Chinenye O Usoh1, Saadia Sherazi2, Barbara Szepietowska2, Valentina Kutyifa2, Scott McNitt2, Anna Papernov2, Meng Wang2, Jeffrey D Alexis3. 1. Division of Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address: cusoh@wakehealth.edu. 2. Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York. 3. Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Abstract
BACKGROUND: Despite previous studies, the mortality risk of patients with diabetes mellitus after left ventricular assist device (LVAD) implant remains unclear. In addition, the relationship between the degree of glycemic control and long-term mortality risk in LVAD patients with diabetes has not been established. METHODS: Ninety-five nondiabetic patients and 96 diabetic patients from the University of Rochester Medical Center who received a HeartMate II (Thoratec, Pleasanton, CA) continuous-flow LVAD between May 2008 and June 2014 were included in this study. The primary outcome was all-cause mortality. Secondary outcomes included rates of infection, neurologic dysfunction, renal dysfunction, and rehospitalization. Kaplan-Meier survival analyses and Cox models were utilized. RESULTS: During follow-up, 32 diabetic patients (33%) and 15 nondiabetic patients (16%) died after LVAD implantation. Cumulative probability of death was higher for diabetic patients when compared with nondiabetic patients (42% versus 21% at 3 years, p = 0.013). There were no significant differences in overall rates of infection, neurologic dysfunction, and rehospitalization between the two groups. However, after an initial secondary outcome event, diabetic patients continued to have a higher mortality rate when compared with nondiabetic patients. There was no statistically significant difference in the risk of death between diabetic patients with pre-LVAD hemoglobin A1c less than 7.0% and diabetic patients with pre-LVAD hemoglobin A1c 7.0% or greater (hazard ratio 1.71, 95% confidence interval: 0.72 to 4.08, p = 0.223). CONCLUSIONS: Diabetic patients who underwent LVAD implantation had a higher risk of death compared with nondiabetic patients. Adverse event rates did not differ between the two groups. Finally, the degree of glycemic control in diabetic patients before LVAD was not found to influence mortality.
BACKGROUND: Despite previous studies, the mortality risk of patients with diabetes mellitus after left ventricular assist device (LVAD) implant remains unclear. In addition, the relationship between the degree of glycemic control and long-term mortality risk in LVADpatients with diabetes has not been established. METHODS: Ninety-five nondiabeticpatients and 96 diabeticpatients from the University of Rochester Medical Center who received a HeartMate II (Thoratec, Pleasanton, CA) continuous-flow LVAD between May 2008 and June 2014 were included in this study. The primary outcome was all-cause mortality. Secondary outcomes included rates of infection, neurologic dysfunction, renal dysfunction, and rehospitalization. Kaplan-Meier survival analyses and Cox models were utilized. RESULTS: During follow-up, 32 diabeticpatients (33%) and 15 nondiabeticpatients (16%) died after LVAD implantation. Cumulative probability of death was higher for diabeticpatients when compared with nondiabeticpatients (42% versus 21% at 3 years, p = 0.013). There were no significant differences in overall rates of infection, neurologic dysfunction, and rehospitalization between the two groups. However, after an initial secondary outcome event, diabeticpatients continued to have a higher mortality rate when compared with nondiabeticpatients. There was no statistically significant difference in the risk of death between diabeticpatients with pre-LVAD hemoglobin A1c less than 7.0% and diabeticpatients with pre-LVAD hemoglobin A1c 7.0% or greater (hazard ratio 1.71, 95% confidence interval: 0.72 to 4.08, p = 0.223). CONCLUSIONS:Diabeticpatients who underwent LVAD implantation had a higher risk of death compared with nondiabeticpatients. Adverse event rates did not differ between the two groups. Finally, the degree of glycemic control in diabeticpatients before LVAD was not found to influence mortality.
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