408 Cardiac resynchronization therapy in patients with diabetes mellitus

Methods: We aimed to analyze the risk for death and HF and the effect of CRT on HF/death in diabetic patients with or without insulin treatment compared to none diabetic population. The study comprised 1278 patients with left bundle branch block in the MADIT-CRT trial with an average follow-up of 3.3y. We used time dependent survival analysis and Cox proportional hazards regression method. Results: In ICD arm patients with diabetes receiving insulin treatment had 2.4-fold higher risk of all-cause mortality (p=0.008), and 2.2-fold higher risk of HF (p<0.001) when compared to non diabetic patients, and 2.8-fold higher risk of death (p=0.01), and 1.6-fold higher risk of HF (p=0.06) when compared to patients with diabetes not treated with insulin. Treatment with CRT-D was associated with a significant 75% risk reduction in all-cause mortality (hazard ratio [HR ] 0.25; 95% confidence interval [CI]: 0.08-0.77; p=0.016) in patients with diabetes receiving insulin. Noteworthy, during the 3-year follow-up, reduction in all-cause mortality was not observed in patients not treated with insulin or in patients with no diabetes (interaction p-value=0.038). Significant risk reduction in HF and in HF/death after CRT treatment was observed across all three investigated groups. There were not significant differences in left ventricular reverse remodeling after CRT-D among diabetic patients with or without insulin treatment compared to the nondiabetic population. Conclusions: Patients with insulin treated diabetes derive significant reduction in mortality and heart failure after implantation of cardiac resynchronization therapy. Patients with diabetes and no insulin and patient without diabetes benefit from CRT by reduction of HF events.

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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)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2019.06.004 ◽

2019 ◽

Vol 124 (6) ◽

pp. 899-906 ◽

Cited By ~ 2

Author(s):

Eugene S.J. Tan ◽

Joevy Lim ◽

Siew Pang Chan ◽

Joshua Tze-Kiat Seow ◽

Devinder Singh ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Prospective Evaluation ◽

Resynchronization Therapy

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Cardiac resynchronization therapy and its effects in patients with type 2 DIAbetes mellitus OPTimized in automatic vs. echo guided approach. Data from the DIA-OPTA investigators

Cardiovascular Diabetology ◽

10.1186/s12933-020-01180-8 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Celestino Sardu ◽

Pasquale Paolisso ◽

Valentino Ducceschi ◽

Matteo Santamaria ◽

Cosimo Sacra ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cox Regression Analysis ◽

Significant Difference

Abstract Objectives To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiography-guided approach. Background The suboptimal atrio-ventricular (AV) and inter-ventricular (VV) delays optimization reduces CRTd response. Therefore, we hypothesized that automatic CRTd optimization might improve clinical outcomes in T2DM patients. Methods We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 consecutive failing heart patients with T2DM, and candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for heart failure (HF) worsening, cardiac deaths and all cause of deaths in T2DM patients treated with CRTd and randomly optimized via automatic (n 93) vs. echocardiography-guided (n 98) approach at 12 months of follow-up. Results We had a significant difference in the rate of CRTd responders (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalizations for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echocardiography-guided group of patients. At multivariate Cox regression analysis, the automatic guided approach (3.636 [1.271–10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537–6.231], CI 95%, p 0.006) predicted rate of CRTd responders. In automatic group, we had significant difference in SonR values comparing the rate of CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), the rate of hospitalizations for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and the rate of cardiac deaths ( 1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047). Conclusions Automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could be predictive of CRTd responders. Notably, there was a significant difference in SonR values for CRTd responders vs. non responders, and about hospitalizations for HF worsening and cardiac deaths. Clinical trial ClinicalTrials.gov Identifier NCT04547244.

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