TY - JOUR
T1 - Long-term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy
AU - Fantoni, Cecilia
AU - Regoli, François
AU - Ghanem, Ali
AU - Raffa, Santi
AU - Klersy, Catherine
AU - Sorgente, Antonio
AU - Faletra, Francesco
AU - Baravelli, Massimo
AU - Inglese, Luigi
AU - Salerno-Uriarte, Jorge A.
AU - Klein, Helmut U.
AU - Moccetti, Tiziano
AU - Auricchio, Angelo
PY - 2008/3
Y1 - 2008/3
N2 - 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 non-diabetic 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 <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 non-diabetic patients.
AB - 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 non-diabetic 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 <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 non-diabetic patients.
KW - Cardiac resynchronization therapy
KW - Diabetes mellitus
KW - Heart failure
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=40249091264&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=40249091264&partnerID=8YFLogxK
U2 - 10.1016/j.ejheart.2008.01.006
DO - 10.1016/j.ejheart.2008.01.006
M3 - Article
C2 - 18296111
AN - SCOPUS:40249091264
VL - 10
SP - 298
EP - 307
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 3
ER -