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 |
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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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