Higher serum fasting glucose levels and prolonged Tpeak–Tend interval (Te) duration are associated with an increased 30-day mortality risk in patients with decompensated chronic heart failure (CHF), according to a study published in Cardiovascular Endocrinology & Metabolism.
Researchers sought to determine whether hyperglycemia and other cardiac damage biomarkers (N terminal-pro-brain natriuretic peptide [NT-proBNP], troponin, repolarization electrocardiography [ECG] variables, etc.) could be used to stratify the 30-day mortality risk in patients with decompensated CHF.
The study enrolled consecutive patients with decompensated CHF from a center in Italy between February 2019 and January 2021. The investigators assessed the RR, QT, and Te intervals from the respective time series in echocardiograms. They then calculated the mean (QT mean and Te mean), variance, and standard deviation (QTSD and TeSD) values for each of these repolarization phase intervals, as well as the variance normalized for the mean of QT (QTVN) and Te (TeVN).
The analysis included 164 patients with acutely decompensated CHF (aged mean 83±10 years; 90 men). In the 30-day follow-up, 26 patients died (overall mortality rate, 16%). Of these patients, 9% died from bronchopneumonia and respiratory failure, 5% from terminal heart failure, and 0.6% from fatal myocardial infarction or sudden cardiac death. The overall cardiovascular mortality rate was 7%.
The patients who died had significantly increased age (P <.05), NT-proBNP level (P <.001), troponin level (P <.01), and fasting glucose level (P <.05) compared with those who survived. The patients who survived also had lower levels of repolarization variability markers compared with those who died (QTSD, P <.01; QTVN, P <.05; TeSD, P <.01; and TeVN, P <.001).
Multivariable regression analysis showed a positive significant association between fasting glucose and 30-day total mortality (P <.01), QTSD (P <.05), and Te mean (P <.01). Multivariable regression analysis also confirmed a positive significant association between 30-day cardiovascular mortality and fasting glucose (P <.05) and Te mean (P <.01).
A study limitation is the absence of patients who were treated with sodium-glucose cotransporter-2 inhibitors.
“…our data seem to indicate that 2 simple, routine, noninvasive, inexpensive, easily repeatable parameters, as fasting glucose and Te mean, are able to improve the stratification for death risk in acute decompensated CHF patients,” the study authors wrote.
Piccirillo G, Moscucci F, Carnovale M, et al. Glucose dysregulation and repolarization variability markers are short-term mortality predictors in decompensated heart failure. Cardiovasc Endocrinol Metab. 2022;11(3):e0264. doi: 10.1097/XCE.0000000000000264