Diabetes and the occurrence of ventricular arrhythmic events in patients with severe left ventricular dysfunction

Abstract

Aims/hypothesis. Diabetes is associated with a higher risk of ischaemic heart disease and heart failure, which frequently lead to rhythm disorders. However, experimental and clinical studies are inconsistent with regard to the risk of arrhythmic events in patients with diabetes. We studied the frequency of ventricular arrhythmic events in patients with and without diabetes. Methods. The study group included 207 patients with severe heart failure. The severity of ventricular arrhythmias was assessed by 24-h Holter monitoring, using prospectively defined measures of ventricular arrhythmic burden. Results. Patients with diabetes comprised 48% of the study group. All measures of ventricular ectopy were much lower in patients with diabetes. Mean hourly ventricular pairs (13.3±3.7 vs 7.2±2.0, p=0.03), mean hourly repetitive ventricular beats (32±9 vs 17±5, p=0.01), and the frequency of ventricular tachycardia episodes per 24 h (36±13 vs 16±6, p=0.01) were lower in patients with diabetes. After inclusion of clinical variables and drug therapies in a multivariate analysis, the negative relationship between diabetes and the frequency of ventricular pairs (p=0.03), repetitive ventricular beats (p=0.04), and ventricular tachycardia (p=0.03) remained independent. In multivariate logistic regression, the risk of developing ventricular tachycardia was lower in patients with diabetes with an adjusted odds ratio of 0.41 (95% CI, 0.22 to 0.75, p=0.004). Conclusion/interpretation. Diabetes confers a protective effect with regard to the occurrence of ventricular arrhythmias in the setting of decompensated heart failure. The precise mechanism of this phenomenon requires further investigation. [Diabetologia (2002[Diabetologia ( ) 45:1440[Diabetologia ( -1445

Heart Failure in Diabetes mellitus: Clinical Features and Prognostic Implications

“…Information concerning prevalence and impact on survival of various clinical variables in the context of DM and established CHF is limited [2,10,11,12,13, 17, 18]. Our results confirm that survival is shortened in diabetics with CHF.…”

“…pulmonary edema on admission [2], anemia, cardiac conduction disturbances, hyponatremia, use of nitrates [12] and higher long-term furosemide dosages, significantly prevailed in this subgroup. RD [11, 13] and peripheral vascular disease [11] also prevailed in the DM subgroup, but did not reach statistical significance. …”

“…Moreover, DM is known to be an independent risk factor for the development of CHF [1, 5, 6] and an independent predictor of morbidity and mortality in CHF [2, 4, 7, 8]. The association with DM was reported in 20–48% of CHF patients [2,3,4,9,10,11,12,13]. The term diabetic cardiomyopathy is assigned to specific changes occurring in the diabetic heart and not necessarily accompanied by coronary artery or valvular disease [3, 9, 10, 14].…”

“…Data regarding treatment modalities, duration, severity of DM and other characteristics of such patients as well as their impact on survival are scarce [10]. Attempts to formulate details of this patient population have only recently been reported [11,12,13]. Despite differences in the study populations and protocols, it emerges that CHF with DM is associated with a more severe clinical profile than CHF free of DM [2, 11, 12].…”

Role of diabetes in heart rhythm disorders

“…Interestingly, another study investigating the asso ciation between diabetes and VA in patients with severe heart failure revealed a negative independent relationship with diabetes and VA in this patient group. Moreover, the authors concluded that DM might have a protective effect for the occurrence of VA in the setting of decompensated heart failure [37] . In summary, DM might play a critical role in creating a vulnerable substrate and/or as a trigger for VA besides the expected risk based on the high extent and incidence of coronary artery disease.…”