Usefulness of Hemoglobin A1c to Predict Outcome After Cardiac Resynchronization Therapy in Patients With Diabetes Mellitus and Heart Failure
Usefulness of Hemoglobin A1c to Predict Outcome After Cardiac Resynchronization Therapy in Patients With Diabetes Mellitus and Heart Failure
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DOI：
10.1016/j.amjcard.2012.04.056
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发表时间：
2012-09-01
影响因子：
2.8
通讯作者：
Das, Saumya
中科院分区：
文献类型：
--
作者：
Shah, Ravi V.;Altman, Robert K.;Das, Saumya
糖尿病合并心力衰竭（HF）患者在心脏复律治疗（CRT）后的临床结局比不伴糖尿病的HF患者更差。I-IF和糖尿病患者代表了越来越多的心血管事件高风险人群，并且越来越多地接受CRT治疗。虽然糖尿病合并心力衰竭患者似乎从CRT中获益，但其临床结局比CRT后无糖尿病患者更差。本研究的目的是确定解释糖尿病患者差异风险的临床预测因素。我们研究了2003年至2010年在马萨诸塞州综合医院CRT门诊就诊的442例收缩期HF患者（169例糖尿病患者），以确定HF和糖尿病患者CRT后结局的预测因素。糖尿病患者比非糖尿病患者更可能有HF的缺血性原因，但在植入时左心室射血分数或HF分类方面没有差异。糖尿病患者的无事件生存率（死亡或HF住院）低于非糖尿病患者（对数秩p = 0.04）。糖尿病的存在是整个人群中差异结局的最重要的独立预测因素（风险比1.65，95%置信区间1.10 - 2.51）。接受胰岛素治疗的糖尿病患者的生存率较差，而未接受胰岛素治疗的患者的生存率与非糖尿病患者相似。植入笔糖化血红蛋白>7%的患者预后较差，而糖化血红蛋白>7%的患者预后较差。
Patients with diabetes and heart failure (HF) have worse clinical outcomes compared to patients with HF without diabetes after cardiac resynchronization therapy (CRT). Patients with I-IF and diabetes represent a growing population at high risk for cardiovascular events and are increasingly treated with CRT. Although patients with diabetes and HF appear to benefit from CRT, their clinical outcomes are worse than those of patients without diabetes after CRT. The aim of this study was to identify clinical predictors that explain the differential hazard in patients with diabetes. We studied 442 patients (169 with diabetes) with systolic HF referred to the Massachusetts General Hospital CRT clinic from 2003 to 2010 to identify predictors of outcomes after CRT in patients with HF and diabetes. Patients with diabetes were more likely to have ischemic causes of HF than those without diabetes, but there was no difference in the left ventricular ejection fraction or HF classification at implantation. Patients with diabetes had poorer event-free survival (death or HF hospitalization) compared to those without diabetes (log-rank p = 0.04). The presence of diabetes was the most important independent predictor of differential outcomes in the entire population (hazard ratio 1.65, 95% confidence interval 1.10 to 2.51). Patients with diabetes receiving insulin therapy had poorer survival, whereas those not receiving insulin therapy had similar survival to patients without diabetes. Patients with pen-implantation glycosylated hemoglobin >7% had worse outcomes, whereas patients with glycosylated hemoglobin