China: Study on Stress Hyperglycemia Ratio and Heart Failure

A recent study has identified an independent association between elevated stress hyperglycemia ratio (SHR) and an increased risk for composite events of all-cause, cardiovascular mortality, and heart failure readmission than those with lower SHR.

The findings, published in Cardiovascular Diabetology, suggest SHR to be a valuable tool for predicting and stratifying long-term adverse risks among heart failure with preserved ejection fraction (HFpEF) patients.

Background

Recent studies have shown that SHR is a potential predictor of future risk in heart failure patients. However, its implications, specifically in HF with preserved ejection fraction, are not fully elucidated. Therefore, Fuad A. Abdu, Tongji University School of Medicine, Shanghai, China, and colleagues aimed to investigate the association between SHR and long-term clinical outcomes in HFpEF patients.

Methodology

For this purpose, the researchers enrolled HFpEF patients between 2015 and 2023 and were followed (mean 41 months) for a composite outcome of all-cause, cardiovascular mortality, and HF rehospitalization. SHR was established as the ratio of acute-chronic glycemia from admission blood glucose and glycated haemoglobin.

ROC analysis was used to determine the optimal cut-off for SHR to predict outcomes based on event prediction, and the cutoff was identified at 0.99. The effect of SHR on adverse risk was determined through the Cox hazards and Kaplan-Meier survival methods.

A Pearson correlation analysis was conducted to evaluate the relationship between SHR and HF severity, as indicated by N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Furthermore, the incremental prognostic value of SHR was further evaluated by the integrated discrimination improvement (IDI) and the net reclassification improvement (NRI).

Results

Among the 400 enrolled patients, 190 encountered composite events over the 41-month follow-up period. The study revealed the following findings:

• SHR was elevated significantly in patients with events compared with those without.
• All patients were stratified into high SHR (n = 124) and low SHR (n = 276) groups based on the SHR cutoff.
• The high SHR group had a significantly higher incidence of adverse events than the low SHR group.
• Additional analysis indicated a poorer prognosis in patients with low left ventricular EF (LVEF) levels (50 < LVEF < 60) and high SHR (SHR > 0.99) in comparison to the other groups.
• In adjusted analysis, after accounting for sex, age, diabetes, and NT-proBNP, elevated SHR remained independently predictive of adverse outcomes (adjusted HR: 2.34).
• Adding SHR to a model with a MAGGIC score provided an incremental improvement in predicting adverse events. Additionally, SHR displayed a slight correlation with NT-proBNP.

Conclusion

In conclusion, SHR showed a significant association with long-term outcomes in the HFpEF population. Elevated SHR is an independent predictor for poor survival in HFpEF patients and seems to correlate with the marker of HF severity.

"These findings suggest that SHR could offer valuable insights for effective risk stratification in this patient population," the researchers wrote.

Reference

Mohammed, AQ., Luo, Y., Wang, K. et al. Stress hyperglycemia ratio as a prognostic indicator for long-term adverse outcomes in heart failure with preserved ejection fraction. Cardiovasc Diabetol 23, 67 (2024). https://doi.org/10.1186/s12933-024-02157-7