Effect of Diabetes Mellitus on Cardiac Resynchronization Therapy and to Prognosis in Heart Failure (from the Prospective Evaluation of Asian With Cardiac Resynchronization Therapy for Heart Failure Study)

Autor: Wee Tiong Yeo, Toon Wei Lim, Joevy Lim, Swee-Chong Seow, Pipin Kojodjojo, Siew Pang Chan, Joshua Tze-Kiat Seow, Devinder Singh, Eugene S.J. Tan
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Time Factors
Heart Ventricles
medicine.medical_treatment
Mean QRS Duration
Cardiac resynchronization therapy
Comorbidity
030204 cardiovascular system & hematology
Disease-Free Survival
Ventricular Function
Left
Prospective evaluation
Cardiac Resynchronization Therapy
Electrocardiography
03 medical and health sciences
0302 clinical medicine
Cause of Death
Diabetes mellitus
Internal medicine
medicine
Clinical endpoint
Humans
Prospective Studies
030212 general & internal medicine
Aged
Heart Failure
Singapore
Left bundle branch block
business.industry
Middle Aged
Prognosis
medicine.disease
Confidence interval
Survival Rate
Diabetes Mellitus
Type 2
Echocardiography
Heart failure
Cardiology
Female
Radiography
Thoracic
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: The American Journal of Cardiology. 124:899-906
ISSN: 0002-9149
Popis: The association of diabetes mellitus (DM) with cardiac resynchronization therapy (CRT) response and cardiovascular outcomes in Asian patients with heart failure (HF) is unclear. This study aims to investigate the effects of DM on CRT response and cardiovascular outcomes in Asian HF patients. Consecutive Asian HF patients receiving CRT were enrolled in the Prospective Evaluation of Asian with CRT for Heart Failure (PEACH) study from 2011 to 2017. CRT response and super-response were defined as decrease in end-systolic volume index ≥15% and ≥30%, respectively. Primary endpoint was time to composite of HF-hospitalization and all-cause mortality. Among 161 patients followed for 3.3 ± 1.5 years (age 66.7 ± 11.2 years, 22% females, mean QRS duration 154.3 ± 22.4 ms, 83% left bundle branch block), 84 (52%) were CRT responders and 57 (35%) were super-responders. Of 82 (51%) patients with DM (100% type 2, mean HbA1c 7.3 ± 1.9%), 35 (43%) were responders. DM attenuated reverse remodeling (CRT response: AOR 0.44, 95% confidence interval [CI] 0.20 to 0.98, p 0.05; super-response: AOR 0.42, 95% CI 0.18 to 0.97, p0.05), and DM increased HF-hospitalization and all-cause mortality (AHR 1.68, 95% CI 1.00 to 2.82, p = 0.05). The extent of CRT-response correlates with higher event-free survival (CRT response: AHR 0.5, 95% CI 0.30 to 0.81, p = 0.005; super-response: AHR 0.27, 95% CI 0.14 to 0.52, p 0.001). In conclusion, the extent of reverse remodeling post-CRT is the strongest predictor of event free survival. However, DM is detrimental to the CRT recipient by attenuating reverse remodeling, inducing end organ dysfunction and is independently associated with worsened clinical outcomes among Asian HF patients.
Databáze: OpenAIRE
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