Effectiveness of Cardiac Resynchronization Therapy in Diabetic Patients with Ischemic and Nonischemic Cardiomyopathy

George, Biju; Barsheshet, Alon; Moss, Arthur J.; Martin, David T.; Ouellet, Gregory; McNitt, Scott; Goldenberg, Ilan

doi:10.1111/j.1542-474x.2011.00476.x

Cited by 13 publications

(8 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In MADIT‐CRT, a consistent effect of CRT‐D as compared to ICD therapy was observed in patients with and without diabetes, with a suggestion of an earlier and greater benefit from CRT‐D in patients with diabetes. Importantly, in the latter trial, the benefit of CRT appears greater in diabetic patients with non‐ischaemic cardiomyopathy than in those with ischaemic cardiomyopathy, although there was no statistically significant interaction (HR 0.30 vs. 0.59; P for interaction 0.10) . This observation led us to further post‐hoc dissection of the effect of CRT in patients with diabetes and non‐ischaemic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 89%

Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT

Nägele

Steffel

Robertson

et al. 2016

European J of Heart Fail

View full text Add to dashboard Cite

AimsAs patients with heart failure (HF) and concomitant diabetes carry a poor prognosis, this post-hoc subgroup analysis aimed to compare the outcomes of patients with and without diabetes randomized in the Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study. Methods and resultsEchoCRT randomized patients with a QRS duration <130 ms and echocardiographic evidence of left ventricular dyssynchrony to CRT turned on (CRT=ON) vs. off (CRT=OFF) following device implantation. At study entry, 328 patients (40.5%) had diabetes. The primary outcome (all-cause death or first hospitalization for worsening HF) occurred more frequently in patients with than without diabetes (32.6% vs. 23%, P = 0.003). A significant treatment interaction was observed for the primary outcome indicating a higher risk for CRT=ON vs. CRT-OFF in patients without [26.5% vs. 19.8%, hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.08-2.31] vs. with diabetes (31.4% vs. 34%; HR 0.86, 95% CI 0.58-1.27; P for interaction 0.041). This effect was mainly driven by a lower rate in HF hospitalizations, but was only of borderline significance after multivariate adjustment (P = 0.063). The most pronounced effect was observed in patients with non-ischaemic cardiomyopathy, where a significantly reduced risk of reaching the primary endpoint for CRT=ON vs. CRT-OFF was observed in patients with (HR 0.27, P = 0.003) vs. patients without diabetes (HR 1.79, P = 0.038; P for interaction 0.005).

show abstract

Section: Discussionmentioning

confidence: 89%

Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT

Nägele

Steffel

Robertson

et al. 2016

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…The worse prognosis in CRT-treated T2DM may be due mainly to the higher mortality of patients with insulin-treated diabetes [ 19 , 21 – 24 ]. On the other hand observing the CRT-D effect in T2DM population at-risk cardiac patients, authors have evidenced a substantial reduction in the risk of HF or death and a significative improvement in cardiac remodeling in those with ischemic and nonischemic cardiomyopathy, with a more pronounced benefit in patients with nonischemic disease [ 20 ]. From these observations T2DM, regardless of the therapy used to treat it and the presence of coronary artery disease, did not influence the beneficial effect of CRT on any end point [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy Outcomes in Type 2 Diabetic Patients: Role of MicroRNA Changes

Sardu

Barbieri

Rizzo

et al. 2016

Journal of Diabetes Research

View full text Add to dashboard Cite

Heart failure (HF) and type 2 diabetes mellitus (T2DM) are two growing and related diseases in general population and particularly in elderly people. In selected patients affected by HF and severe dysfunction of left ventricle ejection fraction (LVEF), with left bundle brunch block, the cardiac resynchronization therapy with a defibrillator (CRT) is the treatment of choice to improve symptoms, NYHA class, and quality of life. CRT effects are related to alterations in genes and microRNAs (miRs) expression, which regulate cardiac processes involved in cardiac apoptosis, cardiac fibrosis, cardiac hypertrophy and angiogenesis, and membrane channel ionic currents. Different studies have shown a different prognosis in T2DM patients and T2DM elderly patients treated by CRT-D. We reviewed the literature data on CRT-D effect on adult and elderly patients with T2DM as compared with nondiabetic patients.

show abstract

“…It affects 25.8 million of the US population (8.3%) and is a major cause of heart disease and stroke. In ICD patients, diabetes mellitus is associated with an increased risk of hospitalization for heart failure, sudden cardiac death, and all-cause mortality [2][3][4][5][6] ; however, the association between diabetes mellitus and inappropriate and appropriate ICD therapy has not been investigated thoroughly. In the Inhibition of Unnecessary RV Pacing With AV Search Hysteresis in ICDs (INTRINSIC-RV) trial, diabetes mellitus was associated with reduced risk of inappropriate shocks in the elderly, but the study did not find an association between inappropriate shocks and mortality.…”

mentioning

confidence: 99%

Influence of Diabetes Mellitus on Inappropriate and Appropriate Implantable Cardioverter-Defibrillator Therapy and Mortality in the Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate Therapy (MADIT-RIT) Trial

et al. 2013

Self Cite

View full text Add to dashboard Cite

T he Multicenter Automatic Defibrillator Implantation TrialReduce Inappropriate Therapy (MADIT-RIT) showed that innovative implantable cardioverter-defibrillator (ICD) programming was associated with a reduction in inappropriate therapy and mortality.1 The MADIT-RIT trial randomized patients with a primary prophylactic ICD indication to 3 different types of ICD programming: conventional programming with a ventricular tachycardia (VT) zone of 170 to 199 bpm, high-rate cutoff with a VT zone ≥200 bpm, or 60-seconddelayed therapy during a VT zone of 170 to 199 bpm. Clinical Perspective on p 701Background-The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery in these patients is unknown. Methods and Results-The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) randomized patients with a primary prophylactic ICD indication to 3 different types of ICD programming: conventional programming with a ventricular tachycardia zone of 170 to 199 bpm (arm A), high-rate cutoff with a ventricular tachycardia zone ≥200 bpm (arm B), or 60-second-delayed therapy (arm C). The end points of inappropriate therapy, appropriate therapy, and death were assessed among 485 patients with and 998 without diabetes mellitus. Innovative ICD programming reduced the risk of inappropriate therapy regardless of diabetes mellitus, although a trend toward a more pronounced effect of high-rate cutoff programming was seen in patients without diabetes mellitus (P for interaction=0.06). Diabetes mellitus was associated with a decreased risk of inappropriate therapy (hazard ratio, 0.54; 95% confidence interval, 0.36-0.80; P=0.002) and increased risk of appropriate therapy (hazard ratio,1.58; 95% confidence interval, 1.17-2.14; P=0.003). In diabetic patients, there was significantly increased risk of death in those who had inappropriate therapy (hazard ratio, 4.17; 95% confidence interval, 1.52-11.40; P=0.005) and appropriate therapy (hazard ratio, 2.49; 95% confidence interval, 1.06-5.87; P=0.037) compared with those who did not. Conclusions-Innovative high-rate cutoff or delayed ICD programming was associated with a reduction in inappropriate therapy in patients with and without diabetes mellitus. Diabetes mellitus was associated with lower risk of inappropriate therapy but higher risk of appropriate therapy. Ruwald et al Diabetes Mellitus and ICD Programming and Therapy 695Diabetes mellitus is a growing burden to the healthcare system. It affects 25.8 million of the US population (8.3%) and is a major cause of heart disease and stroke. In ICD patients, diabetes mellitus is associated with an increased risk of hospitalization for heart failure, sudden cardiac death, and all-cause mortality 2-6 ; however, the association between diabetes mellitus and inappropriate and appropria...

show abstract

Effectiveness of Cardiac Resynchronization Therapy in Diabetic Patients with Ischemic and Nonischemic Cardiomyopathy

Cited by 13 publications

References 21 publications

Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT

Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT

Cardiac Resynchronization Therapy Outcomes in Type 2 Diabetic Patients: Role of MicroRNA Changes

Influence of Diabetes Mellitus on Inappropriate and Appropriate Implantable Cardioverter-Defibrillator Therapy and Mortality in the Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate Therapy (MADIT-RIT) Trial

Contact Info

Product

Resources

About