PhD Scientific Days 2020

Clinical Medicine I. Posters

Benefit of Implanting an ICD in Diabetic CRT Patients

Előadó neve

Dr. Merkel, Eperke Dóra

Előadó munkahelye

Heart and Vascular Center of Semmelweis University

Előadó telefonszáma

06206701214

Előadó e-mail címe

merkel.eperke@gmail.com

Az előadás címe

Benefit of Implanting an ICD in Diabetic CRT Patients

Szerző(k) neve és munkahelye

ED Merkel, A Behon1, WR Schwertner1, R Masszi2, I Osztheimer1, L Geller1, E Zima1, D Becker1, A Kosztin1, B Merkely1
1 Heart and Vascular Center of Semmelweis University
2. Semmelweis University, Faculty of medicine

Szekció

Clinical Medicine I. Posters

Language of the presentation

English

Section, first choice

Clinical Medicine

Section, second choice

Clinical Medicine

Összefoglaló szövege

Introduction
Heart failure (HF) patients with diabetes (DM) have a higher risk for all-cause mortality and also for sudden cardiac death. We lack data on the effect of adding a cardioverter defibrillator (ICD) to cardiac resynchronization therapy (CRT) on all-cause mortality in diabetic patients.
Aims
We aimed to investigate the risk of DM on all-cause mortality in CRT patients, and to examine the beneficial effect of adding an ICD in this patient population.
Methods
We examined retrospectively 2524 patients who underwent CRT implantation based on the current guidelines between 2000 and 2018, of which 927 (36%) had DM. The primary endpoint was all-cause mortality. Time to event data was investigated by Kaplan Meier and Cox regression analysis.
Results
During our mean follow-up time of 4.6 years, 1432 (56%) patients reached the primary endpoint, of which 552 (38%) had DM.
Diabetic CRT patients were more obese (non-DM group BMI 26 vs. DM group BMI 28; p <0.01). Hypertension (66% vs. 82%; p<0.01), ischemic aetiology (44% vs. 56%; p<0.01) and myocardial infarction (36% vs. 43%; p<0.01) were more frequent in the DM group, respectively. DM was associated with a 24% higher risk for all-cause mortality (HR 1.24; 95% CI 1.11-1.38; p‹0.01), also observable with Cox regression analysis (HR 1.17; 95% CI 1.06-1.31; p‹0.01). Addition of an ICD reduced the risk of all-cause mortality significantly by 32% (HR 0.68; CI 0.57-0.8; p<0.01) during the first six years, diminished at long-term (HR 0.94; CI 0.79-1.11; p=0.46). Regarding antidiabetic treatment, insulin (HR 1.82; CI 1.43-2.33; p<0.01) and sulfonylureas (HR 0.67; CI 0.52-0.87; p<0.01) could be associated with a higher all-cause mortality compared to metformin. Patients on metformin with a CRT-D had a significantly better survival up to 5 years (HR 0.56; CI 0.33-0.94; p=0.02), unseen in insulin or sulfonylurea treated patients.
Conclusion
Diabetes was found as an independent predictor of all-cause mortality in CRT patients.
In diabetic CRT patients the addition of an ICD reduced the risk of all-cause mortality mostly seen in the first six years. The type of antidiabetic treatment also altered the outcome, the benefit of implanting an ICD was the most dominant with metformin use. These findings might implicate the relevance of adding an ICD to CRT in those with severe comorbidities such as diabetes.

Additional Information

Supervisor:
Annamaria Kosztin
kosztin.annamaria@gmail.com

Bemutatás módja

Poszter

Kind

Szabad

Status

elfogadva

Accepted presentation method

poszter

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

4650

Start

11:32

End

11:35

Authors (legacy)

ED Merkel, A Behon1, WR Schwertner1, R Masszi2, I Osztheimer1, L Geller1, E Zima1, D Becker1, A Kosztin1, B Merkely1
1 Heart and Vascular Center of Semmelweis University
2. Semmelweis University, Faculty of medicine