Related Experiment Video
Updated: Jul 13, 2025
Modeling and Evaluation of Murine Diabetic Cardiomyopathy Model
Published on: November 29, 2024
Relationship between stress hyperglycemia and worsening heart failure in patients with significant secondary mitral
Haozhang Huang1, Jiulin Liu1, Qiang Li2
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical University, 510080, China; Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Insights
Higher stress hyperglycemia ratio (SHR) indicates an increased risk of worsening heart failure (HF) in patients with coronary artery disease and secondary mitral regurgitation (sMR). This association is particularly pronounced in individuals with normal glucose levels.
Area of Science:
- Cardiology
- Endocrinology
- Valvular Heart Disease
Background:
- Secondary mitral regurgitation (sMR) is common in coronary artery disease (CAD) patients.
- sMR combined with abnormal glucose metabolism increases heart failure (HF) and mortality risks.
- The impact of stress hyperglycemia ratio (SHR) on HF progression in sMR patients with CAD is not well understood.
Purpose of the Study:
- To investigate the association between SHR and worsening HF in CAD patients with significant sMR.
- To evaluate SHR as a predictor of major adverse cardiac events (MACE) in this population.
Main Methods:
- A multi-center observational study included 874 patients with significant sMR post-PCI.
- Patients were categorized into quartiles based on SHR (glucose/HbA1c ratio).
- Primary endpoint was worsening HF; secondary endpoint was MACE, with a median follow-up of 3.7 years.
Main Results:
- The highest SHR quartile (Q4) showed a significantly higher risk of worsening HF (aHR 2.44) compared to the lowest quartile (Q1).
- SHR was not significantly associated with MACE.
- The association between SHR and worsening HF was more pronounced in patients with normoglycemia (p-interaction<0.001).
Conclusions:
- Elevated SHR is linked to an increased risk of worsening HF in CAD patients with significant sMR.
- The predictive value of SHR for worsening HF is particularly relevant in patients with normal glucose regulation.
- SHR may serve as a valuable prognostic marker for HF progression in this patient cohort.
Background And Aims:
Secondary mitral regurgitation (sMR), a major valvular disease, is prevalent in patients with coronary artery disease (CAD), and is associated with higher incidence of heart failure (HF) and mortality when present in combination with abnormal glucose metabolism. We aimed to evaluate the relationship between stress hyperglycemia ratio (SHR) and worsening HF in CAD patients with significant (grade ≥2) sMR.
Methods:
We performed a multi-center observational study of 874 participants with significant sMR following percutaneous coronary intervention (PCI) in the Cardiorenal Improvement-II (CIN-II) cohort. Patients with glucose and glycated hemoglobin (HbA1c) data at admission were included in the analysis, and categorized according to the SHR, the ratio of mmol/L blood glucose to % HbA1c, as quartiles: Q1: <0.74; Q2: 0.74-0.91; Q3: 0.91-1.14; and Q4: ≥1.14. The primary clinical endpoint was worsening HF and the secondary endpoint was major adverse cardiac events (MACE).
Results:
Of the 874 participants (64.1 ± 10.8 years, 80% male), 174 showed worsening HF and 226 developed MACE during a median follow-up of 3.7 years (interquartile range: 1.8-6.2 years). Compared to participants in the lowest quartile (Q1) of SHR, the highest quartile group (Q4) was at significantly higher risks of worsening HF (adjusted hazard ratio, 2.44; 95% confidence interval, 1.51-3.94; p< 0.001), while this was not associated with increased risk of MACE (p>0.05) after adjustment for potential covariates. For worsening HF, the results obtained for the normal glucose regulation subgroup may be more meaningful than those for the diabetes mellitus (DM) and pre-DM groups (p-interaction<0.001). For MACE, the acute myocardial infarction (AMI) (Q4 vs. Q1; HR: 0.65, 95%CI: 0.26-1.59) and non-AMI (Q4 vs. Q1; HR: 2.20, 95%CI: 1.36-3.54) subgroups differed significantly on MACE (p-interaction = 0.006).
Conclusions:
Increasing SHR is associated with a higher risk of worsening of HF in patients with significant sMR, especially in those with normoglycemia.
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
01:28Mitral Regurgitation IV: Nursing Management
01:27Mitral Stenosis IV: Nursing Management
01:25Mitral Regurgitation III: Medical Management
01:29Heart Failure II: Pathophysiology
01:27Heart Failure I: Introduction