Conflict of interest: The MADIT-II study was supported by a research grant from Guidant Corp., St. Paul, Minnesota, to the University of Rochester School of Medicine and Dentistry.
Effectiveness of Cardiac Resynchronization Therapy in Diabetic Patients with Ischemic and Nonischemic Cardiomyopathy
Article first published online: 26 JAN 2012
© 2012, Wiley Periodicals, Inc.
Annals of Noninvasive Electrocardiology
Volume 17, Issue 1, pages 14–21, January 2012
How to Cite
George, J., Barsheshet, A., Moss, A. J., Martin, D., Ouellet, G., McNitt, S. and Goldenberg, I. (2012), Effectiveness of Cardiac Resynchronization Therapy in Diabetic Patients with Ischemic and Nonischemic Cardiomyopathy. Annals of Noninvasive Electrocardiology, 17: 14–21. doi: 10.1111/j.1542-474X.2011.00476.x
- Issue published online: 26 JAN 2012
- Article first published online: 26 JAN 2012
- cardiac resynchronization therapy;
- diabetes mellitus;
- heart failure
Background: Diabetes mellitus (DM) increases the risk for the development of both ischemic and nonischemic cardiomyopathy. We aimed to identify differences in response to cardiac resynchronization therapy with a defibrillator (CRT-D) among DM patients with ischemic or nonischemic cardiomyopathy.
Methods: Cox proportional hazards regression modeling was used to assess clinical response to CRT-D (defined as CRT-D vs. defibrillator-only reduction in the risk of heart failure [HF] or death) and echocardiographic response (defined as percent reduction in left ventricular end diastolic and systolic volume [LVEDV and LVESV, respectively] at 12 month of follow-up compared with baseline values) among 552 diabetic patients with ischemic (n = 367) or nonischemic (n = 185) cardiomyopathy enrolled in MADIT-CRT.
Results: The clinical benefit of CRT-D was more pronounced among nonischemic patients (HR = 0.30 [P < 0.001] than among ischemic patients (HR = 0.59 [P = 0.004]; P for interaction = 0.10). Nonischemic patients also experienced significantly greater reductions in LVESV and LVEDV at 12 months with CRT-D compared with ischemic patients (P < 0.001 for both). Subgroup analysis showed that the most pronounced reduction in HF or death with CRT-D therapy occurred in nonischemic patients who were women (83% risk-reduction [P < 0.001]), had a lower BMI (<30/kg/m2: 79% risk-reduction [P < 0.001]), or had left bundle branch block at enrollment (82% risk-reduction [P < 0.001]).
Conclusions: The present study shows that treatment with CRT-D in at-risk cardiac patients with DM is associated with substantial reductions in the risk of HF or death and improvement in cardiac remodeling in those with ischemic and nonischemic cardiomyopathy, with a more pronounced benefit in patients with nonischemic disease.
Ann Noninvasive Electrocardiol 2012;17(1):14–21