China: In patients with significant secondary mitral regurgitation (sMR), increasing stress hyperglycemia ratio (SHR) is tied to a higher risk of worsening heart failure (HF), especially in those with normoglycemia.
The findings, published in Atherosclerosis, imply that the stress hyperglycemia ratio may be useful for cardiovascular (CV) risk stratification of patients with significant sMR.
Secondary mitral regurgitation is a major valvular disease that is prevalent in patients with coronary artery disease (CAD) and is linked with a higher incidence of mortality and heart failure when present in combination with abnormal glucose metabolism. Jin Liu, Guangdong Provincial People's Hospital, Southern Medical University, China, and colleagues evaluated the relationship between stress hyperglycemia ratio and worsening heart failure in CAD patients with significant (grade ≥2) sMR.

For this purpose, the researchers performed a multi-centre observational study of 874 patients with significant secondary mitral regurgitation following percutaneous coronary intervention (PCI) in the Cardiorenal Improvement-II (CIN-II) cohort.
The analysis included patients with glucose and glycated haemoglobin (HbA1c) data at hospitalization and categorized according to the SHR, as Q1: <0.74; Q2: 0.74–0.91; Q3: 0.91–1.14; and Q4: ≥1.14. SHR is the ratio of mmol/L blood glucose to % HbA1c. The primary clinical endpoint was determined as worsening HF and the secondary endpoint was major adverse cardiac events (MACE).
The researchers reported the following findings:
· 174 of the 874 participants (64.1 ± 10.8 years, 80% male), showed worsening HF and 226 developed MACE during a median follow-up of 3.7 years.
· Compared to participants in the lowest quartile (Q1) of SHR, the highest quartile group (Q4) was at significantly higher risks of worsening HF (adjusted hazard ratio, 2.44), while this was not associated with increased risk of MACE after adjustment for potential covariates.
· For worsening HF, the results obtained for the normal glucose regulation subgroup may be more meaningful than those for the diabetes mellitus (DM) and pre-DM groups.
· For MACE, the acute myocardial infarction (AMI) (Q4 vs. Q1; HR: 0.65) and non-AMI (Q4 vs. Q1; HR: 2.20) subgroups differed significantly on MACE.
"Increasing SHR is tied to a higher risk of worsening of heart failure in patients with significant sMR, particularly in those with normoglycemia," the researchers concluded.
Reference:
Huang, Haozhang, et al. "Relationship Between Stress Hyperglycemia and Worsening Heart Failure in Patients With Significant Secondary Mitral Regurgitation." Atherosclerosis, 2023, p. 117306.