Russian Heart Failure Journal 2007year "RAtional, efficient, Multicomponent therapy in a Battle for Overcoming Diabetes Mellitus in patients with CHF" (RAMBO-DM CHF). Comparative analysis of original data


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2007/

"RAtional, efficient, Multicomponent therapy in a Battle for Overcoming Diabetes Mellitus in patients with CHF" (RAMBO-DM CHF). Comparative analysis of original data

Mareev V. Yu., Lapina Yu. V., Narusov O. Yu., Shestakova M. V., Masenko V. P., Belenkov Yu. N., Baklanova N. A., Filatov D. N., Bolotina M. G.

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Urgency. By present time evidence has been obtained for a clear bidirectional casual relationship between CHF and type 2 DM with a significant worsening of prognosis in their combination. Prospective studies of effects of DM severity and the type of antidiabetic therapy on the course of CHF are presently absent. Aim. Studying peculiarities of the clinico-functional and neuro-hormonal status, carbohydrate metabolism, microcirculation, renal function and autonomic nervous system in patients with CHF and type 2 DM compared to patients with «pure» CHF and diabetic patients with no CHF symptoms. Materials and methods. Three groups of patients were evaluated: Group 1 consisted of 81 patients with mild to moderate II–III NYHA FC CHF of different etiology, EF <45% and type 2 DM [48 (60%) of these patients received oral antidiabetic agents (OAA), 33 (40%) patients received insulin therapy (IT)]; Group 2 included 24 patients with «pure» CHF without disorders of carbohydrate metabolism; Group 3 consisted of 25 patients with type 2 DM with no symptoms of CHF and with preserved LV EF. Control evaluation of patients included assessment of their clinico-functional state, microcirculation (using polarography and hyperoxic and hypoxic tests), renal function (glomerular filtration rate, GFR), autonomic nervous system (24-hour ECG monitoring with determination of daily heart rhythm variability, HRV), neuro-hormonal profile (brain natriuretic peptide, BNP; noradrenaline NA and angiotensin II, AII). Carbohydrate metabolism was evaluated by the level of glycated hemoglobin (HbA1C) and a meal test using a standard breakfast containing 2–3 BU. During the test, fasting and postprandial glucose levels, serum insulin and C-peptide were measured. Results. Patients of Group 1 (CHF + DM) compared to patients with «pure» CHF having similar clinical condition [clinical rating scale (CRS), FC, EF and LV dimensions] and levels of neuro-hormones showed significantly impaired functional capabilities (6-min test and peak oxygen consumption), quality of life, parameters of microcirculation state, and decreases in daily HRV and GFR. Comparative analysis based on the type of antidiabetic therapy (OAA or IT) showed that patients of the main group (CHF + DM) had the same type of intergroup differences; however the differences were more pronounced than in patients receiving IT. Intragroup comparison of patients receiving OAA and IT in Group 1 showed similar changes although differences in most parameters did not reach statistical significance. Overall clinical evaluation of patients with CHF and DM receiving IT confirmed the fact of the most severe condition. Comparison of Group 1 (CHF + DM) and Group 3 (DM) as a whole and based on administered therapy (OAA or IT) revealed worsening of carbohydrate metabolism parameters in Group 3, which further impaired as DM progressed. Also patients with «pure» DM had statistically significantly higher levels of AII both in the groups as a whole and in patients receiving IT. The NA level was significantly higher in subgroups of patients with CHF and DM receiving OAA.

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