Sex-specific impact of diabetes mellitus on left ventricular systolic function and prognosis in heart failure

Background: Diabetes mellitus (DM) aggravates the clinical features and outcomes of heart failure (HF). However, the sex-specific cardiovascular consequence of DM in HF patients remains unclear. We aimed to investigate the sex differences in associations of DM with echocardiographic phenotypes and clinical outcomes of HF.Methods: We studied 4,180 patients admitted for acute HF between 2009 and 2016 (median follow-up, 31.7 months), whose left ventricular global longitudinal strain (LV-GLS) data were available. Patients were compared by sex and DM. Structural equation model (SEM) analysis was performed to evaluate the moderating effects of two causal paths, via ischemic heart disease (IHD) and LV-GLS, linking DM with mortality by sex. Results: Among 1,431 patients with HF and DM (34.2%), women had more preserved LV systolic function, whereas men had more ischemic etiology. Compared to non-diabetic women, diabetic women had lower LV-GLS (11.3% versus 10.1%, pConclusions: DM increases the mortality risk in HF irrespective of sex. However, the main driver leading to mortality differed by sex, suggesting the importance of sex-specific strategies for HF management.