The features of heart failure of ischemic origin in patients with concomitant atrial fibrillation and diabetes mellitus

Abstract

Background. Heart failure (HF) is the final stage of the cardiovascular diseases and one of the main causes of mortality due to them. The prevalence of HF has been steadily increasing in recent years and is ≈ 2 % of the adult population. Diabetes mellitus (DM) is among factors that worsen the prognosis of HF. Type 2 DM is an independent risk factor for the occurrence of HF, and the level of fasting plasma glucose, as well as an increased content of HbA1c are significantly associated with an elevated risk of developing HF. The purpose of the study was to investigate the features of the course of HF, which occurred against the background of postinfarction cardiosclerosis, in patients with concomitant atrial fibrillation (AF) and DM. Materials and methods. Three hundred and ninety-eight patients with HF on the background of postinfarction cardiosclerosis aged 45–65 (54.3 ± 7.2) years were examined, 198 (49.7 %) women and 200 (50.3 %) men. Two hundred and twenty-six (56.8 %) patients had permanent AF, 102 (25.6 %) had concomitant type 2 DM. Diagnoses of AF and HF were carried out in accordance with the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure approved by the Order of the Ministry of Health of Ukraine dated July 3, 2006 No. 436 and in accordance with the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. In addition to general clinical and biochemical blood tests, enzyme immunoassays were performed to determine brain natriuretic peptide, NT-proBNP, galectin-3 and ST-2. A standardized echocardiographic examination was conducted with calculations of the left ventricular ejection fraction (LVEF) and heart dimensions during hospitalization. Results. Patients with HF and concomitant DM, compared to participants without impaired carbohydrate metabolism, have a higher frequency of the disease phenotype with preserved LVEF (48.0 %), higher New York Heart Association functional classes (FC III — 70.0 %) and the risk of re-hospitalization (hazard ratio (HR) = 3.14 (2.05–5.68)). For patients with HF and a permanent AF, but without existing DM, a more pronounced dilatation of the heart cavities, a lower LVEF (by 15 %) and a high risk of re-hospitalization during the first year (HR = 1.235 (1.024–1.489)) are typical. Patients with HF and a concomitant combination of AF and DM have the most unfavorable course of heart pathology: the increased size of the left ventricle is more often registered, and its systolic function is worse (by 19.3 %), with high frequency of the phenotype with reduced LVEF (51.9 %), FC IV (46.2 %), the highest risk of re-hospitalization (HR = 11.30 (4.73–27.04)) and one-year death (HR = 2.95 (2.00–4.36)). Conclusions. Given the risk of re-hospitalization and one-year mortality, the most unfavo­rable combination of concomitant pathology in patients with heart failure of ischemic origin is atrial fibrillation and diabetes mellitus.