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Diabetes mellitus and hemodynamics in advanced heart failure

Benedicte Heegaard1, Tania Deis1, Kasper Rossing1

  • 1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.

International Journal of Cardiology
|March 12, 2023
PubMed

Insights

Diabetes in heart failure patients is linked to worse outcomes. This study found that diabetic patients have higher filling pressures, particularly those with poor glycemic control, suggesting a potential role in heart failure progression.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Diabetes mellitus (DM) presence in heart failure (HF) patients correlates with poorer prognosis.
  • Hemodynamic differences between diabetic and non-diabetic HF patients remain unclear.
  • Understanding DM's impact on HF hemodynamics is crucial for patient outcomes.

Purpose of the Study:

  • To investigate the impact of diabetes mellitus on hemodynamic parameters in heart failure patients.
  • To determine if hemodynamic profiles differ between diabetic and non-diabetic HF patients.
  • To explore the relationship between glycemic control and hemodynamic status in HF.

Main Methods:

  • Invasive hemodynamic evaluation of 598 heart failure patients with reduced ejection fraction (LVEF ≤40%).
  • Comparison of hemodynamic parameters (PCWP, CVP, CI, MAP) between diabetic (n=125) and non-diabetic (n=473) groups.
  • Correlation analysis between HbA1c levels and hemodynamic measurements.

Main Results:

  • Diabetic patients exhibited significantly higher pulmonary capillary wedge pressure (PCWP), mean pulmonary arterial pressure (mPAP), central venous pressure (CVP), and mean arterial pressure (MAP).
  • Adjusted analyses confirmed higher PCWP and CVP in diabetic patients.
  • Elevated HbA1c values were positively correlated with higher PCWP and CVP.

Conclusions:

  • Diabetic patients, especially those with poor glycemic control, present with elevated filling pressures.
  • These findings may suggest a component of diabetic cardiomyopathy, but other factors likely contribute to increased mortality in diabetic HF.
  • Further research is needed to elucidate mechanisms beyond hemodynamics driving adverse outcomes in diabetic HF.
Abstract

Keywords:
Diabetes mellitusHeart failureHemodynamics

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