title: Long-term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy.
abstract: 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.
authors.affiliation: Division of Cardiology, University Hospital, Magdeburg, Germany.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fantoni
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.forename: Ali
authors.initials: A
authors.lastname: Ghanem
authors.forename: Santi
authors.initials: S
authors.lastname: Raffa
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorgente
authors.forename: Francesco
authors.initials: F
authors.lastname: Faletra
authors.forename: Massimo
authors.initials: M
authors.lastname: Baravelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Salerno-Uriarte
authors.forename: Helmut U
authors.initials: HU
authors.lastname: Klein
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: 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