Divergent effect of blood glucose dysregulation on long-term clinical outcome in acute decompensated heart failure: A reappraisal in contemporary practice. (15th October 2022)

• Record Type: Journal Article
• Authors: Chishiki, Toshiki; Nagatomo, Yuji; Saji, Mike; Takei, Makoto; Goda, Ayumi; Kohno, Takashi; Nakano, Shintaro; Nishihata, Yosuke; Ikegami, Yukinori; Shiraishi, Yasuyuki; Kohsaka, Shun; Adachi, Takeshi; Yoshikawa, Tsutomu
• Is Part Of: International journal of cardiology. Volume 365(2022)
• Page Start: 91
• Page End: 99
• Publication Date: 2022-10-15
• Subjects: Blood glucose -- Diabetes mellitus -- Acute decompensated heart failure -- Sudden cardiac death; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.07.041
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The prognostic implication of elevated or decreased blood glucose (BG) level in acute decompensated heart failure (ADHF) has been still controversial. Indices of stress hyperglycemia, expressed by the ratio of BG and chronic BG control, has been reported to be associated with poor outcome in different disease population. We sought to assess BG at admission and %ΔBG, an index of BG deviation from estimated average BG calculated from glycated hemoglobin (HbA1c), on the long-term outcome in ADHF patients. Methods and results: The West Tokyo Heart Failure (WET-HF) Registry is a prospective multicenter registry enrolling consecutive hospitalized ADHF patients. Among the patients ( N = 3078, 77 [67–84] years, male 59%), BG at admission discriminated the long-term (1000 days) incidence of ADHF rehospitalization, but not cardiac death. BG at admission showed a U-shape relationship with the long-term incidence of ADHF rehospitalization after adjustment for covariates. Especially, in patients with HbA1c ≥ 6.5%, the lowest quartile showed the highest risk of ADHF rehospitalization. On the contrary, %ΔBG showed U-shape relationship with the long-term incidence of cardiac death after discharge, rather than ADHF rehospitalization after adjustment for covariates. In addition, elevated %ΔBG was associated with the long-term risk of sudden cardiac death (SCD) even after adjustment for covariates. Conclusions: For ADHF patients, BG at admission and %ΔBG might be a simple, useful tool for predicting and stratifying long-term risk of cardiac events. Especially, elevated %ΔBG might be an important in predicting hard events such as cardiac death or SCD. Highlights: Blood glucose at admission was related to subsequent heart failure rehospitalization. %ΔBG is an index of blood glucose deviation from chronic control. Elevated %ΔBG predicted hard events such as cardiac death or sudden cardiac death. %ΔBG might better reflect sympathetic nerve overactivation rather than blood glucose.