Figure 1

Sex-related differences in the impact of DM on phenotypes, LV-GLS, and causal associations in HF. The main findings of the study are summarized. (Left) Diabetic men and women with HF had different clinical and echocardiographic phenotypes. (Middle) The associations of presentation blood glucose level with the LV-GLS impairment were more pronounced in women. In the RCS curves, LV-GLS continually declined as hyperglycemia became severe in women, while it reached a plateau in men, resulting in the gradual convergence of the two curves. (Right) The main driver from DM to mortality differed; men had a larger effect via IHD than LV-GLS impairment, whereas effect mediating LV-GLS was the only predominant path in women. Dominant pathways are indicated by bold arrows; those with dashes arrows are statistically insignificant. DM = diabetes mellitus; HF = heart failure; IHD = ischemic heart disease; LV-GLS = left ventricular global longitudinal strain; RCS = restricted cubic spline.