© 2008 European Society of Cardiology
Long-term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy
a Division of Cardiology, University Hospital Magdeburg, Germany
b Division of Cardiology, Fondazione Cardiocentro Ticino Lugano, Switzerland
c Department of Cardiovascular Sciences, University of Insubria Varese, Italy
d Cardiovascular Interventional Radiology Department, IRCCS Policlinico San Donato San Donato Milanese, Italy
e Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico S. Matteo Pavia, Italy
f Division of Cardiology, Multimedica Holdings Castellanza Varese, Italy
* Corresponding author. Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland. Tel.: +41 91 805 33 40; fax: +41 91 805 31 67. E-mail address: angelo.auricchio{at}cardiocentro.org (A. Auricchio).
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Abstract |
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Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients.
Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT).
Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed.
Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and non-diabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p=0.363), as was survival free from CRT-D interventions (HR 1.72; p=0.115) and hospitalisations (HR 1.12; p=0.500). On multivariable analysis, NYHA class IV (p=0.002), low LV ejection fraction (p=0.002), absence of beta-blocker therapy (p<0.001), impaired renal function (p=0.003), presence of an epicardial lead (p=0.025), but not diabetes (p=0.821) were associated with a poor outcome after CRT.
Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to non-diabetic patients.
Key Words: Cardiac resynchronization therapy • Diabetes mellitus • Heart failure • Outcome
Received July 22, 2007; Revised November 20, 2007; Accepted January 10, 2008
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