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Updated: Jul 28, 2026
Author Spotlight: Exploring the Relationship Between Lipotoxicity and HFpEF
Published on: March 29, 2024
Long-term glycemic variability predicts compromised development of heart failure with improved ejection fraction: a
Chen Die Yang1, Jia Wei Chen2, Jin Wei Quan2
1Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Insights
Greater glycemic variability, measured by fasting plasma glucose (FPG) variability, is linked to fewer cases of improved ejection fraction (HFimpEF) in heart failure patients. Stable glucose control may aid heart function recovery.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Heart failure (HF) patients on guideline-directed therapies can achieve improved ejection fraction (HFimpEF).
- Glycemic variability (GV) is a key cardiometabolic factor, but its long-term impact on HFimpEF is not well understood.
Purpose of the Study:
- To investigate the association between long-term glycemic variability and the incidence of HFimpEF in patients with heart failure with reduced ejection fraction (HFrEF).
Main Methods:
- 591 hospitalized HFrEF patients (EF≤40%) were enrolled, with echocardiograms at baseline and 12 months.
- HFimpEF was defined as an absolute EF improvement ≥10% and a final EF >40%.
- Long-term fasting plasma glucose (FPG) variability was analyzed for its association with HFimpEF incidence.
Main Results:
- 218 patients (42.0%) developed HFimpEF over a mean follow-up of 12.2 months.
- Higher FPG variability was independently associated with a lower incidence of HFimpEF (OR: 0.487).
- This association persisted across different glycemic levels and in patients with or without diabetes.
Conclusions:
- Increased FPG variability is linked to a reduced likelihood of developing HFimpEF.
- Maintaining stable glycemic control may improve myocardial functional recovery in HF patients, including those without diabetes.
Background:
A substantial portion of heart failure (HF) patients adherent to guideline-directed medical therapies have experienced improved ejection fraction (EF), termed HFimpEF. Glycemic variability (GV) has emerged as a critical cardiometabolic factor. However, the relation between long-term GV and the incidence of HFimpEF is still unclear.
Methods:
A total of 591 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) admitted from January 2013 to December 2020 were consecutively enrolled. Repeat echocardiograms were performed at baseline and after around 12 months. The incidence of HFimpEF, defined as (1) an absolute EF improvement ≥10% and (2) a second EF > 40% and its association with long-term fasting plasma glucose (FPG) variability were analyzed.
Results:
During a mean follow-up of 12.2 ± 0.6 months, 218 (42.0%) patients developed HFimpEF. Multivariate analysis showed FPG variability was independently associated with the incidence of HFimpEF after adjustment for baseline HbA1c, mean FPG during follow-up and other traditional risk factors (odds ratio [OR] for highest vs. lowest quartile of CV of FPG: 0.487 [95% CI 0.257~0.910]). Evaluation of GV by alternative measures yielded similar results. Subgroup analysis revealed that long-term GV was associated with HFimpEF irrespective of glycemic levels and diabetic conditions.
Conclusions:
This study reveals that greater FPG variability is associated with compromised development of HFimpEF. A more stable control of glycemic levels might provide favorable effects on myocardial functional recovery in HF patients even without diabetes.
