| Objective: This study was designed to analyze the clinical characteristics,evaluate the influence of type 2 diabetes mellitus on the prognosis and investigate the risk factors that affected the prognosis in patients with HFpEF and T2DM on the short-term.Methods: our study enrolled 216 patients,these patients were divided into T2DM group(n=72)and non-T2DM(n=144)group according to whether they had type 2 diabetes mellitus or not.Comparing the clinical characteristics of the two groups.The endpoint of observations were the occurrence of endpoint events [all-cause death or cardiovascular events(including rehospitalization for heart failureheart,and acute coronary syndrome)] or the end of two years of follow-up.Log-rank test was used to analyze the influence of T2DM on the different endpoint events in patients with HFpEF during the two years follow-up.Use the Kaplan-Meier method to draw the survival curves of each endpoint event in the two groups.Cox proportional hazards model was used to analyze the independent predictors of cardiovascular events or composite endpoint events(all-cause death and cardiovascular events)in patients with HFpEF and T2DM.Results:1.Comparison of clinical characteristics between patients with and without T2DM: There were no significant differences in sex,age,classifications of function capacity of the new york heart association,proportion of hypertension,chronic kidney disease,stroke,chronic obstructive pulmonary disease,and smoking,the level of NT-pro BNP,and echocardiographic parameters of left ventricle end diastolic/systolic dimension,left atrial dimension,intervenctricular septal thickness,left ventricular mass index,left ventricular end diastolic/systolic volume,left ventricular ejection fraction,and left ventricular relative wall thickness(P>0.05).The T2DM group had higher body mass index,higher level of homocysteine,cystatin-C,triglycerides,glycolsylated hemoglobin,fasting blood glucose,and admission systolic blood pressure,thicker of left ventricular posterior wall thickness,and higher proportion of coronary heart disease,and had lower level of glomerular filtration rate and proportion of atrial fibrillation(P<0.05).2.The influence of T2DM on the short-term prognosis of patients with HFpEF: Between the T2DM group and the non-T2DM group,the occurrence of the endpoint events were as follows: there were 5 cases(6.94%)and 6 cases(4.17%)of all-cause deaths,30 cases(41.67%)and 35 cases(24.31%)of cardiovascular events [among them,there were 18 cases(25%),20 cases(13.89%)of acute coronary syndrome,and 12 cases(16.67%),15 cases(10.42%)of rehospitalization for heart failure],and 34 cases(47.22%)and 36 cases(25%)of composite endpoint events,respectively.Log-Rank test analysis showed that T2DM had a significant impact in the incidence of acute coronary syndrome[HR(95%CI): 2.129(1.071～4.231)],cardiovascular events[HR(95%CI): 2.060(1.216～3.491)] and composite endpoint events[HR(95%CI): 2.292(1.379～3.808)]in patients with HFpEF during the 2-year follow-up.The risk of acute coronary syndrome,cardiovascular events and composite endpoint events in T2DM group was significantly higher than non-T2DM group(P<0.05).but there was no significant impact on rehospitalization for heart failure and all-cause death(P>0.05).3.Prognostic factors in patients with HFpEF and T2DM: There were 5cases(6.94%)of all-cause deaths,30 cases(41.67%)of cardiovascular events,and 34 cases of composite endpoint events(47.22%)in patients with HFpEF and T2DM during the 2-year follow-up.In the Cox proportional hazards models,high levels of homocysteine [HR(95%CI): 1.065(1.010～1.123),P=0.019],triglyceride [HR(95%CI): 1.310(1.084～1.582),P=0.005],and chronic kidney diseases [HR(95%CI): 7.219(1.554～33.534),P=0.012] could independently predict the rehospitalization of cardiovascular events in patients with HFpEF and T2DM.High level of triglyceride [HR(95%CI): 1.299(1.080～1.564),P=0.006],and chronic kidney diseases [HR(95%CI): 8.713(2.364～32.116),P=0.001] could independently predict the occurrence of composite endpoint events in patients with HFpEF and T2DM.Conclusions:1.The patients with HFpEF and T2DM had higher level of body mass index,admission systolic blood pressure,homocysteine,triglyceride,glycolsylated hemoglobin,and fasting blood glucose,more severe renal insufficiency,thicker left ventricular wall thickness,higher proportion of coronary heart disease,and had a lower proportion of atrial fibrillation.2.The patients with HFpEF and T2DM had a significantly higher risk of ACS,cardiovascular events,and composite endpoint events in the short-term.3.High levels of triglycerides,and history of chronic kidney disease were valuable predictors of an increased risk for cardiovascular events and composite endpoint events,and high levels of homocysteine was valuable predictors of an increased risk for cardiovascular events in patients with HFpEF and T2DM. |
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