Department of Internal Medicine and Cardiology, Heart Center Dresden, Technical University of Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany.
Clin Res Cardiol. 2019 Jan;108(1):39-47. doi: 10.1007/s00392-018-1309-0. Epub 2018 Jun 25.
Diabetes mellitus (DM) is a risk factor for cardiovascular disease. However, its effect on procedural and follow-up performance after transcatheter aortic valve replacement (TAVR) remains controversial.
We performed an observational study of all consecutive patients treated with a transfemoral TAVR in a single-center cohort (n = 1818). All patients were stratified by diabetes status and gender. All-cause 3-year mortality was the primary endpoint. Male patients with DM were identified to have substantially increased 3-year mortality [125/314 (39.8%)] compared to males without DM [142/478 (29.7%), p < 0.01]. Male patients with DM had significantly higher 3-year mortality in comparison to female patients with (p < 0.01) or without DM (p < 0.01). There was no difference in 3-year mortality for female patients with [135/465 (29.0%)] and without DM [151/554 (27.3%); p = 0.70]. This increase in mortality in male DM patients was triggered by both cardiovascular and non-cardiovascular mortality. Furthermore, DM served as an independent predictor of 3-year mortality after TAVR selectively only in men. The interaction between male gender and diabetes mellitus was identified as an independent predictor of 3-year mortality [HR 1.88 (1.25; 2.82); p < 0.01]. DM did not affect 30-day mortality for the overall cohort and for males.
Males with DM are a high-risk subgroup of patients after TAVR and require close medical attention including aggressive therapy of modifiable risk factors. Intensified diabetes management may improve long-term survival after TAVR.
糖尿病（DM）是心血管疾病的危险因素。然而，其对经导管主动脉瓣置换术（TAVR）后程序和随访表现的影响仍存在争议。
我们对单中心队列中接受经股 TAVR 的所有连续患者（n=1818）进行了一项观察性研究。所有患者均按糖尿病状况和性别分层。全因 3 年死亡率为主要终点。患有糖尿病的男性患者的 3 年死亡率明显升高[125/314（39.8%）]，而无糖尿病的男性患者为[142/478（29.7%），p<0.01]。与无糖尿病的女性患者相比，患有糖尿病的男性患者的 3 年死亡率明显更高（p<0.01）；与有糖尿病的女性患者相比（p<0.01）或无糖尿病的女性患者相比（p<0.01）。无糖尿病的女性患者的 3 年死亡率为[135/465（29.0%）]，与有糖尿病的女性患者的 3 年死亡率[151/554（27.3%）]无差异（p=0.70）。男性糖尿病患者死亡率升高的原因是心血管和非心血管死亡率均升高。此外，糖尿病仅在男性中是 TAVR 后 3 年死亡率的独立预测因素。男性性别和糖尿病之间的相互作用被确定为 3 年死亡率的独立预测因素[HR 1.88（1.25；2.82）；p<0.01]。DM 不影响整个队列和男性患者的 30 天死亡率。
患有糖尿病的男性患者是 TAVR 后的高危亚组患者，需要密切关注，包括积极治疗可改变的危险因素。强化糖尿病管理可能会改善 TAVR 后的长期生存率。
