title: Effect of Cardiac Resynchronization Therapy in Patients With Insulin-Treated Diabetes Mellitus.
abstract: Diabetes mellitus (DM) modify outcome in patients with heart failure (HF). We aimed to analyze the risk for death, HF alone, combined end point HF/death, and ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with mild HF without DM and in those with DM, further stratified by the presence of insulin treatment. We determined whether cardiac resynchronization therapy with defibrillator (CRT-D) versus implantable cardioverter defibrillator improves clinical outcomes in these 3 subgroups. Cox proportional hazards regression models were used to analyze 1,278 patients with left bundle branch block in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial. Treatment with CRT-D versus implantable cardioverter defibrillator was associated with 76% risk reduction in all-cause mortality (hazard ratio 0.24; 95% confidence interval 0.08 to 0.74, p = 0.012) in subgroup of diabetic patients treated with insulin only (interaction p = 0.043). Significant risk reduction in HF alone, HF/death, and the VT/VF after CRT-D was observed across investigated groups and similar left ventricular reverse remodeling to CRT-D. In conclusion, patients with mild HF with DM treated with insulin derive significant risk reduction in mortality, in HF, and VT/VF after implantation of CRT-D. Diabetic patients not receiving insulin benefit from CRT-D by reduction of HF events.
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Barbara
authors.initials: B
authors.lastname: Szepietowska
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York; Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Ruwald
authors.affiliation: Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York; Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Ruwald
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Sabu
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Department of Medicine, Cardiology, Heart Research Follow up Program, University of Rochester Medical Center, Rochester, New York. Electronic address: wojciech.zareba@heart.rochester.edu.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D017147:Defibrillators, Implantable; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin