Long-term outcome in patients with heart failure and diabetes mellitus treated with cardiac resynchronization therapy

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac resynchronization therapy (CRT) is a proven therapy in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF). However, little is known about the long-term prognosis and the risk of cardiac device-related infective endocarditis (CDRIE) in patients with HF and diabetes mellitus (DM) treated with CRT. Aim To assess the long-term outcomes, mortality predictors, and the risk of CDRIE in patients with HF and DM undergoing CRT. Methods Study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital in a densely inhabited, urban region of Poland (949 subjects [89.6%] with CRT-D; 110 patients with CRT-P [10.4%]; 832 men [78.6%]). Population was divided into DM and control group (without DM); n=367 (34.7%) vs. n=692 (65.3%), respectively. Results During the median follow-up of 1661 days (10th and 90th percentile: 323-3995), all-cause mortality in DM group was significantly higher than in control group (61.9% vs. 50.3%, P=0.0003; Figure 1). The risk of CDRIE was 6.5% vs. 4.9% respectively in both groups (P=0.27). On multivariable regression analysis, older age (HR 1.03, 95%CI 1.01-1.05, P<0.001), ischemic cardiomyopathy (HR 1.60, 95%CI 1.18-2.19, P=0.003), lower left ventricular ejection fraction (HR 0.96, 95%CI 0.94-0.99, P=0.002), higher creatinine level (HR 1.004, 95%CI 1.001-1.006, P=0.001), and diabetes treated with insulin (HR 1.56, 95%CI 1.19-2.05, P=0.001) were identified as independent predictors of higher mortality in patients with DM undergoing CRT impantation. Conclusions Compared with patients without diabetes, mortality rates of those with DM treated with CRT implantation are significantly higher and nearly 2/3 of patients die within 4.5 years. Advanced age, ischemic cardiomyopathy, lower left ventricular ejection fraction, higher creatinine level, and diabetes treated with insulin are independent mortality predictors in subjects with HF and DM treated with cardiac resynchronization therapy. Figure 1. Kaplan-Meier curves for survival of patients with and without diabetes mellitus (DM) treated with cardiac resynchronization therapy (log rank P<0.001)