| Background and Objective: Currently,with the aging population and the ongoing epidemics of obesity,diabetes,and hypertension,heart failure with preserved ejection fraction(HFpEF)is already the most frequent form of heart failure(HF),accounting for nearly half of all HF cases.Moreover,HFpEF is increasing in prevalence at an alarming rate of 1%.HFpEF is a heterogeneous syndrome,and it is associated with high mortality.After HF hospitalization,the 5-year survival of HFpEF is a dismal 35%,worse than most cancers.Type 2 diabetes mellitus(T2DM)is one of the most frequent comorbidity associated with HFpEF(prevalence varying from 40 to 50%).HFpEF patients with T2DM has a worse prognosis than those without T2DM.HFpEF with or without T2DM may be different phenotypes.However,there is currently a lack of effective risk prediction models for early identification of high risk phenotypes in HFpEF patients with T2DM.The integer-based WATCH-DM risk score can facilitate the ease of use in clinical settings.The score integrates the following predictors: Six clinical variables such as age,systolic blood pressure,diastolic blood pressure,body mass index,myocardial infarction,and coronary artery bypass grafting,one ECG variable such as QRS duration,and three laboratory indicators such as serum creatinine,high density lipoprotein cholesterol,and fasting venous glucose.The WATCH-DM risk score has been validated to predict the risk of HF in patients with T2DM,but its ability to predict clinical outcomes in HFpEF patients with T2DM is unknown.Therefore,We aimed to assess whether this risk score could predict the prognosis of HFpEF patients with T2DM.Method: In this study,We enrolled retrospectively 414 patients with HFpEF(70.03±8.654 years,58.70% female),hospitalized in the Department of Cardiology,the First Affiliated Hospital of Dalian Medical University from January 1,2015 to April30,2018.Among them,203 patients(49.03%)were HFpEF patients with T2DM,and211 patients(50.97%)were HFpEF patients without T2DM.Clinical features,co-morbidities,medication,laboratory values,and echocardiographic findings of the patients were collected and recorded.We calculated the WATCH-DM risk score for the HFpEF patients with T2DM and divided this cohort into three groups according to the WATCH-DM risk score: low risk group(≤10 points),medium risk group(11-13 points),and high risk group(≥14 points).Primary endpoints included all-cause death,cardiovascular death,any hospitalization,and HF hospitalization.The cut-off date was December 31,2021,or upon the occurrence of death or rehospitalization.Results: HFpEF patients with T2DM exhibited a trend toward more concentric remodeling/hypertrophy than HFpEF patients without T2DM,and all-cause or cardiovascular mortality rate of the HFpEF patients with T2DM was significantly higher than the HFpEF patients without T2DM(P<0.001).When analyzed as a continuous variable,per 1-point increase in the WATCH-DM risk score was associated with increased risks of all-cause death(HR 1.181),cardiovascular death(HR 1.232),any hospitalization(HR 1.082),and HF hospitalization(HR 1.097).The area under the curve for the WATCH-DM risk score in predicting incident cardiovascular death(0.7061,95% CI 0.6329-0.7792)was higher than that of all-cause death,any hospitalization,or HF hospitalization.Conclusion: As a high-risk phenotype for heart failure,HFpEF patients with T2DM necessitates early risk stratification and specific treatment.To the best of our knowledge,the current study is the first to demonstrate that the WATCH-DM score predicts poor outcomes in HFpEF patients with T2DM.Its convenience may allow for quick risk assessments in busy clinical settings. |
PDF Full Text Request