Relation of Left Ventricular Function to Long-Term Mortality Among Diabetic Patients Hospitalized with Acute Heart Failure

Ella Shaviv Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel Ilan Goldenberg Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel Sharon Shalom Natanzon Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel Robert Klempfner Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel Yael Peled Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel Nir Shlomo Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel Israel Mazin Cardiology, The Leviev Heart Center, Sheba Medical Center, Israel Sakler School of Medicine, Tel Aviv University, Israel

Background:

Diabetes Mellitus (DM) has long been associated with increased cardiovascular related morbidity and mortality among patients with heart failure. However, there are limited data on the possible differential association between DM and long-term morbidity and mortality among HF patients with varying degrees of left ventricular dysfunction.

Methods

The study population comprised 2981 DM patients who were hospitalized with acute HF between the years 2008-2016 at Sheba Medical Center. Study patients were categorized according to the recent European Society of Cardiology heart failure guidelines, as HFrEF (≤40%), HFmrEF (41%-49%) and HFpEF (≥50%).

Results:

Overall mortality rate at 5-year of follow-up in the DM study population was 42%. Kaplan Meier survival analysis (Figure) showed that at 5 years of follow-up mortality rates were highest among patients with HFrEF (46%), intermediate among those with HFmrEF (44%), and lowest among HFpEF patients (38%), Consistent with these findings, multivariate analysis showed that, as compared with the HFpEF group, DM patients with HFrEF experienced a significant 49% (p<0.001) risk increase in long-term mortality, and those with HFmrEF experienced a corresponding 24% (p=0.045) risk increase. The association between LVEF and mortality was consistent among patients with an ischemic and non-ischemic etiology of HF.

Conclusion

DM patients hospitalized with acute HF experience very high mortality rates at 5-years that are inversely related to the degree of left ventricular function. These findings may be used for improved risk stratification in this high-risk population.

Ella Shaviv