Identification of latent disorders of carbohydrate metabolism in conjunction with neurohormonal status in hospitalized patients with chronic heart failure of ischemic etiology

Aim. To reveal latent disorders of carbohydrate metabolism (CHM) in conjunction with neurohormonal status in hospitalized patients with chronic heart failure (CHF) of ischemic etiology.Material and methods. We analyzed 174 patients with NYHA class II-IV CHF of ischemic etiology who received the same standard CHF therapy (P-adrenergic blockers, mineralocorticoid receptor antagonists, angiotensin-converting enzyme inhibitors, diuretics), did not have disorders of CHM and never took hypoglycemic agent. We conducted oral glucose tolerance test (OGTT) and general clinical examination. The levels of brain natriuretic peptide, aldosterone and insulin was determined by enzyme immunoassay. Insulin resistance (IR) is assessed using the HOMA-IR index.Results. Among 174 hospitalized patients with NYHA class II-IV CHF of ischemic etiology disorders of CHM was detected in 52,3% of patients: 33,9% of those had impaired glucose tolerance (IGT), 1,7% — impaired fasting glucose (IFG), 16,7% — newly diagnosed type 2 diabetes mellitus (DM), in 47,7% of the patients disorders of CHM was not found. In all patients with CHF, along with elevated levels of brain natriuretic peptide and aldosterone, insulin levels were also increased. IR elevated with the increase in the severity of disorders of CHM (in the group without disorders of CHM — 10,78 (8,9-12,2), IGT — 14,6 (11,2-18,2), newly diagnosed type 2 DM — 18,6 (15,19-26,7). Also the concentration of aldosterone was higher in the group with DM, compared with the ITG group (p2-3<0,01).Conclusion. The presence and progression of IR in patients with CHF of ischemic etiology in conjunction with neurohormonal status emphasizes the importance of timely detection of latent CHM disorders with its future management

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p<0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p<0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM