Abstract 2428: Clinical Determinants And Prognostic Importance Of Glycosylated Haemoglobin In Chronic Heart Failure
Purpose. Abnormalities in glucose metabolism are frequent in chronic heart failure (CHF). The prognostic importance of glycosylated haemoglobin (Hb A1c) is well known in diabetes. In CHF glucose-related protein damage may be dependent on factors linked to heart failure itself, i.e. inflammation or oxydative stress. We examined important clinical and laboratory as well as body composition measures and their relationship to Hb A1c. We assessed prognosticators by Cox proportional hazard analysis.
Material & Methods. Using the turbidimetric method we measured Hb A1c level in 369 patients with CHF (308 male; 61 female; age 54±13 years; NYHA: I/II/III/IV 40, 136, 146, 43; ischaemic: 66%; diabetes 23%). All patients underwent routine laboratory and functional assessment combined with body composition analysis by DEXA. Patients were optimally treated with beta-blockers, ACE-I/ARB, diuretics and spironolactone, if appropriate. All patients were followed for a median of 589 days. During follow-up, 42 (11%) of patients died.
Results. In this population, the median Hb A1c was 6.2% (range 4.7 to 12.9%). There was stepwise increase of Hb A1c according to NYHA class (I: 6.3±1.0%, II: 6.3±1.0%, III: 6.6±1.1%, IV: 6.8±1.7%, ANOVA p<0.02). Hb A1c correlated with age (r=0.16, p<.02), NYHA class (r=0.23, p=.0001), percent change of body mass from CHF onset (r=0.17, p<.01), creatinine (r=0.19, p=.006), serum uric acid (r=0.17, p=0.01), and NT-proBNP (r=0.15, p=.02), but not with fasting glucose and any global or regional body composition variables. Cox analysis showed that only age (p=0.02), NYHA class (p<0.0001) and NT-proBNP (p=.03) independently predicted survival as did also Hb A1c (Hb A1c <6.0%: 5% mortality; Hb A1c 6.0 –7.0%: 12%; Hb A1c >7.0%: 21%, ANOVA p<.004).
Conclusions. In CHF patients, plasma levels of haemoglobin A1c are linked to HF severity and to patient prognosis.