PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

The role of Adding an ICD to CRT in Patients with Diabetes

Text of the abstract

Introduction Heart failure (HF) and diabetes mellitus (DM) are common causes of death alone but their coexistance multiple the risk of mortality. Moreover, sudden cardiac death (SCD) is more common in DM than in non-DM patients. However, data about the long-term effect of implantable cardioverter defibrillator to cardiac resynchronization therapy (CRT-D) on patients’ mortality is scarce.
Aims Our aim was to investigate the relevance of adding an ICD to CRT on long-term outcome in patients by the presence of DM.
Method Altogether 2656 CRT implanted patients were collected retrospectively, who underwent a CRT implantation in our center between 2000 to 2021. In the total cohort, 964 (36%) patients had DM. Device Implantations were performed by the current guidelines. The primary endpoint was all-cause mortality, secondary endpoint was the composite end-point wereof all-cause mortality and heart failure hospitalization. Log rank adn Cox multivariate analysis were used.
Results During the mean 4.215 (2.27-6.94) years of follow up time, 637 (39%) had DM out of the 1639 (62%) patients who reached the primary endpoint. The DM patients had higher BMI (29 kg/m2 vs. 27 kg/m2; p<0.001), lower creatinine levels [105 (μmol/L) vs. 100 (μmol/L); p<0.001]), higher prevalence of hypertonia (83% vs. 66%; p<0.001), NYHA III-,IV class (61% vs. 53%; p<0,001), ischemic etiology (57% vs. 44%; p<0.001), previous acute myocardial infarction (43% vs. 35%; p<0.001), and higher prevalece of male gender (77% vs. 74%; p<0.041) compared to non-DM patients. Those patients with DM showed a 24% higher risk of all-cause mortality (HR: 1.238; CI: 95% 1.115-1.374; P<0.001) compared to non-DM patients, also observable after adjusting for relevant clinical parameters such as age, gender, creatinin levels, BMI, NYHA, hypertension, ischaemic etiology and the addition of an ICD (HR: 1.28 95% CI 1.06-1.55 P=0.009). Adding an ICD for CRT patients with DM reduces the risk of all-cause mortality by 19% (HR 1.19 95% CI: 0.99-1.42; p=<0.,048).
Conclusion In CRT patients diabetes was found as an independent predictor of all-cause mortality. In CRT patients with diabetes, the addition of an ICD reduced the risk of long-term all-cause mortality. These findings emphasize the importance of adding an ICD to CRT in those with severe comorbidities such as DM.