Diabetes mellitus and hemodynamics in advanced heart failure

Background: The presence of diabetes in patients with heart failure (HF) is associated with a worse prognosis. It is unclear if hemodynamics in HF patients with DM differ from those of non-diabetic patients and how this might influence outcome. This study aims to discover the impact of DM on hemodynamics in HF patients. Methods: Consecutive patients (n = 598) with HF and reduced ejection fraction (LVEF <= 40%) undergoing invasive hemodynamic evaluation were included (non-DM: n = 473, DM: n = 125). Hemodynamic parameters included pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP). Mean follow-up was 9.5 +/- 5.1 years.Results: Patients with DM (82.7% male, mean age 57.1 +/- 10.1 years, mean HbA1c 60 +/- 21 mmol/mol) had higher PCWP, mPAP, CVP and higher MAP. Adjusted analysis demonstrated that DM patients had higher PCWP and CVP. Increasing HbA1c-values were correlated with higher PCWP (p = 0.017) and CVP (p = 0.043).Conclusion: Patients with DM, especially those with poor glycemic control, have higher filling pressures. This may be a feature of diabetic cardiomyopathy, however, other unknown mechanisms beyond hemodynamic factors are likely to explain the increased mortality associated with diabetes in HF.

Automated summary

This study aims to investigate the impact of diabetes on hemodynamics in heart failure patients. It found that heart failure patients with diabetes have higher filling pressures, including pulmonary capillary wedge pressure, central venous pressure, cardiac index, and mean arterial pressure. Additionally, poor glycemic control in diabetic patients is associated with higher filling pressures. Therefore, diabetic cardiomyopathy may contribute to the increased mortality in heart failure patients with diabetes, but other unknown mechanisms beyond hemodynamic factors are also likely involved.