Anomalie metaboliche
Insulino-resistenza
 Iperattività del sistema nervoso ortosimpatico
 Stile di vita sedentario
 Disfunzione endoteliale
 Perdita di massa muscolare
 Influenza di citochine (TNF-alpha, leptina..)
Iperglicemia
Aumento della concentrazione degli FFA
The cardiotoxic triad:
Myocardial ischemia
Hypertension
Diabetic cardiomyopathy
Stratton IM. UKPDS 35. BMJ 2000;321:405–412
Kaplan-Meier estimates of the proportion of patients with
hospitalization for CHF divided into classes of glycemia at
baseline (log rank P<0.001)
Held, C. et al. Circulation 2007
Scompenso cardiaco, diabete e prognosi
Shindler DM et al. SOLVD Trials and Registry. Am J Cardiol 1996;77:1017
EURObservational Research
Program:
The Heart Failure Pilot Survey
(ESC-HF Pilot)
Aldo P Maggioni, Ulf Dahlström, Gerasimos Filippatos, Ovidiu
Chioncel, Marisa Crespo Leiro, Jaroslaw Drozdz, Friedrich Fruhwald,
Lars Gullestad, Damien Logeart, Marco Metra, John Parissis, Hans
Persson, Piotr Ponikowski, Mathias Rauchhaus, Adriaan Voors, Olav
Wendelboe Nielsen, Faiez Zannad, Luigi Tavazzi
on the behalf of the Heart Failure Association of the ESC (HFA)
Disclosures: None
EURObservational
Research Programme
Comparison between Acute and Chronic HF:
baseline characteristics
CHF pts
(n. 3226)
AHF pts
(n. 1892)
67±13
70±13
Females, %
29.7
37.3
Ischemic etiology, %
40.4
50.7
84.9
64.0
SBP (mmHg), mean±SD
125±20
133±29
HR (bpm), mean±SD
72±14
88±24
Treated hypertension, %
58.3
61.8
Diabetes mellitus, %
29.0
35.1
History of Atrial Fibrillation, %
38.6
43.7
Chronic kidney dysfunction, %
18.5
26.0
ICD, %
13.3
6.0
CRT, %
1.1
0.4
EURObservational
8.7
2.9
Research Programme
Age (years), mean±SD
documented by coronary angiography, %
CRT-D, %
EuroHeart Failure Survey
Other Concomitant Diagnoses
% 10.701 pts Female 47% Mean age 71 yrs
EURObservational
Research Programme
Cleland JF et Al, European Heart Journal (2003) 24, 442–463
From: Heart Failure–Associated Hospitalizations in the United States
J Am Coll Cardiol. 2013;61(12):1259-1267. doi:10.1016/j.jacc.2012.12.038
Figure Legend:
Rates of Heart Failure–Related Hospitalization
Annual age- and sex-adjusted rates of hospitalizations in the United States with a diagnosis of heart failure (HF) in the primary
versus secondary position are shown.
Date of download:
3/19/2013
Copyright © The American College of Cardiology.
All rights reserved.
From: Heart Failure–Associated Hospitalizations in the United States
J Am Coll Cardiol. 2013;61(12):1259-1267. doi:10.1016/j.jacc.2012.12.038
No DM!
Figure Legend:
Trends in Prevalence of the 10 Most Common Primary Diagnoses for Heart Failure–Related Hospitalizations, Other Than Heart
Failure Itself
Bars represent the percent of all heart failure–related hospitalizations that were related to a given diagnosis for a 3-year period.
Values of p< 0.001 for each diagnosis across all years. COPD = chronic obstructive pulmonary disease.
Date of download:
3/19/2013
Copyright © The American College of Cardiology.
All rights reserved.
Non considerato il DM
Dati UOC Fermo
2011
2012
RICOVERI SC
257
256
UOMINI
64%
61%
DEG. MEDIA
8,2
7.2
ETA’ MEDIA
74,9
75
DECESSI
6%
6%
PAZ CON DM
21%
15%
UOMINI
58%
66%
DEG. MEDIA
10,4
8,3
ETA’ MEDIA
75
77,4
DECESSI
4%
5%
CONCLUSIONI
• DM E SC sono frequentemente associati
• Il peso della comorbilità DM nelle
ospedalizzazioni è importante ma non
sufficientemente indagato
• Il DM è un importante determinante
prognostico
• Nella riduzione delle riospedalizzazioni è
importante un attento controllo metabolico
del diabete
Domenico Gabrielli
Association of noncardiac morbidities
with death in CHF patients
Braunstein JB et Al. J Am Coll Cardiol 2003;42:1226 –33