Available online 15 November 2022, 101411

Incidence of decline in LV systolic function increases with the elevation of HbA1c.

Elevated HbA1c is a predictor of decline in LV systolic function in CAD patients.

Decline in LV systolic function would improve the risk of cardiovascular death.

The aim of this study was to investigate the association of HbA1c and left ventricular (LV) systolic function among patients with coronary artery disease (CAD).

CAD patients from the Cardiorenal ImprovemeNt (CIN version 1.1, NCT05050877) registry were included in the study. They were separated into four groups based on HbA1c levels (Q1: HbA1c<5.7%; Q2: 5.7% ≤ HbA1c < 6.1%; Q3: 6.1% ≤ HbA1c < 6.9%; Q4: HbA1c ≥ 6.9%). The endpoint was decline in LV systolic function, defined as an absolute decrease in LV ejection fraction (LVEF) ≥10% from baseline to follow-up with 3-12 months. The association of HbA1c and LVEF was assessed by logistics regression models.

CAD patients (n=3,994) (age 62.9 ± 10.6 years; 22.2% female) were included in the final analysis. A decline in LV systolic function was recorded in 429 (11%) patients during follow-up. After fully adjusting for confounders, HbA1c was significantly associated with the high risk of decline in LV systolic function (OR 1.12 [95%CI 1.05;1.20] P = 0.001). By stratifying HbA1c as four groups, there is a significantly increased risk of decline in LV systolic function when HbA1c ≥6.1% (Q2, Q3 and Q4 vs Q1, with OR 1.22 [0.88;1.68] P = 0.235; OR 1.48 [1.07;2.05] P = 0.019; OR 1.60 [1.160;2.22] P = 0.004, respectively). Meanwhile, patients with decline in LV systolic function had a higher risk of cardiovascular death.

Elevated HbA1c is a predictor of decline in LV systolic function in CAD patients. Clinicians should be aware of the risk of decline in LV systolic function in CAD patients with elevated HbA1c, and take measures as soon as possible.

Coronary artery disease

Hemoglobin A1c

Glucose metabolism

Left ventricular ejection fraction

Left ventricular systolic function

© 2022 Published by Elsevier Masson SAS.