Cardiac resynchronization therapy and its effects in patients with type 2 DIAbetes mellitus OPTimized in automatic vs. echo guided approach. Data from the DIA-OPTA investigators
Autor: | Raffaele Marfella, Celestino Sardu, Cosimo Sacra, Valentino Ducceschi, Massimo Massetti, Antonio Ruocco, Pasquale Paolisso, Matteo Santamaria |
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Přispěvatelé: | Sardu, Celestino, Paolisso, Pasquale, Ducceschi, Valentino, Santamaria, Matteo, Sacra, Cosimo, Massetti, Massimo, Ruocco, Antonio, Marfella, Raffaele |
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty lcsh:Diseases of the circulatory (Cardiovascular) system Time Factors genetic structures Endocrinology Diabetes and Metabolism medicine.medical_treatment Clinical Decision-Making Cardiac resynchronization therapy behavioral disciplines and activities Risk Assessment Predictive Value of Tests Risk Factors Internal medicine Diabetes mellitus Type 2 diabetes mellitus Medicine Humans Cardiac Resynchronization Therapy Devices Prospective Studies Settore MED/23 - CHIRURGIA CARDIACA Angiology Original Investigation Aged Heart Failure Atrium (architecture) business.industry Proportional hazards model Type 2 Diabetes Mellitus Middle Aged Automatic CRTd optimization medicine.disease Echocardiography Doppler Clinical trial Treatment Outcome nervous system Diabetes Mellitus Type 2 Italy lcsh:RC666-701 Heart failure Remote Sensing Technology Female Cardiology and Cardiovascular Medicine business psychological phenomena and processes |
Zdroj: | Cardiovascular Diabetology, Vol 19, Iss 1, Pp 1-14 (2020) Cardiovascular Diabetology |
Popis: | Objectives To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiography-guided approach. Background The suboptimal atrio-ventricular (AV) and inter-ventricular (VV) delays optimization reduces CRTd response. Therefore, we hypothesized that automatic CRTd optimization might improve clinical outcomes in T2DM patients. Methods We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 consecutive failing heart patients with T2DM, and candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for heart failure (HF) worsening, cardiac deaths and all cause of deaths in T2DM patients treated with CRTd and randomly optimized via automatic (n 93) vs. echocardiography-guided (n 98) approach at 12 months of follow-up. Results We had a significant difference in the rate of CRTd responders (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalizations for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echocardiography-guided group of patients. At multivariate Cox regression analysis, the automatic guided approach (3.636 [1.271–10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537–6.231], CI 95%, p 0.006) predicted rate of CRTd responders. In automatic group, we had significant difference in SonR values comparing the rate of CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), the rate of hospitalizations for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and the rate of cardiac deaths ( 1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047). Conclusions Automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could be predictive of CRTd responders. Notably, there was a significant difference in SonR values for CRTd responders vs. non responders, and about hospitalizations for HF worsening and cardiac deaths. Clinical trial ClinicalTrials.gov Identifier NCT04547244. |
Databáze: | OpenAIRE |
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