Abstract
Introduction Diabetes mellitus (DM) is a well-known risk factor for morbidity and mortality in patients with cardiovascular diseases, including heart failure. Diabetes is known to worsen long-term outcomes in heart transplantation recipients, but its impact on outcomes after left ventricular assist device (LVAD) implantation remains unclear. Methods We searched Medline, Embase, Scopus and the Cochrane Library for publications reporting outcomes after LVADs in diabetic and non-diabetic patients through April 2018. Outcomes were compared under the random-effects model and heterogeneity examined via Chi2 and I2 statistics. Results A total of 6 studies including 1543 LVAD recipients were included in the analysis. Of these, 584 (38%) had DM. Most of the patients included received a HeartMate II (HMII 64.7%, HVAD 7.5%, pulsatile-LVAD 27.7%). The median hemoglobin A1C among diabetic patients was 7.2% ± 1.4. Compared with the non-diabetic group, the overall rate of stroke was significantly higher in the diabetic population (OR 1.49; 95% CI 1.13-1.97; p=0.005; Figure 1 ). The difference in stroke rate persisted when only continuous-flow LVADs were analyzed (OR 1.5; 95% CI 1.08-2.08; p=0.01). The overall mortality in diabetic patients at 3 years was greater when compared to the non-diabetic group (OR 1.77; 95% CI 1.14-2.76; p=0.01). Other adverse events analyzed including device-related infections, systemic infections, pump thrombosis/exchange, renal failure, and bleeding were comparable between both groups. Conclusion Our analysis suggests that diabetic patients receiving LVADs are at an increased risk of stroke when compared to non-diabetic patients. Furthermore, the risk of mortality after LVAD implantation among patients with diabetes appears to be greater when compared to non-diabetic patients. Diabetes should be considered as another important variable when assessing the overall risk for a potential LVAD candidate. Larger cohorts are needed to better understand the impact of DM on post-LVAD therapy.
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