Cardiac resynchronization therapy with a defibrillator (CRTd) in failing heart patients with type 2 diabetes mellitus and treated by glucagon-like peptide 1 receptor agonists (GLP-1 RA) therapy vs. conventional hypoglycemic drugs: arrhythmic burden, hospitalizations for heart failure, and CRTd responders rate

Abstract

ObjectivesTo evaluate clinical outcomes in patients with diabetes, treated by cardiac resynchronization therapy with a defibrillator (CRT-d), and glucagon-like peptide 1 receptor agonists (GLP-1 RA) in addition to conventional hypoglycemic therapy vs. CRTd patients under conventional hypoglycemic drugs.BackgroundPatients with diabetes treated by CRTd experienced an amelioration of functional New York Association Heart class, reduction of hospital admissions, and mortality, in a percentage about 60%. However, about 40% of CRTd patients with diabetes experience a worse prognosis.Materials and methodsWe investigated the 12-months prognosis of CRTd patients with diabetes, previously treated with hypoglycemic drugs therapy (n 271) vs. a matched cohort of CRTd patients with diabetes treated with GLP-1 RA in addition to conventional hypoglycemic therapy (n 288).ResultsAt follow up CRTd patients with diabetes treated by GLP-1 RA therapy vs. CRTd patients with diabetes that did not receive GLP-1 RA therapy, experienced a significant reduction of NYHA class (p value < 0.05), associated to higher values of 6 min walking test (p value < 0.05), and higher rate of CRTd responders (p value < 0.05). GLP-1 RA patients vs. controls at follow up end experienced lower AF events (p value < 0.05), lower VT events (p value < 0.05), lower rate of hospitalization for heart failure worsening (p value < 0.05), and higher rate of CRTd responders (p value < 0.05). To date, GLP-1 RA therapy may predict a reduction of AF events (HR 0.603, CI [0.411–0.884]), VT events (HR 0.964, CI [0.963–0.992]), and hospitalization for heart failure worsening (HR 0.119, CI [0.028–0.508]), and a higher CRT responders rate (HR 3.707, CI [1.226–14.570]).ConclusionsGLP-1 RA drugs in addition to conventional hypoglycemic therapy may significantly reduce systemic inflammation and circulating BNP levels in CRTd patients with diabetes, leading to a significant improvement of LVEF and of the 6 min walking test, and to a reduction of the arrhythmic burden. Consequently, GLP-1 RA drugs in addition to conventional hypoglycemic therapy may reduce hospital admissions for heart failure worsening, by increasing CRTd responders rate.Trial registration NCT03282136. Registered 9 December 2017 “retrospectively registered”

Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

“…Biomarkers offer a desirable strategy for improving risk stratification and clinical decision making for STEMI patient management [7,19,50]. Our findings indicate that CRP provides useful information for the prediction of risk of post-STEMI LVSD and HF hospitalization, which enhances the overall prognostic value of already well-known risk factors (e.g., elevated BNP concentration, which is related to adverse clinical outcomes including reduced LVEF and increased rate of hospitalization for HF) [7,19,50,51]. Other biomarkers may also be potentially valuable for monitoring and predicting of HF development, for example ST2 protein [52].…”

Impact of intentional weight loss on diabetic kidney disease

“…Aberrant GLP‐1 signalling plays an important role in renal and cardiac disease progression in diabetes, and enhanced GLP‐1 signalling after RYGB surgery appears to be central to weight‐loss‐independent benefits in cardiac and renal function observed postoperatively. Indeed, Sardu et al examined outcomes in patients with diabetes and heart failure receiving cardiac resynchronization therapy and treated with conventional hypoglycaemic drugs versus those treated with GLP‐1RAs, and found symptom burden (New York Heart Association class) and arrhythmia prevalence to be reduced among the latter …”

“…Heart Association class) and arrhythmia prevalence to be reduced among the latter. 15 Inflammation accompanying obesity also contributes to cardiac and renal disease progression in people with DKD. Plasma soluble tumour necrosis factor receptor (sTNFR)1 and sTNFR2 levels predict risk of end-stage renal disease independently of conventional clinical variables in people with T2DM.…”

Cardiac Resynchronization Therapy and its Effects in Patients with type 2 DIAbetes Mellitus OPTimized in Automatic vs. Echo Guided Approach. Data from the DIA-OPTA Investigators

“…decades to develop new therapeutic approaches to improve the cardiac pump e ciency, the CRTd responders rate and the clinical outcomes in CRTd patients with T2DM. In this setting, the use of multipolar left-ventricular (LV) pacing leads, and the optimization of device programming mode has been seen as an important advancement in T2DM patients with CRTd (6,7,8). On other hand, also T2DM patients receiving a multipolar CRTd could experience a worse prognosis (6).…”

“…In this setting, the use of multipolar left-ventricular (LV) pacing leads, and the optimization of device programming mode has been seen as an important advancement in T2DM patients with CRTd (6,7,8). On other hand, also T2DM patients receiving a multipolar CRTd could experience a worse prognosis (6). In CRTd patients, this could be due to the reduction of cardiac pump, that is more evidenced in patients with the loss of atrioventricular (AV) and interventricular (IV) synchrony (9).…”