Long‐term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy

Abstract

Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients. Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT). Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed. Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and nondiabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p = 0.363), as was survival free from CRT-D interventions (HR 1.72; p = 0.115) and hospitalisations (HR 1.12; p = 0.500). On multivariable analysis, NYHA class IV (p = 0.002), low LV ejection fraction (p = 0.002), absence of beta-blocker therapy (p b 0.001), impaired renal function (p = 0.003), presence of an epicardial lead (p = 0.025), but not diabetes (p = 0.821) were associated with a poor outcome after CRT. Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to nondiabetic patients.

Cardiac resynchronization therapy is effective even in elderly patients with comorbidities

“…The pathophysiology underlying HF in diabetic patients differs from that of non-diabetic patients, and it has been questioned whether CRT is equally beneficial in patients with and without diabetes. In accordance with previous studies, in our work, diabetes was not a predictor of poor response to CRT [28,29].…”

Cardiac Resynchronization Therapy Reduces the Risk of Cardiac Events in Patients With Diabetes Enrolled in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

“…Small observational studies have suggested that patients with diabetes who also have severe heart failure derive similar benefits from CRT when compared with patients without diabetes. 17,18 However, other observational reports suggest that patients with both diabetes and ischemic heart disease as well as those treated with insulin obtain little or no benefit from CRT. 19,20 Data derived from randomized, clinical trials of CRT in advanced (NYHA class III and IV) heart failure have recently been analyzed in relation to the impact of diabetes on therapeutic responses, and these reports are consistent with our findings.…”

Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure

“…8 Previous studies of the impact of diabetes mellitus on clinically meaningful outcomes after CRT-D therapy have been conflicting, perhaps, in part, because of differences in study design, population, time period, and length of followup. Some have found that diabetes mellitus is not related to prognosis among patients receiving CRT-D therapy, [8][9][10][11][12] others have reported worse outcomes. [13][14][15][16] A meta-analysis of the post hoc analyses of individual randomized trials of CRT (including 5 randomized controlled trials with 2923 patients, among whom 955 with diabetes mellitus) found that diabetes mellitus increased the risk of death after device insertion.…”

“…Although our finding of a higher mortality risk among patients with diabetes mellitus is similar to that of the aforementioned meta-analysis, some individual studies have previously reported no mortality differences. [8][9][10][11][12] However, these studies have included a limited number of patients with diabetes mellitus or patients receiving CRT therapy only without ICDs and also had a shorter time frame of follow-up not extending beyond 1 year, which possibly influenced the frequency and correlates of adverse outcomes. These studies have also lacked the diversity of our study population with respect to race, age, or sex and did not always characterize outcomes other than death.…”

“…Alternatively, patients with diabetes mellitus may derive less benefit after CRT-D placement. Although some studies found similar improvements in LV performance and remodeling in diabetic and nondiabetic patients after CRT, 8,11,17 others reported a more pronounced LV reverse remodeling and function improvement after CRT among patients without diabetes. [13][14][15] The latter findings suggest that limited reverse remodeling among patients with diabetes may partially explain differential outcomes of CRT.…”