Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Eur J Heart Fail. 2011 Feb;13(2):195-9. doi: 10.1093/eurjhf/hfq204. Epub 2010 Nov 23.
Left ventricular assist devices (LVADs) are increasingly used as therapeutic options for patients with advanced congestive heart failure (CHF), many of whom suffer from diabetes mellitus (DM). The aim of this study was to evaluate the effect of restoration of normal cardiac output using LVAD support on diabetes control in patients with advanced CHF.
A retrospective chart review of all clinic patients supported with long-term LVADs between July 2008 and July 2009 at Columbia University Medical Center was performed. Patients with DM diagnosed prior to device implantation were included in this analysis. Clinical and laboratory data within 1 month preceding and 6 months following LVAD implantation were collected. Of 43 LVAD patients followed in our clinic during the study period, 15 had a diagnosis of DM. Thirteen of the 15 patients were male, mean age was 63 ± 11 years, and the pre-LVAD left ventricular ejection fraction (LVEF) was 16.5 ± 5.7%. Fasting glucose levels, HbA1c, and daily insulin requirement within 1 month before and an average of 4.0 ± 2.3 months after LVAD placement were 157.7 ± 50.6 vs. 104.1 ± 21.4 mg/dL, 7.7 ± 0.9 vs. 6.0 ± 0.8.%, and 53.3 ± 51.7 vs. 24.2 ± 27.2 IU, respectively (P < 0.05 for all comparisons). Six of the 15 patients were completely free of antidiabetic medications and had blood glucose < 126 mg/dL as well as HbA1c < 6% after LVAD. Body mass index (BMI) was slightly increased after LVAD (28.7 ± 5.3 vs. 30.2 ± 4.1 kg/m², P NS).
Restoration of normal cardiac output after LVAD implantation improves diabetic control in patients with advanced CHF. Additional studies are warranted to determine the mechanisms that worsen or possibly induce DM in patients with advanced CHF.
左心室辅助装置（LVAD）越来越多地被用作晚期充血性心力衰竭（CHF）患者的治疗选择，其中许多患者患有糖尿病（DM）。本研究的目的是评估使用 LVAD 支持恢复正常心输出量对晚期 CHF 患者糖尿病控制的影响。
对 2008 年 7 月至 2009 年 7 月在哥伦比亚大学医学中心接受长期 LVAD 支持的所有门诊患者进行了回顾性图表审查。该分析包括在装置植入前诊断为 DM 的患者。收集 LVAD 植入前 1 个月内和植入后 6 个月内的临床和实验室数据。在研究期间，我们诊所随访的 43 名 LVAD 患者中，有 15 名患有 DM。15 名患者中有 13 名是男性，平均年龄为 63 ± 11 岁，LVAD 前左心室射血分数（LVEF）为 16.5 ± 5.7%。植入 LVAD 前 1 个月内和植入后平均 4.0 ± 2.3 个月时的空腹血糖水平、HbA1c 和每日胰岛素需求分别为 157.7 ± 50.6 与 104.1 ± 21.4 mg/dL、7.7 ± 0.9 与 6.0 ± 0.8%、53.3 ± 51.7 与 24.2 ± 27.2 IU（所有比较均 P < 0.05）。15 名患者中有 6 名完全无需抗糖尿病药物，LVAD 后血糖 < 126 mg/dL，HbA1c < 6%。LVAD 后 BMI 略有升高（28.7 ± 5.3 与 30.2 ± 4.1 kg/m²，P NS）。
LVAD 植入后恢复正常心输出量可改善晚期 CHF 患者的糖尿病控制。需要进一步研究以确定在晚期 CHF 患者中导致或可能导致 DM 的机制。
