Abstract 16756: Diabetes Has No Impact on Mortality or Other Major Adverse Outcomes After Continuous-Flow Left Ventricular Assist Device Implantation
Background: Diabetes mellitus (DM) confers higher mortality for patients with heart failure and for individuals undergoing cardiothoracic surgery, when compared to patients without DM. However it is unknown whether DM raises the risk of mortality or major device-related complications in patients with heart failure who receive a continuous-flow left ventricular assist device (LVAD).
Methods and Results: The impact of DM on outcomes was assessed in 300 consecutive adults who received continuous-flow LVAD support at a single center between 2006-13 (129 DM, 171 no DM). Diabetes was defined as HbA1c ≥6.5% and/or taking DM medications at hospital admission for LVAD implantation. Significant differences between the DM versus non-DM groups included age (58±10 vs 52±15 years, p=0.002), ischemic heart failure etiology (55% vs 39%, p=0.005), body mass index (29.1±5 vs 27.0±6 kg/m2, p=0.0002), pre-LVAD creatinine (1.5±0.5 vs 1.3±0.4 mg/dL, p=0.002), pre-LVAD sodium (133±6 vs 135±6 mmol/L, p=0.004), left ventricular end-diastolic diameter (6.7±0.9 vs 7.0±1.2 cm, p=0.006) and Heartmate II Risk Score (1.5±0.8 vs 1.2±0.8, p=0.009), respectively. The mean duration of LVAD support was 403±380 days in the DM group and 390±370 days in the non-DM group (p=0.95). Ninety-three patients died on LVAD support, 43 with DM and 50 from the non-DM group (p=0.45). Cardiac transplantation occurred in 39 of the DM group versus 44 of the non-DM group (p=0.43). After controlling for 8 co-variables in a Cox proportional hazards model, DM was not associated with all-cause mortality (HR 0.92, 95% CI 0.59-1.43, p=0.71). Diabetes was also not associated with the secondary composite endpoints of mortality, intracranial hemorrhage, thromboembolic stroke, TIA and pump thrombosis (HR 0.99, 0.68-1.45, p=0.97), or with mortality, driveline infections and pump infections (HR 1.03, 0.71-1.50, p=0.88). In a separate model restricted to the 129 DM patients, pre-LVAD HbA1c was unassociated with all-cause mortality (p=0.028).
Conclusion: DM, even when poorly controlled, does not increase the mortality risk after continuous-flow LVAD implantation; nor does DM increase the risk of a composite of mortality, neurological events and pump thrombosis, or of mortality and device-related infections.
- Heart failure
- Type 2 Diabetes
- Artificial heart/Cardiac support devices
- Transplantation/medical aspects
- © 2013 by American Heart Association, Inc.