Abstract 10331: Predictors of Outcomes Following Cardiac Resynchronization Therapy in Diabetics with Heart Failure: A Prospective Cohort Study
Background: Diabetes Mellitus (DM) is associated with worse outcome in heart failure (HF). There is incomplete understanding of characteristics and outcome of patients with DM who receive cardiac resynchronization therapy (CRT).
Methods: 452 patients (179 with DM) were prospectively followed after CRT. Patients with and without DM were compared. Kaplan-Meier analysis for survival free of HF hospitalization at 2 years with a 30-day blanking period after implant was performed. Univariate and multivariate regression using univariate predictors (p≤0.1) was performed in each group.
Results: 1) Patients with DM more often had ischemic etiology, HTN, and prior CABG but there was no difference in HF medications, LVEF, LV size, creatinine, NYHA class, or QRS duration. 2) LVEF 6 months after CRT increased in DMs (5.7±11%) and non-DMs (8.9±11%, p=0.01 for both), with no significant difference in the frequency of echocardiographic (ECHO) responders (decrease in LVESD > 10% or increase in LVEF > 5% points, p= 0.1). 3) ECHO response was a predictor of event free survival in both groups (HR 0.53, p = 0.048 in DMs, HR= 0.49, p = 0.015 in non-DMs). 4) Patients with DM had poorer event free survival at 2 years (Figure). 5) There was no differences in univariate predictors of outcome between DM and non-DM including ischemic etiology. In a multivariate model female gender (HR 0.42, P = .04), Cr > 2 mg/dl (HR = 2.1, P = .04), NYHA class (HR = 2.1, P = .02), and LVEF (R = 0.96, P = .04) were independent predictors of outcome in patients without DM. Only beta-blocker use (HR = 0.89, P = .02) was significant in those with DM.
Conclusion: Patients with DM referred for CRT more often have ischemic etiology, HTN, and prior CABG. Despite improvement in LVEF, patients with DM have worse event free survival after CRT. Our data suggest that HF in diabetes may be a distinct phenotype, responding differently to CRT. Further investigation to determine novel predictors of outcome in DM is warranted.
- © 2011 by American Heart Association, Inc.