We have previously shown a reduction in HF events with cardiac resynchronization therapy
with defibrillator (CRT-D) in patients with mild heart failure (HF) and diabetes mellitus
(DM). It remains unknown whether HF remission in DM patients with CRT-D translates
into reduced mortality. The effects of CRT-D versus an implantable cardioverter-defibrillator
(ICD) alone to reduce long-term mortality were assessed in patients with left bundle
branch block with DM (n = 386) and without DM (n = 982), enrolled in the Multicenter
Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy
(MADIT-CRT). We further subdivided DM patients by insulin and noninsulin therapy.
Kaplan-Meier survival analyses and multivariate cox proportional hazards regression
models were utilized. At the 7-year follow-up, CRT-D was associated with a lower mortality
in DM patients compared with ICD alone (21% vs 42%, p = 0.02), similar to non-DM patients
(16 vs 24%, p = 0.014). CRT-D was associated with a 41% reduction in the risk of long-term
all-cause mortality in DM patients (hazard ratio [HR] 0.59, 95% confidence interval
0.36 to 0.96, p = 0.033) and a similar reduction in non-DM patients (HR 0.69, 95%
confidence interval 0.48 to 0.99, p = 0.045, treatment-diabetes interaction p = 0.611).
Among DM patients, mortality benefit was evident in insulin-treated patients only
(HR 0.40, p = 0.030). Reductions in HF events were present in all groups. In the MADIT-CRT,
patients with mild HF with DM derive significant long-term survival benefit from CRT-D,
similar to those without DM. The mortality benefit from CRT-D within the DM subgroup
seems to be confined to patients with insulin treated diabetes.
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Article info
Publication history
Published online: March 14, 2018
Accepted:
February 27,
2018
Received:
December 23,
2017
Footnotes
The Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) study was supported by a research grant from Boston Scientific (St. Paul, Minnesota) to the University of Rochester School of Medicine and Dentistry.
See page 1573 for disclosure information.
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