Diastolic function in patients with heart failure with preserved ejection fraction and atrial fibrillation: impact of diabetes

Ruxandra-Nicoleta Horodinschi; Camelia Cristina Diaconu

Diastolic function in patients with heart failure with preserved ejection fraction and atrial fibrillation: impact of diabetes

Am J Cardiovasc Dis. 2021 Oct 25;11(5):564-575. eCollection 2021.

Authors

Ruxandra-Nicoleta Horodinschi^{1

2}, Camelia Cristina Diaconu^{1

2}

Affiliations

¹ Department of Internal Medicine, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania.
² Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest Bucharest, Romania.

PMID: 34849288
PMCID: PMC8611268

Abstract

Introduction: The objective of our study was to evaluate the severity of diastolic dysfunction in patients with heart failure with preserved ejection fraction (HFpEF), atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) compared to those with HFpEF and AF without DM.

Material and methods: This is an observational, prospective, case-control study. We selected 720 patients with heart failure consecutively admitted between March 2019-December 2020, of whom 253 patients with AF. After applying the inclusion/exclusion criteria, 105 subjects remained in the study. The patients were divided into two groups, according to the presence of T2DM: group A (39 patients with T2DM, 37.14%), group B (66 patients without T2DM, 62.85%). 2D transthoracic echocardiography was performed in all patients. The study was approved by the Ethics Committee of the hospital. Statistical analysis was performed using R software, version 4.0.2.

Results: Patients with HFpEF, AF, and T2DM had higher LV filling pressures compared to those without DM (OR = 5.00, 95% CI: 1.77-15.19). Moreover, patients with insulin-requiring T2DM (OR = 6.25, 95% CI: 1.50-25.98) had higher LV filling pressures than those treated with oral antidiabetic drugs (OR = 4.44, 95% CI: 1.37-15.17). We demonstrated that patients with T2DM had higher E/e' ratio (difference -2.78, P 0.0003, 95% CI: -4.24 to -1.31) and lower deceleration time (DT) (difference 23.04, P 0.0002, 95% CI: 11.10-34.97) than those without T2DM.

Conclusions: Patients with HFpEF, AF and T2DM have higher LV filling pressures than those without T2DM, suggesting that the presence of T2DM leads to a more severe diastolic dysfunction.

Keywords: Heart failure with preserved ejection fraction; atrial fibrillation; diabetes mellitus; diastolic dysfunction; left ventricular filling pressures.