糖尿病对晚期心力衰竭患者接受或未接受除颤器的心脏再同步治疗的影响。

Influence of diabetes on cardiac resynchronization therapy with or without defibrillator in patients with advanced heart failure.

作者信息

Ghali Jalal K, Boehmer John, Feldman Arthur M, Saxon Leslie A, Demarco Teresa, Carson Peter, Yong Patrick, Galle Elizabeth G, Leigh Jill, Ecklund Fred L, Bristow Michael R

机构信息

Wayne State University School of Medicine, Detroit, Michigan 48201, USA.

出版信息

J Card Fail. 2007 Nov;13(9):769-73. doi: 10.1016/j.cardfail.2007.06.723.

DOI:10.1016/j.cardfail.2007.06.723

PMID:17996827

Abstract

OBJECTIVES

We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF).

BACKGROUND

In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF.

METHODS

The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance.

RESULTS

The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients.

CONCLUSION

In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.

摘要

目的

我们进行了一项事后分析，以确定植入式心脏复律除颤器（CRT-D）或无除颤器（CRT-P）的心脏再同步治疗对晚期心力衰竭（HF）糖尿病患者预后的影响。

背景

在收缩性HF患者中，糖尿病是发病率和死亡率的独立预测因素。关于其对晚期HF患者CRT-D或CRT-P的影响尚无数据。

方法

检查心力衰竭试验中药物治疗、起搏和除颤比较的数据库，以确定CRT（CRT-D和CRT-P）对糖尿病患者预后的影响。对糖尿病患者（n = 622）进行全因死亡率或住院率、全因死亡率或心血管住院率、全因死亡率或HF住院率以及全因死亡率分析。使用Cox比例风险模型，对年龄、性别、纽约心脏协会分级、缺血状态、体重指数、左心室射血分数、心率、QRS波、左或右束支传导阻滞、血压、合并症（肾衰竭、颈动脉疾病、外周血管疾病、高血压、冠状动脉搭桥术和心房颤动）、药物治疗和器械（有无除颤器）进行校正，以估计风险比（HR）和显著性。

结果

在最佳药物治疗组中，糖尿病患者的总体预后与非糖尿病患者相似。与最佳药物治疗相比，接受CRT治疗的糖尿病患者在全因死亡率或全因住院率（HR = 0.77，95%置信区间[CI] 0.62 - 0.97）、全因死亡率或心血管住院率（HR = 0.67，95% CI 0.53 - 0.85）、全因死亡率或HF住院率（HR = 0.52，95% CI 0.40 - 0.69）以及全因死亡率（HR = 0.67，95% CI 0.45 - 0.99）方面有显著降低。糖尿病患者和非糖尿病患者的手术相关并发症和住院时间相同。