Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT.

Abstract

AIMS:

As patients with heart failure (HF) and concomitant diabetes carry a poor prognosis, this post-hoc subgroup analysis aimed to compare the outcomes of patients with and without diabetes randomized in the Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study.

METHODS AND RESULTS:

EchoCRT randomized patients with a QRS duration <130 ms and echocardiographic evidence of left ventricular dyssynchrony to CRT turned on (CRT=ON) vs. off (CRT=OFF) following device implantation. At study entry, 328 patients (40.5%) had diabetes. The primary outcome (all-cause death or first hospitalization for worsening HF) occurred more frequently in patients with than without diabetes (32.6% vs. 23%, P = 0.003). A significant treatment interaction was observed for the primary outcome indicating a higher risk for CRT=ON vs. CRT-OFF in patients without [26.5% vs. 19.8%, hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.08-2.31] vs. with diabetes (31.4% vs. 34%; HR 0.86, 95% CI 0.58-1.27; P for interaction 0.041). This effect was mainly driven by a lower rate in HF hospitalizations, but was only of borderline significance after multivariate adjustment (P = 0.063). The most pronounced effect was observed in patients with non-ischaemic cardiomyopathy, where a significantly reduced risk of reaching the primary endpoint for CRT=ON vs. CRT-OFF was observed in patients with (HR 0.27, P = 0.003) vs. patients without diabetes (HR 1.79, P = 0.038; P for interaction 0.005). No treatment interaction by diabetes diagnosis was found for mortality endpoints.

CONCLUSION:

In EchoCRT, HF patients with a narrow QRS complex and coexisting diabetes demonstrated a signal for less harm caused by CRT compared with patients without diabetes, which was driven by differences in hospitalizations owing to HF.

• Authors: Matthias P Nägele, Jan Steffel, Michele Robertson, Jagmeet P Singh, Andreas J Flammer, Jeroen J Bax, Jeffrey S Borer, Kenneth Dickstein, Ian Ford, John Gorcsan 3rd, Daniel Gras, Henry Krum, Peter Sogaard, Johannes Holzmeister, William T Abraham, Josep Brugada, Frank Ruschitzka
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 19 Issue 1 Pg. 80-87 (01 2017) ISSN: 1879-0844 [Electronic] England
• PMID: 27862715 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Topics

• Aged
• Arrhythmias, Cardiac (complications, therapy)
• Cardiac Resynchronization Therapy
• Diabetes Complications
• Diabetes Mellitus
• Echocardiography
• Female
• Heart Failure (complications, therapy)
• Hospitalization
• Humans
• Male
• Middle Aged
• Proportional Hazards Models