Castelvecchio Serenella, Ranucci Marco, Di Donato Marisa, Menicanti Lorenzo
Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
Ann Thorac Surg. 2009 Nov;88(5):1451-6. doi: 10.1016/j.athoracsur.2009.07.006.
This study aimed to identify the impact of diabetes mellitus and related comorbidities on long-term survival of heart failure patients who had undergone surgical ventricular restoration. Surgical ventricular restoration is an optional therapeutic strategy for patients with ischemic dilated cardiomyopathy. Reported prognostic predictors for late morbidity and mortality are predominantly related to cardiac conditions, whereas the prognostic impact of comorbidities still needs to be defined.
A total of 329 patients (234 nondiabetic and 95 diabetic) who survived the surgical ventricular restoration operation were admitted to this study. Cardiac mortality follow-up data were collected. Actuarial survival curves were calculated for the two groups; differences between groups and the impact of other comorbidities were established using a log-rank test and a Cox regression analysis.
The mean follow-up time was 44 months. Diabetic patients had a significantly worse survival rate: at 5 years, their survival rate was 81%, versus 89% for nondiabetic patients (p = 0.019). Other comorbidities significantly associated with the survival rate were chronic renal failure, New York Heart Association class, and liver dysfunction. Diabetic patients without comorbidities had a survival rate similar to that of nondiabetic patients. Diabetic patients with at least one comorbidity had a significantly worse outcome. Diabetic patients with chronic renal failure had a 5-year survival rate of 40%, versus 85% for nondiabetic patients (p = 0.002).
Noncomplicated diabetes has no negative impact on long-term survival after surgical ventricular restoration. Conversely, complicated diabetes, namely the presence of chronic renal failure, carries a long-term cardiac mortality risk that is four times higher than the risk for nondiabetic patients.
本研究旨在确定糖尿病及相关合并症对接受外科心室修复术的心力衰竭患者长期生存的影响。外科心室修复术是缺血性扩张型心肌病患者的一种可选治疗策略。报道的晚期发病率和死亡率的预后预测因素主要与心脏状况有关，而合并症的预后影响仍有待确定。
本研究纳入了329例接受外科心室修复术后存活的患者（234例非糖尿病患者和95例糖尿病患者）。收集心脏死亡率随访数据。计算两组的精算生存曲线；使用对数秩检验和Cox回归分析确定组间差异及其他合并症的影响。
平均随访时间为44个月。糖尿病患者的生存率明显较差：5年时，其生存率为81%，而非糖尿病患者为89%（p = 0.019）。与生存率显著相关的其他合并症为慢性肾衰竭、纽约心脏协会心功能分级和肝功能不全。无合并症的糖尿病患者生存率与非糖尿病患者相似。至少有一种合并症的糖尿病患者预后明显较差。合并慢性肾衰竭的糖尿病患者5年生存率为40%，而非糖尿病患者为85%（p = 0.002）。
单纯性糖尿病对外科心室修复术后的长期生存无负面影响。相反，复杂性糖尿病，即存在慢性肾衰竭，其长期心脏死亡风险是非糖尿病患者的四倍。
