Fantoni Cecilia, Regoli François, Ghanem Ali, Raffa Santi, Klersy Catherine, Sorgente Antonio, Faletra Francesco, Baravelli Massimo, Inglese Luigi, Salerno-Uriarte Jorge A, Klein Helmut U, Moccetti Tiziano, Auricchio Angelo
Division of Cardiology, University Hospital, Magdeburg, Germany.
Eur J Heart Fail. 2008 Mar;10(3):298-307. doi: 10.1016/j.ejheart.2008.01.006. Epub 2008 Mar 4.
Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients.
To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT).
We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed.
CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and non-diabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p=0.363), as was survival free from CRT-D interventions (HR 1.72; p=0.115) and hospitalisations (HR 1.12; p=0.500). On multivariable analysis, NYHA class IV (p=0.002), low LV ejection fraction (p=0.002), absence of beta-blocker therapy (p<0.001), impaired renal function (p=0.003), presence of an epicardial lead (p=0.025), but not diabetes (p=0.821) were associated with a poor outcome after CRT.
Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to non-diabetic patients.
糖尿病是心力衰竭（HF）患者发病率和死亡率增加的独立危险因素。
比较接受心脏再同步治疗（CRT）的糖尿病和非糖尿病HF患者的功能和结构改善情况以及长期预后。
我们比较了141例糖尿病患者和214例非糖尿病连续患者对CRT的反应。主要事件包括：任何原因导致的死亡、紧急心脏移植和植入左心室（LV）辅助装置。还分析了住院频率和除颤器（CRT-D）放电情况。
在34个月的中位随访期内，CRT能够显著改善糖尿病和非糖尿病患者的功能能力、心室几何形状和神经体液失衡。糖尿病和非糖尿病患者的总体无事件生存率相似（风险比1.23，p = 0.363），无CRT-D干预的生存率（风险比1.72；p = 0.115）和住院率（风险比1.12；p = 0.500）也相似。多变量分析显示，纽约心脏协会（NYHA）IV级（p = 0.002）、左心室射血分数低（p = 0.002）、未接受β受体阻滞剂治疗（p < 0.001）、肾功能受损（p = 0.003）、存在心外膜导线（p = 0.025）与CRT后预后不良相关，但糖尿病（p = 0.821）与之无关。
接受CRT治疗的糖尿病HF患者的功能和生存预后非常良好，与非糖尿病患者相当。
