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Microvascular Disease in Patients With Diabetes With Heart Failure and Reduced Ejection Versus Preserved Ejection

Jasper Tromp1,2,3, Shir Lynn Lim4, Wan Ting Tay1

  • 1National Heart Centre Singapore, Singapore.

Diabetes Care
|July 12, 2019
PubMed

Insights

Diabetic microvascular complications are linked to heart failure with preserved ejection fraction (HFpEF) and worse quality of life. These complications may represent a distinct manifestation of diabetes in HFpEF patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Microvascular complications are frequent in diabetes mellitus (DM).
  • Heart failure (HF) in DM is often attributed to macrovascular disease, typically HF with reduced ejection fraction (HFrEF).
  • HF with preserved ejection fraction (HFpEF) in DM patients may stem from microvascular disease.

Purpose of the Study:

  • To investigate the prevalence of microvascular complications in patients with HF and DM.
  • To examine the association between microvascular complications and clinical outcomes.
  • To assess cardiac structure and function in relation to microvascular complications in HF patients with DM.

Main Methods:

  • Prospective enrollment of 2,800 participants with HF and DM from the ASIAN-HF registry.
  • Assessment of microvascular complications including neuropathy, nephropathy, and retinopathy.
  • Analysis of cardiac structure, function, clinical outcomes, and quality of life.

Main Results:

  • 21.5% of participants with DM had microvascular complications.
  • Microvascular complications were associated with a higher likelihood of HFpEF (OR 1.70) and increased with the number of complications.
  • Microvascular complications correlated with greater left ventricular hypertrophy, reduced quality of life in HFpEF, and similar adverse outcomes compared to HFrEF.

Conclusions:

  • Diabetic microvascular disease is more prevalent in HFpEF and associated with greater adverse cardiac remodeling and quality of life impairment.
  • HFpEF may represent a specific clinical manifestation of microvascular disease in patients with diabetes mellitus.
  • Microvascular complications in DM patients with HF are linked to adverse clinical outcomes regardless of HF type.
Abstract

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