Sun Hui, Guan Yuqing, Wang Lei, Zhao Yong, Lv Hong, Bi Xiuping, Wang Huating, Zhang Xuejing, Liu Li, Wei Min, Song Hui, Su Guohai
Department of Cardiology, Jinan Central Hospital, Affiliated with Shandong University, Jinan, Shandong Province, 250013, China.
Department of Geriatric Cardiology, Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province, 250021, China.
BMC Cardiovasc Disord. 2015 Mar 21;15:25. doi: 10.1186/s12872-015-0018-0.
Diabetes mellitus is an independent risk factor of increased morbidity and mortality in patients with heart failure. Cardiac resynchronization therapy (CRT), a pacemaker-based therapy for dyssynchronous heart failure, improves cardiac performance and quality of life, but its effect on mortality in patients with diabetes is uncertain.
We performed a meta-analysis of results from randomized controlled trials (RCTs) of the long-term outcome of cardiac resynchronization therapy for heart failure in diabetic and non-diabetic patients. Literature search of MEDLINE via Pubmed for reports of randomized controlled trials of Cardiac resynchronization for chronic symptomatic left-ventricular dysfunction in patients with and without diabetes mellitus, with death as the outcome. Relevant data were analyzed by use of a random-effects model. Reports published from 1994 to 2011 that described RCTs of CRT for treating chronic symptomatic left ventricular dysfunction in patients with and without diabetes, with all-cause mortality as an outcome.
A total of 5 randomized controlled trials met the inclusion criteria, for 2,923 patients. The quality of studies was good to moderate. Cardiac resynchronization significantly reduced the mortality for heart failure patients with or without diabetes mellitus. Mortality was 24.3% for diabetic patients with heart failure and 20.4 % for non-diabetics (odds ratio 1.28, 95% confidence interval 1.06-1.55; P = 0.010).
Cardiac resynchronization therapy (CRT) may reduce mortality from progressive heart failure in patients with or without diabetes mellitus, but mortality may be higher for patients with than without diabetes after CRT for heart failure.
糖尿病是心力衰竭患者发病率和死亡率增加的独立危险因素。心脏再同步治疗（CRT）是一种用于治疗不同步心力衰竭的起搏器治疗方法，可改善心脏功能和生活质量，但其对糖尿病患者死亡率的影响尚不确定。
我们对糖尿病和非糖尿病患者心力衰竭心脏再同步治疗长期结果的随机对照试验（RCT）结果进行了荟萃分析。通过Pubmed在MEDLINE上检索有关糖尿病患者和非糖尿病患者慢性症状性左心室功能障碍心脏再同步治疗的随机对照试验报告，以死亡作为结局指标。使用随机效应模型分析相关数据。报告发表于1994年至2011年，描述了以全因死亡率为结局指标的CRT治疗有或无糖尿病的慢性症状性左心室功能障碍患者的随机对照试验。
共有5项随机对照试验符合纳入标准，涉及2923例患者。研究质量为良至中等。心脏再同步治疗显著降低了有或无糖尿病的心力衰竭患者的死亡率。心力衰竭糖尿病患者的死亡率为24.3%，非糖尿病患者为20.4%（优势比1.28，95%置信区间1.06 - 1.55；P = 0.010）。
心脏再同步治疗（CRT）可能降低有或无糖尿病的进行性心力衰竭患者的死亡率，但心力衰竭患者接受CRT治疗后，糖尿病患者的死亡率可能高于非糖尿病患者。
