Abstract 16277: Hyperglycemia in Congestive Heart Failure Patients is Associated to Sympathetic Overactivity
Background: sympathetic activation is a hallmark of acute and chronic heart failure (CHF). Recently, abnormalities of blood glucose concentrations at presentation, among patients with CHF, have been shown to be powerfully prognosticator for 30-day mortality. We sought to assess if sympathetic activity could explain this feature.
Methods: We prospectively recorded sympathetic activity using muscle sympathetic nerve activity (MSNA), plasmatic glucose levels, echocardiographic ejection fraction (EF) in patients admitted for CHF in our department. These patients were followed up for one year.
Results: A total of 139 CHF non diabetic patients were recruited, mean age was 61±1 years, 78,5% were male, mean BMI=25±0,4Kg/m2, EF was 26,6±0,9% and mean BNP level was 450±99 μg/ml. After 1 year follow up 28 patients (20.1%) died.
Compared with survivors, non survivors had significantly higher MSNA (65,83±2,7 vs 53,66±1,1 burst/min; p<0,00001), higher BNP (948±378 vs 382±59 μg/ml; p<0,0001), higher plasmatic creatinine (158±14 vs 110±4 mmol/l; p<0,001) and lower hemoglobin level (11,95±0,5 vs 13,1±0,2 g/dl; p<0,05). When classifying as HISA (Highly Increased Sympathetic Activity) patients in which MSNA measured vas over the 75° percentile and as NHISA (No Highly Increased Sympathetic Activity) patients with MSNA<75°percentile we observed that all deaths at 1 month were in the HISA group (10,81% vs 0; p<0,001). The risk of 1 year mortality associated with HISA appeared consistent (43,24% vs 11,81%; odd ratio: 5,65; p<0,0001) (figure).
Comparing the two groups, HISA’s patients showed higher blood glucose concentrations (5,7±0,27 vs 5,2±0,09 mmol/l; p=0,03) and lower hemoglobine (12,1±0,3 vs 13,2±0,2 g/dl; p=0,01).
Conclusions: We show for the first time the possible link between elevated blood glucose and sympathetic overactivity. This could explain how hyperglycaemia contributes to the progression of CHF and increases morbidity and mortality in these patients.
- © 2013 by American Heart Association, Inc.