Long-term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy.
BACKGROUND
Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients.


OBJECTIVE
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.
Fantoni
Cecilia
C
Division of Cardiology, University Hospital, Magdeburg, Germany.
Regoli
François
F
Ghanem
Ali
A
Raffa
Santi
S
Klersy
Catherine
C
Sorgente
Antonio
A
Faletra
Francesco
F
Baravelli
Massimo
M
Inglese
Luigi
L
Salerno-Uriarte
Jorge A
JA
Klein
Helmut U
HU
Moccetti
Tiziano
T
Auricchio
Angelo
A
D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000150:complications; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007333:Insulin Resistance; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D016896:Treatment Outcome