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Effectiveness of Cardiac Resynchronization Therapy in Diabetic Patients with Ischemic and Nonischemic Cardiomyopathy

Authors


  • 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.

Ilan Goldenberg, M.D., Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642. Fax: 585-273-5283; E-mail: Ilan.Goldenberg@heart.rochester.edu

Abstract

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

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