Abstract 12114: Effect of Cardiac Resynchronization Therapy in Diabetic Patients: MADIT-CRT
Introduction: The benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients (pts) with diabetes mellitus (DM) is unclear. We evaluated the effect of CRT in DM and non-DM pts in the MADIT-CRT trial.
Methods: Patients with NYHA class I or II HF (N=1820; mean age 65 years; 75% male; left ventricular ejection fraction (EF) ≤35% QRS duration ≥130 ms) were randomized to implantable defibrillator (ICD) or CRT+ICD (CRT-D). DM was present in 552 of the study pts (30%). We used Cox regression to determine hazard ratio of CRT-D vs ICD therapy for the primary end point (HF hospitalization or death, whichever comes first) in DM and non-DM patients.
Results: Compared to the non-DM pts, those with DM had more coronary risk factors. There were no differences in EF or in beta blocker or ACE-inhibitor use in DM and non-DM pts, but DM pts had higher BNP and shorter 6min walk distance. During an average follow-up of 2.4 years, DM pts experienced significantly higher cardiac event rates than non-DM pts. CRT-D therapy was associated with significant reductions in the risk of heart failure or death in both DM and non-DM patients when compared to ICD therapy, with consistently lower CRT-D:ICD hazard ratios for heart failure or death in DM than non-DM pts in the total population, and in those with ischemic cardiomyopathy, non-ischemic cardiomyopathy, or LBBB conduction disturbance (Table). There were no significant treatment × diabetes interactions in any of the 4 pt groups (Table). There were no significant differences in ventricular remodeling, arrhythmia events, or device complications including infection between DM and non-DM pts.
Conclusion: CRT-D therapy is associated with significant and meaningful reductions in the risk of heart failure or death in DM and non-DM pts with low EF and wide QRS complex. There was a consistently greater CRT-D benefit in DM than non-DM pts, especially in DM pts with a LBBB conduction pattern who experienced a 65% reduction in the risk of cardiac events.
- Heart failure
- Type 2 Diabetes
- Bi-ventricular pacing
- Clinical trials
- Implantable cardioconvert defibrillator
- © 2010 by American Heart Association, Inc.