Effect of Diabetes Mellitus on Cardiac Resynchronization Therapy and to Prognosis in Heart Failure (from the Prospective Evaluation of Asian With Cardiac Resynchronization Therapy for Heart Failure Study)

Tan, Esther; Lim, Joevy; Chan, Siew Pang; Seow, Joshua Tze-Kiat; Singh, Devinder; Yeo, Wee‐Song; Lim, Toon Wei; Kojodjojo, Pipin; Seow, Swee‐Chong

doi:10.1016/j.amjcard.2019.06.004

Cited by 9 publications

(12 citation statements)

References 29 publications

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“…Yet the worse prognosis of patients with ICM compared with non‐ICM may also outweigh the additional risk conferred by DM among patients with ICM. The increased mortality risk associated with DM was not accompanied by a strong signal for impaired LV reverse remodelling, which has been considered a main mechanism underlying improved survival after CRT 22,23 . While we did not observe an association between diabetes and LV reverse remodelling defined by an improvement in LVEF ≥ 10% compared with baseline, diabetes was associated with an impaired CRT response if defined as a reduction of LVESVI by ≥15%.…”

Section: Discussioncontrasting

confidence: 63%

“…The increased mortality risk associated with DM was not accompanied by a strong signal for impaired LV reverse remodelling, which has been considered a main mechanism underlying improved survival after CRT. 22,23 While we did not observe an association between diabetes and LV reverse remodelling defined by an improvement in LVEF ≥ 10% compared with baseline, diabetes was associated with an impaired CRT response if defined as a reduction of LVESVI by ≥15%. This difference may be due to LVESVI being the more sensitive parameter compared with LVEF.…”

Section: Discussionmentioning

confidence: 53%

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Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long‐term retrospective cohort study

Kahr

Trenson²,

Schindler

et al. 2020

ESC Heart Failure

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Aims Cardiac resynchronization therapy (CRT) has become an important therapy in patients with heart failure with reduced left ventricular ejection fraction (LVEF). The effect of diabetes on long-term outcome in these patients is controversial. We assessed the effect of diabetes on long-term outcome in CRT patients and investigated the role of diabetes in ischaemic and non-ischaemic cardiomyopathy. Methods and results All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were enrolled. The study endpoints were (i) a composite of ventricular assist device (VAD) implantation, heart transplantation, or all-cause mortality; and (ii) reverse remodelling (improvement of LVEF ≥ 10% or reduction of left ventricular end-systolic volume ≥ 15%). Median follow-up of the 418 patients (age 64.6 ± 11.6 years, 22.5% female, 25.1% diabetes) was 4.8 years [inter-quartile range: 2.8;7.4]. Diabetic patients had an increased risk to reach the composite endpoint [adjusted hazard ratio (aHR) 1.48 [95% CI 1.12-2.16], P = 0.041]. Other factors associated with an increased risk to reach the composite endpoint were a lower body mass index or baseline LVEF (aHR 0.95 [0.91; 0.98] and 0.97 [0.95; 0.99], P < 0.01 each), and a higher New York Heart Association functional class or creatinine level (aHR 2.14 [1.38; 3.30] and 1.04 [1.01; 1.05], P < 0.05 each). Early response to CRT, defined as LVEF improvement ≥ 10%, was associated with a lower risk to reach the composite endpoint (aHR 0.60 [0.40; 0.89], P = 0.011). Reverse remodelling did not differ between diabetic and non-diabetic patients with respect to LVEF improvement ≥ 10% (aHR 0.60 [0.32; 1.14], P = 0.118). However, diabetes was associated with decreased reverse remodelling with respect to a reduction of left ventricular end-systolic volume ≥ 15% (aHR 0.45 [0.21; 0.97], P = 0.043). In patients with ischaemic cardiomyopathy, survival rates were not significantly different between diabetic and non-diabetic patients (HR 1.28 [0.83-1.97], P = 0.101), whereas in patients with non-ischaemic cardiomyopathy, diabetic patients had a higher risk of reaching the composite endpoint (HR 1.65 [1.06-2.58], P = 0.027). The latter effect was dependent on other risk factors (aHR 1.47 [0.83-2.61], P = 0.451). The risk of insulin-dependent patients was not significantly higher than in patients under oral antidiabetic drugs (HR 1.55 [95% CI 0.92-2.61], P = 0.102). Conclusions Long-term follow-up revealed diabetes mellitus as independent risk factor for all-cause mortality, heart transplantation, or VAD in heart failure patients undergoing CRT. The detrimental effect of diabetes appeared to weigh heavier in patients with non-ischaemic compared with ischaemic cardiomyopathy.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 53%

Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long‐term retrospective cohort study

Kahr

Trenson²,

Schindler

et al. 2020

ESC Heart Failure

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“…Of note, in HF, the use of CRTs is associated with a high non‐response‐rate in case of concomitant HF and DM. 22 …”

Section: Discussionmentioning

confidence: 99%

“…This causes pathological cardiac remodelling, which could be shown by LV dilatation and declined contractile function. Of note, in HF, the use of CRTs is associated with a high non‐response‐rate in case of concomitant HF and DM 22 …”

Section: Discussionmentioning

confidence: 99%

“…Of note, in HF, the use of CRTs is associated with a high non-response-rate in case of concomitant HF and DM. 22 Data on the response-rate to sacubitril/valsartan treatment in HF and concomitant DM are sparse. Recently published data of a post-hoc analysis of PROVE-HF trial showed that treatment with sacubitril/valsartan reverse cardiac remodelling in a similar rate in DM and non-DM patients.…”

Section: Predictors Of Mortalitymentioning

confidence: 99%

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The impact of sacubitril/valsartan on outcome in patients suffering from heart failure with a concomitant diabetes mellitus

et al. 2022

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Background Guidelines classify sacubitril/valsartan as a significant part of medical treatment of heart failure with reduced ejection fraction (HFrEF). Data have shown that the HbA1c levels in patients with diabetes mellitus could be impacted by sacubitril/valsartan. A possible positive effect in diabetes patients treated with sacubitril/valsartan on outcome and echocardiography parameters is not well studied yet. Aims The aim of the present study was to compare the impact of sacubitril/valsartan on life‐threatening arrhythmias, atrial fibrillation, different echocardiography parameters and congestion rate in patients suffering from HFrEF according to the diagnosis diabetes mellitus or no diabetes mellitus. Methods and results Consecutive 240 patients with HFrEF from 2016 to 2020 were treated with sacubitril/valsartan and separated to concomitant diabetes mellitus ( n = 87, median age 68 years interquartile range (IQR) [32–87]) or no diabetes mellitus ( n = 153, median age 66 year IQR [34–89]). Different comorbidities and outcome data were evaluated over a follow‐up period of 24 months. Arterial hypertension (87% vs. 64%; P < 0.01) and coronary artery disease (74% vs. 60%; P = 0.03) were more often documented in patients with diabetes mellitus compared with patients without diabetes mellitus. Over the follow‐up of 24 months several changes were noted in both subgroups: Median left ventricular ejection fraction (EF) increased significantly in non‐diabetes (27% IQR [3–44] at baseline to 35% IQR [13–64]; P < 0.001), but not in diabetic patients (29% IQR [10–65] at baseline to 30% IQR [13–55]; P = 0.11). Accordingly, NT‐proBNP and troponin‐I levels decreased significantly in non‐diabetes patients (NT‐brain natriuretic peptide [NT‐proBNP] from median 1445 pg/mL IQR [12.6–74 676] to 491 pg/mL IQR [13–4571]; P < 0.001, troponin‐I levels from 0.099 ng/mL IQR [0.009–138.69] to 0.023 ng/mL IQR [0.006–0.635]; P < 0.001), but not in diabetic patients (NT‐proBNP from 1395 pg/mL IQR [100–29 924] to 885 pg/mL IQR [159–4331]; P = 0.06, troponin‐I levels from 0.05 ng/mL IQR [0.013–103.0] to 0.020 ng/mL IQR [0.015–0.514]; P = 0.27). No significant change of laboratory parameters e. g. glomerular filtration rate, potassium level and creatinine levels were found in diabetes or non‐diabetes patients. Comparing further echocardiography data, left atrial surface area, right atrial surface area, E/A ratio did not show a significant change either in the diabetes or non‐diabetes group. However, the tricuspid annular plane systolic excursion was significantly increased in non‐diabetes mellitus patients (from 17 mm IQR [3–31] to 18 mm [2.5–31]; P = 0.04)...

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Clinical and gated SPECT MPI parameters associated with super-response to cardiac resynchronization therapy

Mesquita

Peix²,

Fernandes

et al. 2022

Journal of Nuclear Cardiology

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Effect of Diabetes Mellitus on Cardiac Resynchronization Therapy and to Prognosis in Heart Failure (from the Prospective Evaluation of Asian With Cardiac Resynchronization Therapy for Heart Failure Study)

Cited by 9 publications

References 29 publications

Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long‐term retrospective cohort study

Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long‐term retrospective cohort study

The impact of sacubitril/valsartan on outcome in patients suffering from heart failure with a concomitant diabetes mellitus

Clinical and gated SPECT MPI parameters associated with super-response to cardiac resynchronization therapy

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