Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction).

Tytuł:: Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction).
Autorzy:: Kristensen SL; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Mogensen UM; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Jhund PS; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Petrie MC; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Preiss D; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Win S; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Køber L; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
McKelvie RS; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Zile MR; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Anand IS; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Komajda M; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Gottdiener JS; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Carson PE; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
McMurray JJ; From BHF Cardiovascular Research Centre, University of Glasgow, Scotland, UK (S.L.K., U.M.M., P.S.J., M.C.P., J.J.V.M.); Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (S.L.K., U.M.M., L.K.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (D.P.); Mayo Clinic, Rochester, MN (S.W.); Western University, London, ON, Canada (R.S.M.); Ralph H. Johnsons Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); Division of Cardiology, University of Minnesota, Minneapolis (I.S.A.); Université Paris 6 and Hospital Pitié-Salpétrière, Paris, France (M.K.); University of Maryland Medical Center, Baltimore (J.S.G.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.). .
Źródło:: Circulation [Circulation] 2017 Feb 21; Vol. 135 (8), pp. 724-735. Date of Electronic Publication: 2017 Jan 04.
Typ publikacji:: Journal Article; Randomized Controlled Trial
Język:: English
Imprint Name(s):: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: [Dallas, Tex., etc., American Heart Association, etc.]
MeSH Terms:: Echocardiography*
Biphenyl Compounds/*therapeutic use
Diabetes Mellitus, Type 2/*complications
Heart Failure/*drug therapy
Stroke Volume/*physiology
Tetrazoles/*therapeutic use
Aged ; Body Mass Index ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Diabetes Mellitus, Type 2/diagnosis ; Female ; Follow-Up Studies ; Heart Failure/diagnostic imaging ; Heart Failure/physiopathology ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/physiopathology ; Hospitalization ; Humans ; Incidence ; Irbesartan ; Male ; Natriuretic Peptide, Brain/metabolism ; Peptide Fragments/metabolism ; Proportional Hazards Models ; Treatment Outcome
Contributed Indexing:: Keywords: diabetes mellitus; echocardiography; heart failure
Molecular Sequence:: ClinicalTrials.gov NCT00095238
Substance Nomenclature:: 0 (Biphenyl Compounds)
0 (Peptide Fragments)
0 (Tetrazoles)
0 (pro-brain natriuretic peptide (1-76))
114471-18-0 (Natriuretic Peptide, Brain)
J0E2756Z7N (Irbesartan)
Entry Date(s):: Date Created: 20170106 Date Completed: 20170509 Latest Revision: 20220409
Update Code:: 20240104
DOI:: 10.1161/CIRCULATIONAHA.116.024593
PMID:: 28052977
: Czasopismo naukowe

Background: In patients with heart failure and preserved ejection fraction, little is known about the characteristics of, and outcomes in, those with and without diabetes mellitus.
Methods: We examined clinical and echocardiographic characteristics and outcomes in the I-Preserve trial (Irbesartan in Heart Failure With Preserved Ejection Fraction) according to history of diabetes mellitus. Cox regression models were used to estimate hazard ratios for cardiovascular outcomes adjusted for known predictors, including age, sex, natriuretic peptides, and comorbidity. Echocardiographic data were available in 745 patients and were additionally adjusted for in supplementary analyses.
Results: Overall, 1134 of 4128 patients (27%) had diabetes mellitus. Compared with those without diabetes mellitus, they were more likely to have a history of myocardial infarction (28% versus 22%), higher body mass index (31 versus 29 kg/m 2 ), worse Minnesota Living With Heart Failure score (48 versus 40), higher median N-terminal pro-B-type natriuretic peptide concentration (403 versus 320 pg/mL; all P <0.01), more signs of congestion, but no significant difference in left ventricular ejection fraction. Patients with diabetes mellitus had a greater left ventricular mass and left atrial area than patients without diabetes mellitus. Doppler E-wave velocity (86 versus 76 cm/s; P <0.0001) and the E/e' ratio (11.7 versus 10.4; P =0.010) were higher in patients with diabetes mellitus. Over a median follow-up of 4.1 years, cardiovascular death or heart failure hospitalization occurred in 34% of patients with diabetes mellitus versus 22% of those without diabetes mellitus (adjusted hazard ratio, 1.75; 95% confidence interval, 1.49-2.05), and 28% versus 19% of patients with and without diabetes mellitus died (adjusted hazard ratio, 1.59; confidence interval, 1.33-1.91).
Conclusions: In heart failure with preserved ejection fraction, patients with diabetes mellitus have more signs of congestion, worse quality of life, higher N-terminal pro-B-type natriuretic peptide levels, and a poorer prognosis. They also display greater structural and functional echocardiographic abnormalities. Further investigation is needed to determine the mediators of the adverse impact of diabetes mellitus on outcomes in heart failure with preserved ejection fraction and whether they are modifiable.
Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00095238.
(© 2017 American Heart Association, Inc.)

Comment in: Circulation. 2017 Feb 21;135(8):736-740. (PMID: 28052978)

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