Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long-term retrospective cohort study
| Autor: | Peter C. Kahr, Matthias Schindler, Andreas J. Flammer, Ardan M. Saguner, Johanna Tonko, Daniel Hofer, Devdas T. Inderbitzin, Sander Trenson, Frank Ruschitzka, Alexander Breitenstein, P.A. Kaufmann, Jan Steffel, Joël Kuster, Stephan Winnik |
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| Přispěvatelé: | University of Zurich, Winnik, Stephan |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Cardiac & Cardiovascular Systems Ischaemic cardiomyopathy IMPACT medicine.medical_treatment Cardiomyopathy 030204 cardiovascular system & hematology Ventricular Function Left Cardiac Resynchronization Therapy 0302 clinical medicine Diabetes mellitus 030212 general & internal medicine Heart transplantation Cardiac resynchronization therapy Ejection fraction All‐cause mortality Non‐ischaemic cardiomyopathy Middle Aged All-cause mortality Non-ischaemic cardiomyopathy DEFIBRILLATOR Cardiology 10209 Clinic for Cardiology CRT Female Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine medicine.medical_specialty 610 Medicine & health Lower risk 2705 Cardiology and Cardiovascular Medicine 03 medical and health sciences MORBIDITY Internal medicine medicine Diabetes Mellitus Diseases of the circulatory (Cardiovascular) system Humans Risk factor METAANALYSIS Aged Retrospective Studies HEART-FAILURE PATIENTS Science & Technology CARDIOMYOPATHY business.industry MORTALITY Stroke Volume medicine.disease DYSFUNCTION RC666-701 Heart failure Cardiovascular System & Cardiology business |
| Zdroj: | ESC Heart Failure, Vol 7, Iss 5, Pp 2773-2783 (2020) |
| Popis: | AIMS: Cardiac resynchronization therapy (CRT) has become an important therapy in patients with heart failure with reduced left ventricular ejection fraction (LVEF). The effect of diabetes on long-term outcome in these patients is controversial. We assessed the effect of diabetes on long-term outcome in CRT patients and investigated the role of diabetes in ischaemic and non-ischaemic cardiomyopathy. METHODS AND RESULTS: All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were enrolled. The study endpoints were (i) a composite of ventricular assist device (VAD) implantation, heart transplantation, or all-cause mortality; and (ii) reverse remodelling (improvement of LVEF ≥ 10% or reduction of left ventricular end-systolic volume ≥ 15%). Median follow-up of the 418 patients (age 64.6 ± 11.6 years, 22.5% female, 25.1% diabetes) was 4.8 years [inter-quartile range: 2.8;7.4]. Diabetic patients had an increased risk to reach the composite endpoint [adjusted hazard ratio (aHR) 1.48 [95% CI 1.12-2.16], P = 0.041]. Other factors associated with an increased risk to reach the composite endpoint were a lower body mass index or baseline LVEF (aHR 0.95 [0.91; 0.98] and 0.97 [0.95; 0.99], P < 0.01 each), and a higher New York Heart Association functional class or creatinine level (aHR 2.14 [1.38; 3.30] and 1.04 [1.01; 1.05], P < 0.05 each). Early response to CRT, defined as LVEF improvement ≥ 10%, was associated with a lower risk to reach the composite endpoint (aHR 0.60 [0.40; 0.89], P = 0.011). Reverse remodelling did not differ between diabetic and non-diabetic patients with respect to LVEF improvement ≥ 10% (aHR 0.60 [0.32; 1.14], P = 0.118). However, diabetes was associated with decreased reverse remodelling with respect to a reduction of left ventricular end-systolic volume ≥ 15% (aHR 0.45 [0.21; 0.97], P = 0.043). In patients with ischaemic cardiomyopathy, survival rates were not significantly different between diabetic and non-diabetic patients (HR 1.28 [0.83-1.97], P = 0.101), whereas in patients with non-ischaemic cardiomyopathy, diabetic patients had a higher risk of reaching the composite endpoint (HR 1.65 [1.06-2.58], P = 0.027). The latter effect was dependent on other risk factors (aHR 1.47 [0.83-2.61], P = 0.451). The risk of insulin-dependent patients was not significantly higher than in patients under oral antidiabetic drugs (HR 1.55 [95% CI 0.92-2.61], P = 0.102). CONCLUSIONS: Long-term follow-up revealed diabetes mellitus as independent risk factor for all-cause mortality, heart transplantation, or VAD in heart failure patients undergoing CRT. The detrimental effect of diabetes appeared to weigh heavier in patients with non-ischaemic compared with ischaemic cardiomyopathy. ispartof: ESC HEART FAILURE vol:7 issue:5 pages:2773-2783 ispartof: location:England status: published |
| Databáze: | OpenAIRE |
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