The impact of diabetes mellitus and microvascular complications on heart failure biomarkers
Poster
Florina Fringu
1 Abstract
1.1 Background
The prevalence of heart failure (HF) is increased in diabetic patients. Several studies confirmed the prognostic role of ST2 and Galectin-3 (Gal-3) in HF patients, but the relationship between diabetes mellitus (DM) along with its complications and the new biomarkers is still uncertain.
1.2 Methods
88 subjects with decompensated heart failure (NYHA classes III-IV) were enrolled, with a mean age of 69.82 ± 9.5 years, 61.7% of which were men and 47.9% of them with previous DM. All patients were evaluated both clinically and echocardiographically. The entire cohort had serum concentrations of ST2, Gal-3 and NT-proBNP measured upon admission. Patients with DM were divided into two groups: those with DM microvascular complications (retinopathy, nephropathy or polyneuropathy - 58.9%) or without- 41.1%.
1.3 Results
Mean left ventricular ejection fraction (LVEF) was 38.84 ± 11.3%, without significant differences between the two groups (p-NS). Concerning HF biomarkers, the following mean values were obtained: ST2 - 46.32 ± 25.8 ng/ml, Gal 3-15.19 ± 6.7 ng/ml, NT-pro BNP - 3493.04 ± 3884.8 pg/ml. There were no statistically significant differences between patients with or without DM: ST2 : 47.51 ± 28.7ng/ml vs 44.89 ± 23.1 ng/ml; Gal-3: 15.25 ± 7.7ng/ml vs 15.07 ± 5.7ng/ml; NT-proBNP: 3857.42 ± 3844.2 pg/ml vs 3104.28 ± 3940.4 pg/ml. When comparing the two groups of diabetic subjects, only Gal-3 values were found to be consistently higher in subjects with microvascular complications: 16.23 ± 4.9 ng/ml vs 13.74 ± 10.4 ng/ml (p=0.005); ST2 : 53.21 ± 31.9ng/ml vs 39.5 ± 23.3 ng/ml (p-NS); NT-proBNP : 4364.9 ± 4213.9 pg/ml vs 3188.96 ± 3350.0 pg/ml (p=NS). ST 2 levels correlated significantly with NT-proBNP levels (r=0.24; p=0.03), hypocholesterolemia (r= 0.22; p=0.048) and GFR (r=-0.22) in both groups. There was no direct correlation between ST2 levels and the NYHA class (p=0.334). Gal-3 levels also correlated well with LVEF value (r=0.22; p=0.048), NT-pro BNP levels (r=0.40; p < 0.0001) and NYHA class (p <0.0001).
Table 1. Summary of the most relevant paramenters in all groups of patients.
Factor | Levels | control | DM w/ complic. | DM with complic. | Total | Statistics |
Group | 63 (52.5%) | 24 (20.0%) | 33 (27.5%) | 120 | ||
Diabetes | 0 | 24 (100.0%) | 33 (100.0%) | 57 (47.9%) | V=1.00 (p<0.001) | |
Diabetes complications | 0 | 0 | 33 (100.0%) | 33 (58.9%) | ||
Age (years) | Mean ±SD | 69.03 ±10.5 | 69.04 ±7.35 | 71.88 ±8.85 | 69.82 ±9.51 | 1-way ANOVA: p=0.346 |
*M(R) | 69 (45:90) | 68 (58:84) | 74 (55:88) | 70 (45:90) | ||
Sex | F | 14 (22.2%) | 12 (50.0%) | 20 (60.6%) | 46 (38.3%) | V=0.36 (p<0.001) |
M | 49 (77.8%) | 12 (50.0%) | 13 (39.4%) | 74 (61.7%) | ||
ST2 (ng/ml) | Mean ±SD | 45.18 ±22.9 | 40.32 ±22.9 | 53.21 ±31.9 | 46.32 ±25.8 | Kruskal-Wallis: p=0.346 |
*M(R) | 40 (17:130) | 32 (16:109) | 44 (15:120) | 40 (15:130) | ||
Galectin-3 (ng/ml) | Mean ±SD | 15.12 ±5.69 | 14.03 ±10.2 | 16.23 ±4.9 | 15.19 ±6.69 | Kruskal-Wallis: p=0.052 |
*M(R) | 13.5 (7.2:27) | 11 (6:51) | 17.05 (7.4:26) | 13.35 (6:51) | ||
NT-proBNP (pg/ml) | Mean ±SD | 3153.36 ±3924.5 | 3201.92 ±3277.0 | 4364.90 ±4213.9 | 3493.04 ±3884.8 | Kruskal-Wallis: p=0.517 |
*M(R) | 2300 (137:27069) | 2306 (283:13000) | 2542 (145:15000) | 2459 (137:27069) | ||
Weight (kg) | Mean ±SD | 82.80 ±18.7 | 79.54 ±16.3 | 85.41 ±15.9 | 82.84 ±17.5 | 1-way ANOVA: p=0.465 |
*M(R) | 80 (45:121) | 80 (45:115) | 87 (50:112) | 80 (45:121) | ||
Height (m) | Mean ±SD | 1.70 ±0.0738 | 1.65 ±0.0865 | 1.66 ±0.0692 | 1.68 ±0.0775 | Kruskal-Wallis: p=0.034 |
*M(R) | 1.7 (1.5:1.9) | 1.64 (1.5:1.8) | 1.67 (1.5:1.8) | 1.68 (1.5:1.9) | ||
BMI (kg/m²) | Mean ±SD | 28.88 ±6.8 | 29.15 ±5.53 | 31.17 ±5.73 | 29.57 ±6.29 | 1-way ANOVA: p=0.239 |
*M(R) | 27.64 (17.58:44.08) | 30.02 (18.93:42.24) | 31.9 (17.3:41.8) | 29.69 (17.3:44.08) | ||
Hemoglobin | Mean ±SD | 13.05 ±1.88 | 12.75 ±2.16 | 12.48 ±1.85 | 12.83 ±1.93 | Kruskal-Wallis: p=0.484 |
*M(R) | 13.2 (9.1:19.2) | 12.95 (8.7:16.6) | 13 (7.4:15.5) | 13 (7.4:19.2) | ||
Hematocrite | Mean ±SD | 39.72 ±5.26 | 38.37 ±5.94 | 37.09 ±7.0 | 38.75 ±5.96 | Kruskal-Wallis: p=0.247 |
*M(R) | 40 (27.9:58) | 38.4 (25.8:48.7) | 39.2 (13.9:48.9) | 39.9 (13.9:58) | ||
Cholesterol | Mean ±SD | 158.65 ±39.8 | 162.10 ±66.7 | 152.30 ±47.5 | 157.58 ±48.1 | Kruskal-Wallis: p=0.595 |
*M(R) | 159.5 (79:240) | 157.5 (9.43:317) | 145 (64:316) | 155 (9.43:317) | ||
LDL | Mean ±SD | 94.86 ±31.9 | 98.46 ±50.7 | 88.47 ±39.4 | 93.82 ±38.2 | Kruskal-Wallis: p=0.615 |
*M(R) | 98.5 (9:164) | 85 (27:222) | 85 (6:190) | 92 (6:222) | ||
HDL | Mean ±SD | 40.44 ±12.6 | 44.12 ±31.0 | 37.58 ±12.5 | 40.39 ±17.8 | Kruskal-Wallis: p=0.359 |
*M(R) | 38.5 (21:90) | 36 (18:166) | 36 (19:94) | 38 (18:166) | ||
Triglycerides | Mean ±SD | 113.29 ±58.4 | 146.42 ±86.7 | 120.73 ±48.3 | 122.03 ±63.4 | Kruskal-Wallis: p=0.097 |
*M(R) | 101 (51:361) | 117.5 (43:399) | 113 (58:255) | 109 (43:399) | ||
Uric acid | Mean ±SD | 8.09 ±2.31 | 8.03 ±2.48 | 8.23 ±2.45 | 8.12 ±2.37 | Kruskal-Wallis: p=0.942 |
*M(R) | 7.8 (3.96:14.1) | 7.91 (4.4:14.26) | 7.99 (3.7:13.61) | 7.86 (3.7:14.26) | ||
TSH | Mean ±SD | 2.65 ±4.66 | 3.72 ±5.03 | 2.23 ±1.51 | 2.71 ±4.01 | Kruskal-Wallis: p=0.442 |
*M(R) | 1.46 (0:22) | 1.62 (0:18.8) | 1.71 (0.28:5.86) | 1.54 (0:22) | ||
Glucose | Mean ±SD | 101.45 ±18.5 | 124.38 ±26.7 | 129.18 ±58.1 | 113.76 ±37.4 | Kruskal-Wallis: p<0.001 |
*M(R) | 97.5 (79:195) | 120 (85:182) | 111 (65:293) | 104 (65:293) | ||
Urea | Mean ±SD | 62.27 ±32.3 | 63.08 ±28.9 | 73.97 ±35.1 | 65.68 ±32.6 | Kruskal-Wallis: p=0.162 |
*M(R) | 55 (24:170) | 54.5 (29:137) | 68 (31:161) | 57 (24:170) | ||
Creatinin | Mean ±SD | 1.28 ±0.482 | 1.10 ±0.364 | 1.31 ±0.75 | 1.25 ±0.552 | Kruskal-Wallis: p=0.406 |
*M(R) | 1.11 (0.55:2.57) | 1.01 (0.53:2.34) | 1.23 (0.56:4.89) | 1.11 (0.53:4.89) | ||
Creatinin clerence | Mean ±SD | 64.89 ±26.5 | 68.88 ±26.7 | 59.49 ±25.7 | 64.20 ±26.3 | Kruskal-Wallis: p=0.447 |
*M(R) | 64 (20:147) | 64.6 (22.2:163.4) | 60.2 (9.2:117.4) | 62.8 (9.2:163.4) | ||
Iron | Mean ±SD | 36.92 ±10.9 | 39.88 ±12.4 | 41.76 ±10.8 | 38.84 ±11.3 | Kruskal-Wallis: p=0.152 |
*M(R) | 38 (16:56) | 42.5 (20:60) | 40 (25:64) | 40 (16:64) | ||
Retinopathy | 0 | 0 | 13 (39.4%) | 13 (21.3%) | V=0.48 (p<0.001) | |
Nephopathy | 0 | 0 | 19 (57.6%) | 19 (31.1%) | V=0.62 (p<0.001) | |
PNP | 0 | 0 | 24 (72.7%) | 24 (39.3%) | V=0.74 (p<0.001) | |
AV | Mean ±SD | 76.33 ±16.6 | 72.32 ±13.9 | 77.73 ±21.4 | 75.91 ±17.5 | Kruskal-Wallis: p=0.600 |
*M(R) | 74 (54:120) | 71 (50:110) | 71 (30:130) | 72 (30:130) | ||
Hypertension | nu | 23 (39.0%) | 9 (40.9%) | 6 (18.2%) | 38 (33.3%) | V=0.27 (p=0.002) |
II | 25 (42.4%) | 12 (54.5%) | 11 (33.3%) | 48 (42.1%) | ||
III | 11 (18.6%) | 1 (4.5%) | 16 (48.5%) | 28 (24.6%) | ||
ACOMI | 6 (10.2%) | 3 (13.6%) | 9 (27.3%) | 18 (15.8%) | V=0.20 (p=0.093) | |
ICD | 14 (23.7%) | 4 (18.2%) | 2 (6.1%) | 20 (17.5%) | V=0.20 (p=0.102) | |
VS1 | Mean ±SD | 61.92 ±11.2 | 58.00 ±11.3 | 55.56 ±10.5 | 59.38 ±11.3 | Kruskal-Wallis: p=0.035 |
*M(R) | 60 (39:90) | 57 (38:74) | 54.5 (40:79) | 59 (38:90) | ||
VS2 | Mean ±SD | 48.30 ±13.4 | 43.96 ±14.0 | 40.56 ±12.8 | 45.29 ±13.7 | Kruskal-Wallis: p=0.032 |
*M(R) | 49 (24:79) | 41 (20:66) | 36 (20:61) | 44 (20:79) | ||
E/A | <1 | 12 (40.0%) | 5 (38.5%) | 10 (52.6%) | 27 (43.5%) | V=0.20 (p=0.312) |
≥1 | 7 (23.3%) | 6 (46.2%) | 3 (15.8%) | 16 (25.8%) | ||
≥2 | 11 (36.7%) | 2 (15.4%) | 6 (31.6%) | 19 (30.6%) | ||
Left atrium | Mean ±SD | 49.42 ±7.39 | 47.96 ±8.33 | 48.59 ±8.2 | 48.90 ±7.77 | 1-way ANOVA: p=0.715 |
*M(R) | 49.5 (35:70) | 47.5 (28:64) | 48.5 (35:70) | 49 (28:70) | ||
CKD | no | 8 (24.2%) | 6 (50.0%) | 5 (27.8%) | 19 (30.2%) | V=0.23 (p=0.337) |
stage 3 | 21 (63.6%) | 4 (33.3%) | 11 (61.1%) | 36 (57.1%) | ||
stage 4 | 4 (12.1%) | 2 (16.7%) | 1 (5.6%) | 7 (11.1%) | ||
stage 5 | 0 | 0 | 1 (5.6%) | 1 (1.6%) | ||
NYHA Class | II | 8 (13.3%) | 7 (31.8%) | 6 (18.2%) | 21 (18.3%) | V=0.13 (p=0.448) |
III | 39 (65.0%) | 11 (50.0%) | 20 (60.6%) | 70 (60.9%) | ||
IV | 13 (21.7%) | 4 (18.2%) | 7 (21.2%) | 24 (20.9%) | ||
Iscaemic cardioathy | 28 (44.4%) | 14 (58.3%) | 25 (75.8%) | 67 (55.8%) | V=0.27 (p=0.013) | |
Fibrilation | 42 (66.7%) | 13 (54.2%) | 22 (66.7%) | 77 (64.2%) | V=0.10 (p=0.521) | |
HTP | 33 (58.9%) | 12 (52.2%) | 16 (51.6%) | 61 (55.5%) | V=0.07 (p=0.756) | |
COPD | 15 (28.3%) | 5 (25.0%) | 7 (24.1%) | 27 (26.5%) | V=0.04 (p=0.907) | |
Asthma | 3 (5.4%) | 4 (20.0%) | 1 (3.4%) | 8 (7.6%) | V=0.23 (p=0.065) | |
VD | Mean ±SD | 30.67 ±7.52 | 30.42 ±7.1 | 32.57 ±9.2 | 31.09 ±7.85 | Kruskal-Wallis: p=0.438 |
*M(R) | 30 (16:52) | 30 (21:48) | 32 (11:49) | 30 (11:52) | ||
PAPS | Mean ±SD | 49.11 ±14.5 | 49.79 ±19.3 | 51.86 ±20.4 | 50.04 ±17.1 | Kruskal-Wallis: p=0.883 |
*M(R) | 50 (25:75) | 45 (23:90) | 47 (17:90) | 46 (17:90) | ||
MLHF | Mean ±SD | 58.42 ±6.49 | 63.00 ±7.35 | 59.00 ±7.8 | 59.71 ±6.99 | 1-way ANOVA: p=0.425 |
*M(R) | 60 (50:70) | 64 (54:72) | 58 (50:70) | 60 (50:72) | ||
Diur | 57 (90.5%) | 24 (100.0%) | 31 (93.9%) | 112 (93.3%) | V=0.15 (p=0.278) | |
Nitr | 25 (39.7%) | 14 (58.3%) | 15 (45.5%) | 54 (45.0%) | V=0.14 (p=0.294) | |
IEC | 30 (47.6%) | 13 (54.2%) | 17 (51.5%) | 60 (50.0%) | V=0.05 (p=0.844) | |
Digoxin | 20 (31.7%) | 5 (20.8%) | 12 (36.4%) | 37 (30.8%) | V=0.12 (p=0.444) | |
Bet Bl | 54 (85.7%) | 22 (91.7%) | 26 (78.8%) | 102 (85.0%) | V=0.12 (p=0.394) | |
Antiagr | 19 (30.2%) | 10 (41.7%) | 11 (33.3%) | 40 (33.3%) | V=0.09 (p=0.596) | |
ACO | 40 (63.5%) | 15 (62.5%) | 24 (72.7%) | 79 (65.8%) | V=0.09 (p=0.616) | |
Antiaritmice | 28 (44.4%) | 9 (37.5%) | 11 (33.3%) | 48 (40.0%) | V=0.10 (p=0.551) | |
Sartani | 17 (27.0%) | 6 (25.0%) | 13 (39.4%) | 36 (30.0%) | V=0.13 (p=0.378) | |
Entresto | 4 (6.3%) | 1 (4.3%) | 3 (9.1%) | 8 (6.7%) | V=0.07 (p=0.773) | |
Spirono | 48 (76.2%) | 19 (79.2%) | 27 (81.8%) | 94 (78.3%) | V=0.06 (p=0.812) | |
Statina | 27 (42.9%) | 16 (69.6%) | 21 (63.6%) | 64 (53.8%) | V=0.24 (p=0.037) | |
ADO | 2 (3.2%) | 16 (66.7%) | 17 (51.5%) | 35 (29.2%) | V=0.61 (p<0.001) | |
Insulina | 0 | 5 (20.8%) | 20 (60.6%) | 25 (20.8%) | V=0.63 (p<0.001) | |
*M(R) = Mediana (min:max); MW = Test Mann-Whitney; OR/RR = odds-ratio / risc relativ [cu IC 95%] și p calculat prin testul Fisher); V = Cramer V (p calculat prin testul Chi²). | ||||||
Table 2. Summary of the most relevant paramenters in all groups of patients.
Factor | Levels | yes | no | Total | Statistics |
Diabetes | 57 (47.9%) | 62 (52.1%) | 119 | ||
Diabetes complications | 33 (58.9%) | 0 | 33 (58.9%) | OR=1.43 [0.03, 74.42] (p=1.000) | |
Group | control | 0 | 62 (100.0%) | 62 (52.1%) | V=1.00 (p<0.001) |
DM w/ complic. | 24 (42.1%) | 0 | 24 (20.2%) | ||
DM with complic. | 33 (57.9%) | 0 | 33 (27.7%) | ||
Age (years) | Mean ±SD | 70.68 ±8.3 | 69.35 ±10.3 | 69.82 ±9.51 | T-test: p=0.441 |
*M(R) | 70 (55:88) | 69.5 (45:90) | 70 (45:90) | ||
Sex | F | 32 (56.1%) | 14 (22.6%) | 46 (38.7%) | OR=4.39 [1.99, 9.69] (p<0.001) |
M | 25 (43.9%) | 48 (77.4%) | 73 (61.3%) | ||
ST2 (ng/ml) | Mean ±SD | 47.51 ±28.7 | 44.89 ±23.1 | 46.32 ±25.8 | MW: p=0.888 |
*M(R) | 40 (15:120) | 40 (17:130) | 40 (15:130) | ||
Galectin-3 (ng/ml) | Mean ±SD | 15.25 ±7.67 | 15.07 ±5.75 | 15.19 ±6.69 | MW: p=0.822 |
*M(R) | 12.8 (6:51) | 13.35 (7.2:27) | 13.35 (6:51) | ||
NT-proBNP (pg/ml) | Mean ±SD | 3857.42 ±3844.2 | 3104.28 ±3940.4 | 3493.04 ±3884.8 | MW: p=0.297 |
*M(R) | 2532 (145:15000) | 2210.5 (137:27069) | 2459 (137:27069) | ||
Weight (kg) | Mean ±SD | 82.89 ±16.2 | 82.40 ±18.7 | 82.84 ±17.5 | T-test: p=0.880 |
*M(R) | 81.5 (45:115) | 80 (45:121) | 80 (45:121) | ||
Height (m) | Mean ±SD | 1.65 ±0.0764 | 1.70 ±0.0742 | 1.68 ±0.0775 | MW: p=0.008 |
*M(R) | 1.66 (1.5:1.8) | 1.7 (1.5:1.9) | 1.68 (1.5:1.9) | ||
BMI (kg/m²) | Mean ±SD | 30.30 ±5.68 | 28.70 ±6.73 | 29.57 ±6.29 | T-test: p=0.173 |
*M(R) | 30.76 (17.3:42.24) | 27.34 (17.58:44.08) | 29.69 (17.3:44.08) | ||
Hemoglobin | Mean ±SD | 12.59 ±1.97 | 13.08 ±1.88 | 12.83 ±1.93 | MW: p=0.232 |
*M(R) | 13 (7.4:16.6) | 13.2 (9.1:19.2) | 13 (7.4:19.2) | ||
Hematocrite | Mean ±SD | 37.65 ±6.53 | 39.79 ±5.28 | 38.75 ±5.96 | MW: p=0.081 |
*M(R) | 38.4 (13.9:48.9) | 40 (27.9:58) | 39.9 (13.9:58) | ||
Cholesterol | Mean ±SD | 156.43 ±56.0 | 159.08 ±40.0 | 157.58 ±48.1 | MW: p=0.548 |
*M(R) | 153 (9.43:317) | 160 (79:240) | 155 (9.43:317) | ||
LDL | Mean ±SD | 92.67 ±44.3 | 94.88 ±32.2 | 93.82 ±38.2 | Welch: p=0.759 |
*M(R) | 85 (6:222) | 103 (9:164) | 92 (6:222) | ||
HDL | Mean ±SD | 40.33 ±22.3 | 40.74 ±12.5 | 40.39 ±17.8 | MW: p=0.115 |
*M(R) | 36 (18:166) | 39 (21:90) | 38 (18:166) | ||
Triglycerides | Mean ±SD | 131.54 ±67.7 | 113.85 ±58.7 | 122.03 ±63.4 | MW: p=0.057 |
*M(R) | 116 (43:399) | 101 (51:361) | 109 (43:399) | ||
Uric acid | Mean ±SD | 8.15 ±2.44 | 8.08 ±2.33 | 8.12 ±2.37 | MW: p=0.855 |
*M(R) | 7.94 (3.7:14.26) | 7.77 (3.96:14.1) | 7.86 (3.7:14.26) | ||
TSH | Mean ±SD | 2.77 ±3.29 | 2.70 ±4.71 | 2.71 ±4.01 | MW: p=0.270 |
*M(R) | 1.65 (0:18.8) | 1.48 (0:22) | 1.54 (0:22) | ||
Glucose | Mean ±SD | 127.16 ±47.2 | 101.30 ±18.6 | 113.76 ±37.4 | MW: p<0.001 |
*M(R) | 118 (65:293) | 97 (79:195) | 104 (65:293) | ||
Urea | Mean ±SD | 69.39 ±32.8 | 61.34 ±31.7 | 65.68 ±32.6 | MW: p=0.097 |
*M(R) | 62 (29:161) | 55 (24:170) | 57 (24:170) | ||
Creatinin | Mean ±SD | 1.22 ±0.622 | 1.27 ±0.48 | 1.25 ±0.552 | MW: p=0.467 |
*M(R) | 1.11 (0.53:4.89) | 1.11 (0.55:2.57) | 1.11 (0.53:4.89) | ||
Creatinin clerence | Mean ±SD | 63.45 ±26.3 | 65.29 ±26.5 | 64.20 ±26.3 | MW: p=0.657 |
*M(R) | 62.6 (9.2:163.4) | 64.2 (20:147) | 62.8 (9.2:163.4) | ||
Iron | Mean ±SD | 40.96 ±11.4 | 36.87 ±11.0 | 38.84 ±11.3 | MW: p=0.060 |
*M(R) | 40 (20:64) | 37.5 (16:56) | 40 (16:64) | ||
Retinopathy | 13 (23.2%) | 0 | 13 (21.3%) | OR=3.41 [0.18, 65.80] (p=0.575) | |
Nephopathy | 19 (33.9%) | 0 | 19 (31.1%) | OR=5.72 [0.30, 108.88] (p=0.313) | |
PNP | 24 (42.9%) | 0 | 24 (39.3%) | OR=8.29 [0.44, 157.20] (p=0.147) | |
AV | Mean ±SD | 75.44 ±18.6 | 76.61 ±16.6 | 75.91 ±17.5 | MW: p=0.922 |
*M(R) | 71 (30:130) | 75 (54:120) | 72 (30:130) | ||
Hypertension | nu | 15 (27.3%) | 23 (39.7%) | 38 (33.6%) | V=0.16 (p=0.233) |
II | 23 (41.8%) | 24 (41.4%) | 47 (41.6%) | ||
III | 17 (30.9%) | 11 (19.0%) | 28 (24.8%) | ||
ACOMI | 12 (21.8%) | 6 (10.3%) | 18 (15.9%) | OR=2.42 [0.84, 6.98] (p=0.125) | |
ICD | 6 (10.9%) | 13 (22.4%) | 19 (16.8%) | OR=0.42 [0.15, 1.21] (p=0.133) | |
VS1 | Mean ±SD | 56.61 ±10.8 | 61.98 ±11.3 | 59.38 ±11.3 | MW: p=0.013 |
*M(R) | 55.5 (38:79) | 60 (39:90) | 59 (38:90) | ||
VS2 | Mean ±SD | 42.02 ±13.3 | 48.43 ±13.4 | 45.29 ±13.7 | MW: p=0.015 |
*M(R) | 40 (20:66) | 49.5 (24:79) | 44 (20:79) | ||
E/A | <1 | 15 (46.9%) | 11 (37.9%) | 26 (42.6%) | V=0.14 (p=0.550) |
≥1 | 9 (28.1%) | 7 (24.1%) | 16 (26.2%) | ||
≥2 | 8 (25.0%) | 11 (37.9%) | 19 (31.1%) | ||
Left atrium | Mean ±SD | 48.32 ±8.18 | 49.66 ±7.22 | 48.90 ±7.77 | T-test: p=0.351 |
*M(R) | 48 (28:70) | 50 (36:70) | 49 (28:70) | ||
CKD | no | 11 (36.7%) | 8 (24.2%) | 19 (30.2%) | V=0.20 (p=0.479) |
stage 3 | 15 (50.0%) | 21 (63.6%) | 36 (57.1%) | ||
stage 4 | 3 (10.0%) | 4 (12.1%) | 7 (11.1%) | ||
stage 5 | 1 (3.3%) | 0 | 1 (1.6%) | ||
NYHA Class | II | 13 (23.6%) | 8 (13.3%) | 21 (18.3%) | V=0.13 (p=0.357) |
III | 31 (56.4%) | 39 (65.0%) | 70 (60.9%) | ||
IV | 11 (20.0%) | 13 (21.7%) | 24 (20.9%) | ||
Iscaemic cardioathy | 39 (68.4%) | 28 (45.2%) | 67 (56.3%) | OR=2.63 [1.24, 5.57] (p=0.016) | |
Fibrilation | 35 (61.4%) | 41 (66.1%) | 76 (63.9%) | OR=0.81 [0.39, 1.72] (p=0.703) | |
HTP | 28 (51.9%) | 32 (58.2%) | 60 (55.0%) | OR=0.77 [0.36, 1.65] (p=0.566) | |
COPD | 12 (24.5%) | 15 (28.3%) | 27 (26.5%) | OR=0.82 [0.34, 1.99] (p=0.823) | |
Asthma | 5 (10.2%) | 3 (5.4%) | 8 (7.6%) | OR=2.01 [0.45, 8.87] (p=0.468) | |
VD | Mean ±SD | 31.60 ±8.29 | 30.67 ±7.52 | 31.09 ±7.85 | MW: p=0.412 |
*M(R) | 31 (11:49) | 30 (16:52) | 30 (11:52) | ||
PAPS | Mean ±SD | 51.03 ±19.7 | 49.11 ±14.5 | 50.04 ±17.1 | MW: p=0.941 |
*M(R) | 45 (17:90) | 50 (25:75) | 46 (17:90) | ||
MLHF | Mean ±SD | 61.00 ±7.52 | 58.42 ±6.49 | 59.71 ±6.99 | T-test: p=0.377 |
*M(R) | 59.5 (50:72) | 60 (50:70) | 60 (50:72) | ||
Diur | 55 (96.5%) | 56 (90.3%) | 111 (93.3%) | OR=2.95 [0.57, 15.23] (p=0.276) | |
Nitr | 29 (50.9%) | 24 (38.7%) | 53 (44.5%) | OR=1.64 [0.79, 3.40] (p=0.201) | |
IEC | 30 (52.6%) | 30 (48.4%) | 60 (50.4%) | OR=1.19 [0.58, 2.43] (p=0.715) | |
Digoxin | 17 (29.8%) | 20 (32.3%) | 37 (31.1%) | OR=0.89 [0.41, 1.94] (p=0.844) | |
Bet Bl | 48 (84.2%) | 53 (85.5%) | 101 (84.9%) | OR=0.91 [0.33, 2.47] (p=1.000) | |
Antiagr | 21 (36.8%) | 18 (29.0%) | 39 (32.8%) | OR=1.43 [0.66, 3.07] (p=0.436) | |
ACO | 39 (68.4%) | 40 (64.5%) | 79 (66.4%) | OR=1.19 [0.56, 2.56] (p=0.701) | |
Antiaritmice | 20 (35.1%) | 27 (43.5%) | 47 (39.5%) | OR=0.70 [0.33, 1.47] (p=0.356) | |
Sartani | 19 (33.3%) | 17 (27.4%) | 36 (30.3%) | OR=1.32 [0.60, 2.90] (p=0.551) | |
Entresto | 4 (7.1%) | 4 (6.5%) | 8 (6.8%) | OR=1.12 [0.27, 4.69] (p=1.000) | |
Spirono | 46 (80.7%) | 47 (75.8%) | 93 (78.2%) | OR=1.33 [0.55, 3.21] (p=0.658) | |
Statina | 37 (66.1%) | 27 (43.5%) | 64 (54.2%) | OR=2.52 [1.20, 5.33] (p=0.017) | |
ADO | 33 (57.9%) | 2 (3.2%) | 35 (29.4%) | OR=41.25 [9.17, 185.56] (p<0.001) | |
Insulina | 25 (43.9%) | 0 | 25 (21.0%) | OR=98.08 [5.78, 1 663.23] (p<0.001) | |
*M(R) = Mediana (min:max); MW = Test Mann-Whitney; OR/RR = odds-ratio / risc relativ [cu IC 95%] și p calculat prin testul Fisher); V = Cramer V (p calculat prin testul Chi²). | |||||
Table 3. Summary of the most relevant paramenters in all groups of patients.
Factor | Levels | yes | no | Total | Statistics |
Diabetes complications | 33 (58.9%) | 23 (41.1%) | 56 | ||
Diabetes | 33 (100.0%) | 23 (100.0%) | 56 (100.0%) | OR=1.43 [0.03, 74.42] (p=1.000) | |
Group | control | 0 | 0 | 0 | |
DM w/ complic. | 0 | 23 (100.0%) | 23 (41.1%) | ||
DM with complic. | 33 (100.0%) | 0 | 33 (58.9%) | ||
Age (years) | Mean ±SD | 71.88 ±8.85 | 69.35 ±7.36 | 69.82 ±9.51 | T-test: p=0.265 |
*M(R) | 74 (55:88) | 68 (58:84) | 70 (45:90) | ||
Sex | F | 20 (60.6%) | 12 (52.2%) | 32 (57.1%) | OR=1.41 [0.48, 4.13] (p=0.590) |
M | 13 (39.4%) | 11 (47.8%) | 24 (42.9%) | ||
ST2 (ng/ml) | Mean ±SD | 53.21 ±31.9 | 39.50 ±23.3 | 46.32 ±25.8 | MW: p=0.194 |
*M(R) | 44 (15:120) | 31 (16:109) | 40 (15:130) | ||
Galectin-3 (ng/ml) | Mean ±SD | 16.23 ±4.9 | 13.74 ±10.4 | 15.19 ±6.69 | MW: p=0.007 |
*M(R) | 17.05 (7.4:26) | 10.95 (6:51) | 13.35 (6:51) | ||
NT-proBNP (pg/ml) | Mean ±SD | 4364.90 ±4213.9 | 3188.96 ±3350.0 | 3493.04 ±3884.8 | MW: p=0.624 |
*M(R) | 2542 (145:15000) | 2147 (283:13000) | 2459 (137:27069) | ||
Weight (kg) | Mean ±SD | 85.41 ±15.9 | 80.57 ±15.8 | 82.84 ±17.5 | T-test: p=0.269 |
*M(R) | 87 (50:112) | 80 (45:115) | 80 (45:121) | ||
Height (m) | Mean ±SD | 1.66 ±0.0692 | 1.65 ±0.0872 | 1.68 ±0.0775 | MW: p=0.738 |
*M(R) | 1.67 (1.5:1.8) | 1.63 (1.5:1.8) | 1.68 (1.5:1.9) | ||
BMI (kg/m²) | Mean ±SD | 31.17 ±5.73 | 29.60 ±5.2 | 29.57 ±6.29 | T-test: p=0.304 |
*M(R) | 31.9 (17.3:41.8) | 30.35 (20:42.24) | 29.69 (17.3:44.08) | ||
Hemoglobin | Mean ±SD | 12.48 ±1.85 | 12.72 ±2.2 | 12.83 ±1.93 | MW: p=0.790 |
*M(R) | 13 (7.4:15.5) | 12.9 (8.7:16.6) | 13 (7.4:19.2) | ||
Hematocrite | Mean ±SD | 37.09 ±7.0 | 38.27 ±6.06 | 38.75 ±5.96 | MW: p=0.854 |
*M(R) | 39.2 (13.9:48.9) | 38.4 (25.8:48.7) | 39.9 (13.9:58) | ||
Cholesterol | Mean ±SD | 152.30 ±47.5 | 164.54 ±67.1 | 157.58 ±48.1 | MW: p=0.342 |
*M(R) | 145 (64:316) | 160 (9.43:317) | 155 (9.43:317) | ||
LDL | Mean ±SD | 88.47 ±39.4 | 100.17 ±51.1 | 93.82 ±38.2 | T-test: p=0.337 |
*M(R) | 85 (6:190) | 87 (27:222) | 92 (6:222) | ||
HDL | Mean ±SD | 37.58 ±12.5 | 44.91 ±31.5 | 40.39 ±17.8 | MW: p=0.907 |
*M(R) | 36 (19:94) | 36 (18:166) | 38 (18:166) | ||
Triglycerides | Mean ±SD | 120.73 ±48.3 | 147.74 ±88.4 | 122.03 ±63.4 | MW: p=0.405 |
*M(R) | 113 (58:255) | 118 (43:399) | 109 (43:399) | ||
Uric acid | Mean ±SD | 8.23 ±2.45 | 7.90 ±2.46 | 8.12 ±2.37 | MW: p=0.641 |
*M(R) | 7.99 (3.7:13.61) | 7.87 (4.4:14.26) | 7.86 (3.7:14.26) | ||
TSH | Mean ±SD | 2.23 ±1.51 | 3.42 ±5.11 | 2.71 ±4.01 | MW: p=0.695 |
*M(R) | 1.71 (0.28:5.86) | 1.61 (0:18.8) | 1.54 (0:22) | ||
Glucose | Mean ±SD | 129.18 ±58.1 | 125.13 ±27.0 | 113.76 ±37.4 | MW: p=0.444 |
*M(R) | 111 (65:293) | 122 (85:182) | 104 (65:293) | ||
Urea | Mean ±SD | 73.97 ±35.1 | 62.30 ±29.3 | 65.68 ±32.6 | MW: p=0.167 |
*M(R) | 68 (31:161) | 52 (29:137) | 57 (24:170) | ||
Creatinin | Mean ±SD | 1.31 ±0.75 | 1.09 ±0.37 | 1.25 ±0.552 | MW: p=0.237 |
*M(R) | 1.23 (0.56:4.89) | 1.01 (0.53:2.34) | 1.11 (0.53:4.89) | ||
Creatinin clerence | Mean ±SD | 59.49 ±25.7 | 69.28 ±27.3 | 64.20 ±26.3 | MW: p=0.197 |
*M(R) | 60.2 (9.2:117.4) | 65 (22.2:163.4) | 62.8 (9.2:163.4) | ||
Iron | Mean ±SD | 41.76 ±10.8 | 40.61 ±12.2 | 38.84 ±11.3 | MW: p=0.828 |
*M(R) | 40 (25:64) | 45 (20:60) | 40 (16:64) | ||
Retinopathy | 13 (39.4%) | 0 | 13 (23.2%) | OR=30.95 [1.73, 553.67] (p<0.001) | |
Nephopathy | 19 (57.6%) | 0 | 19 (33.9%) | OR=63.21 [3.54, 1 128.71] (p<0.001) | |
PNP | 24 (72.7%) | 0 | 24 (42.9%) | OR=121.21 [6.67, 2 201.96] (p<0.001) | |
AV | Mean ±SD | 77.73 ±21.4 | 72.32 ±13.9 | 75.91 ±17.5 | MW: p=0.352 |
*M(R) | 71 (30:130) | 71 (50:110) | 72 (30:130) | ||
Hypertension | nu | 6 (18.2%) | 9 (40.9%) | 15 (27.3%) | V=0.47 (p=0.002) |
II | 11 (33.3%) | 12 (54.5%) | 23 (41.8%) | ||
III | 16 (48.5%) | 1 (4.5%) | 17 (30.9%) | ||
ACOMI | 9 (27.3%) | 3 (13.6%) | 12 (21.8%) | OR=2.38 [0.56, 10.01] (p=0.324) | |
ICD | 2 (6.1%) | 4 (18.2%) | 6 (10.9%) | OR=0.29 [0.05, 1.75] (p=0.204) | |
VS1 | Mean ±SD | 55.56 ±10.5 | 57.48 ±11.2 | 59.38 ±11.3 | MW: p=0.562 |
*M(R) | 54.5 (40:79) | 56 (38:74) | 59 (38:90) | ||
VS2 | Mean ±SD | 40.56 ±12.8 | 43.39 ±14.0 | 45.29 ±13.7 | MW: p=0.422 |
*M(R) | 36 (20:61) | 40 (20:66) | 44 (20:79) | ||
E/A | <1 | 10 (52.6%) | 5 (38.5%) | 15 (46.9%) | V=0.34 (p=0.160) |
≥1 | 3 (15.8%) | 6 (46.2%) | 9 (28.1%) | ||
≥2 | 6 (31.6%) | 2 (15.4%) | 8 (25.0%) | ||
Left atrium | Mean ±SD | 48.59 ±8.2 | 48.09 ±8.49 | 48.90 ±7.77 | T-test: p=0.825 |
*M(R) | 48.5 (35:70) | 48 (28:64) | 49 (28:70) | ||
CKD | no | 5 (27.8%) | 6 (54.5%) | 11 (37.9%) | V=0.40 (p=0.206) |
stage 3 | 11 (61.1%) | 3 (27.3%) | 14 (48.3%) | ||
stage 4 | 1 (5.6%) | 2 (18.2%) | 3 (10.3%) | ||
stage 5 | 1 (5.6%) | 0 | 1 (3.4%) | ||
NYHA Class | II | 6 (18.2%) | 7 (33.3%) | 13 (24.1%) | V=0.18 (p=0.426) |
III | 20 (60.6%) | 11 (52.4%) | 31 (57.4%) | ||
IV | 7 (21.2%) | 3 (14.3%) | 10 (18.5%) | ||
Iscaemic cardioathy | 25 (75.8%) | 13 (56.5%) | 38 (67.9%) | OR=2.40 [0.76, 7.56] (p=0.155) | |
Fibrilation | 22 (66.7%) | 12 (52.2%) | 34 (60.7%) | OR=1.83 [0.61, 5.47] (p=0.405) | |
HTP | 16 (51.6%) | 11 (50.0%) | 27 (50.9%) | OR=1.07 [0.36, 3.18] (p=1.000) | |
COPD | 7 (24.1%) | 5 (25.0%) | 12 (24.5%) | OR=0.95 [0.25, 3.58] (p=1.000) | |
Asthma | 1 (3.4%) | 4 (20.0%) | 5 (10.2%) | OR=0.14 [0.01, 1.39] (p=0.144) | |
VD | Mean ±SD | 32.57 ±9.2 | 30.42 ±7.1 | 31.09 ±7.85 | MW: p=0.324 |
*M(R) | 32 (11:49) | 30 (21:48) | 30 (11:52) | ||
PAPS | Mean ±SD | 51.86 ±20.4 | 49.79 ±19.3 | 50.04 ±17.1 | MW: p=0.660 |
*M(R) | 47 (17:90) | 45 (23:90) | 46 (17:90) | ||
MLHF | Mean ±SD | 59.00 ±7.8 | 61.20 ±6.57 | 59.71 ±6.99 | T-test: p=0.630 |
*M(R) | 58 (50:70) | 60 (54:68) | 60 (50:72) | ||
Diur | 31 (93.9%) | 23 (100.0%) | 54 (96.4%) | OR=0.27 [0.01, 5.85] (p=0.507) | |
Nitr | 15 (45.5%) | 14 (60.9%) | 29 (51.8%) | OR=0.54 [0.18, 1.58] (p=0.289) | |
IEC | 17 (51.5%) | 12 (52.2%) | 29 (51.8%) | OR=0.97 [0.34, 2.83] (p=1.000) | |
Digoxin | 12 (36.4%) | 4 (17.4%) | 16 (28.6%) | OR=2.71 [0.75, 9.87] (p=0.145) | |
Bet Bl | 26 (78.8%) | 21 (91.3%) | 47 (83.9%) | OR=0.35 [0.07, 1.89] (p=0.282) | |
Antiagr | 11 (33.3%) | 9 (39.1%) | 20 (35.7%) | OR=0.78 [0.26, 2.35] (p=0.779) | |
ACO | 24 (72.7%) | 14 (60.9%) | 38 (67.9%) | OR=1.71 [0.55, 5.33] (p=0.394) | |
Antiaritmice | 11 (33.3%) | 8 (34.8%) | 19 (33.9%) | OR=0.94 [0.31, 2.88] (p=1.000) | |
Sartani | 13 (39.4%) | 6 (26.1%) | 19 (33.9%) | OR=1.84 [0.58, 5.90] (p=0.394) | |
Entresto | 3 (9.1%) | 1 (4.5%) | 4 (7.3%) | OR=2.10 [0.20, 21.60] (p=0.642) | |
Spirono | 27 (81.8%) | 18 (78.3%) | 45 (80.4%) | OR=1.25 [0.33, 4.72] (p=0.746) | |
Statina | 21 (63.6%) | 15 (68.2%) | 36 (65.5%) | OR=0.82 [0.26, 2.56] (p=0.779) | |
ADO | 17 (51.5%) | 15 (65.2%) | 32 (57.1%) | OR=0.57 [0.19, 1.70] (p=0.412) | |
Insulina | 20 (60.6%) | 5 (21.7%) | 25 (44.6%) | OR=5.54 [1.65, 18.61] (p=0.006) | |
*M(R) = Mediana (min:max); MW = Test Mann-Whitney; OR/RR = odds-ratio / risc relativ [cu IC 95%] și p calculat prin testul Fisher); V = Cramer V (p calculat prin testul Chi²). | |||||
1.4 Conclusions
Biomarkers of HF used for screening the general population are also useful in patients with DM, with Galectin-3 levels being significantly higher in diabetic patients with microvascular complications than in those without.
2 Figures
2.1 ST2-Biomarker Insuf Cardiaca
2.2 Galectina 3- Biomarker Insuf Cardiaca
2.3 BNP
2.4 Fe
2.5 Correlations
2.6 Correlations2
2.7 Correlation matrix
2.7.1 All patients
2.7.2 Control group
2.7.3 DM without complications group
2.7.4 DM with complications group
3 Extra
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