
2021 ◽  
pp. dc210236
Author(s):  
Lynette J. Oost ◽  
Amber A.W.A. van der Heijden ◽  
Emma A. Vermeulen ◽  
Caro Bos ◽  
Petra J.M. Elders ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Serum Magnesium

P2636Stage B predictors of non-ischemic heart failure in type 2 diabetes mellitus

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Klabnik ◽  
J Murin
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Left Atrial ◽  
Systolic Dysfunction ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

Abstract Purpose Stage B heart failure (SBHF), defined as LV hypertrophy (LVH) and impaired ejection fraction (EF), is precursor of reduced (HFrEF), mid-range (HFmrEF) or preserved (HFpEF) heart failure in type 2 diabetes mellitus (T2DM). Left atrial enlargement (LAE) and left ventricular diastolic or systolic dysfunction (assessed with tissue doppler and speckle-tracking echocardiography) are not accepted as HF stage B equivalents. Methods 396 consecutive community-based elderly (≥65 years) patients (pts) with asymptomatic T2DM (age 76±4 years; 64% women) with preserved EF (≥40%) and no atrial fibrillation, ischemic or valvular heart disease referred to echolab and prospectively followed from January 2015 by regional cardiologist. Results Prevalence of SBHF was observed in 6% after 2 years (EF≤40%) and LVH have 13% at baseline and 20% pts after 2 years. Left atrial enlargement (>34 ml/m2) occurs in 31%, resp. 48% pts after 24 months, diastolic dysfunction (E/e' >14) in 42%, resp. 68%. Systolic dysfunction (S' ≤6.0 cm/s) was observed in 20%, resp. 33% pts, and reduced global longitudinal (GLS <16%) in 23%, resp. 40% pts (all p<0.001). After a mean follow-up of 31±4 months developed new HF 19% pts (1% HFrEF, 6% HFmrEF and 12% HFpEF). The strongest predictors of incident HFpEF were older age (15%, 45% among men and 20%, 60% among women ages 65–74, and 75–85 years, p<0.001), new-onset atrial fibrillation: hazard ratio (HR) 1.4, p<0.01, and NTproBNP >125 pg/ml (HR 2,8, p<0.001). Significant (p<0.001) echocardiografic predictors of incident HFpEF were LVH (HR 2.90), systolic dysfunction (S' ≤6.0 cm/s, HR 2.2) and reduced GLS (HR 2.38). But not abnormal E/e' and LAE were associated with incident HF. Conclusions New echocardiographic parameters are useful in prediction of incident HF and should be added to standard SBHF criteria in asymptomatic patients with type 2 diabetes mellitus. Additional research is needed to update HF screening guidelines. Acknowledgement/Funding Supported by grant from the Slovak Society of Cardiology 2015 Selective screening of heart failure stages in regional settings

CLINICAL CHARACTERISTICS OF PATIENTS WITH CHRONIC HEART FAILURE AND TYPE 2 DIABETES MELLITUS WHO REQUIRE IMPLANTATION OF PERMANENT PACEMAKER

2021 ◽  
pp. 18-22
Author(s):  
O. S. Voronenko ◽  
M. S. Brynza
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Heart Failure ◽  
Clinical Characteristics ◽  
Pacemaker Implantation ◽  
Gender And Age

In recent decades, there has been a rise of chronic heart failure mortality. Among the huge range of modern methods of this pathology treatment, the cardioresynchronizing therapy stands out, it allows the improvement of the patient's heart function, reduces clinical signs of the disease, improves well−being, as well as diminishes morbidity and mortality. The use of this method in the patients with a comorbid pathology, i.e. in those with chronic heart failure and type 2 diabetes, deserves a special attention. In order to determine the clinical characteristics of the patients who required a pacemaker implantation, we examined 203 patients who had reasonable indications for this in accordance with the ACC / ANA and ESC current recommendations. Another important criterion for inclusion into the group of implantation was considered to be the presence of comorbid Diabetes mellitus type 2. The gender and age characteristics of the surveyed population were dominated by elderly male patients. The presence of concomitant cardiovascular pathology depending on the age of patients was analyzed, which showed mostly hypertension of stage 2−3, a constant atrial fibrillation. In structure of comorbid pathology the somatic diseases, including type 2 Diabetes mellitus prevailed. Electrostimulators were implanted into the examined cohort of patients, among which 132 devices worked in DDD mode, 71 of the installed stimulators had the DDDR mode. The research results concluded that the implantation of a pacemaker became a necessary procedure for elderly patients, mostly men, with a high prevalence of cardiovascular (coronary heart disease, hypertension, persistent atrial fibrillation) and somatic pathology in the form of type 2 Diabetes mellitus. Key words: chronic heart failure, type 2 diabetes mellitus, pacemaker implantation, clinical features, gender and age characteristics.

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