Glycosylated haemoglobin is associated with neurohormonal activation and poor outcome in chronic heart failure patients with mild left ventricular systolic dysfunction

Aims We aimed to evaluate the impact of glycometabolic imbalance as assessed by glycosylated haemoglobin[HbA(1c)] on neurohormonalactivation and outcome in chronic heart failure ( CHF). Methods and results Nine hundred and twenty CHFpatients (65 ± 12 years, left ventricular ejection fraction 33 ± 10%, 29% diabetic patients) underwent a thorough humoral and clinical characterization, including HbA(1c), and were then followed up for the endpoint of cardiac death. In the whole population, diagnosis of diabetes resulted in no difference in neurohormonalor echocardiographic data, or in outcome. Conversely, the diabetic patients with HbA(1c) above 7% showed, in comparison to both diabetic patients with HbA(1c) below 7% and non-diabetic individuals, higher plasma renin activity(1.81, 0.48–5.68 vs. 1.23, 0.43–2.8 and 1.29, 0.44–5 ng/ml/h, respectively; P  Conclusion Glycometabolic imbalance, as represented by HbA(1c), is associated with neurohormonalactivation and poor prognosis in CHFpatients, beyond diabetes. The impact of metabolic derangement on prognosis appears greater at the early stages of CHF, when it might exacerbate neurohormonalactivation.