CLINICAL STUDY: HEART FAILURE
Prognostic impact of diabetes mellitus in patients with heart failure according to the etiology of left ventricular systolic dysfunction
Daniel L. Dries, MD, MPH*,
Nancy K. Sweitzer, MD, PhD ,
Mark H. Drazner, MD*,
Lynne W. Stevenson, MD and
Bernard J. Gersh, MB, DPhil
* Heart Failure Research Group and D. W. Reynolds Cardiovascular Research Center, Division of Cardiology, University of Texas Southwestern Medical School, Dallas, Texas, USA
Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received November 1, 2000;
revised manuscript received March 27, 2001,
accepted April 27, 2001.
Reprint requests and correspondence: Dr. Daniel L. Dries, Heart Failure Research Group, Reynolds Cardiovascular Research Center, Room H8.116, 5323 Harry Hines Boulevard, Dallas, Texas 75309
daniel.dries{at}utsouthwestern.edu
OBJECTIVES
We sought to determine the relative impact of diabetes mellitus on prognosis in ischemic compared with nonischemic cardiomyopathy.
BACKGROUND
Ischemic myocardium is characterized by increased reliance on aerobic and anaerobic glycolysis. Because glucose utilization by cardiomyocytes is an insulin-mediated process, we hypothesized that diabetes would have a more adverse impact on mortality and progression of heart failure in ischemic compared with nonischemic cardiomyopathy.
METHODS
We performed a retrospective analysis of the Studies Of Left Ventricular Dysfunction (SOLVD) Prevention and Treatment trials.
RESULTS
In adjusted analyses, diabetes mellitus was strongly associated with an increased risk for all-cause mortality in patients with ischemic cardiomyopathy, (relative risk [RR] 1.37, 95% confidence interval [CI] 1.21 to 1.55; p < 0.0001), but not in those with nonischemic cardiomyopathy (RR 0.98, 95% CI 0.76 to 1.32; p = 0.98). The increased mortality in patients with ischemic cardiomyopathy compared with nonischemic cardiomyopathy was limited to those with ischemic cardiomyopathy and diabetes mellitus (RR 1.37, 95% CI 1.21 to 1.56; p < 0.0001). When patients with ischemic cardiomyopathy and diabetes mellitus were excluded, there was no significant difference in mortality risk between the ischemic and nonischemic cardiomyopathy groups after adjusted analysis (RR 0.99, 95% CI 0.86 to 1.15; p = 0.99). Previous surgical revascularization identified patients within the cohort with ischemic cardiomyopathy and diabetes mellitus, with improved prognosis.
CONCLUSIONS
The differential impact of diabetes on mortality and heart failure progression according to the etiology of heart failure suggests that diabetes and ischemic heart disease interact to accelerate the progression of myocardial dysfunction. Evaluation of the potential for revascularization may be particularly important in patients with ischemic cardiomyopathy and diabetes mellitus.
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Abbreviations and Acronyms
| | NYHA | = New York Heart Association | | SOLVD | = Studies Of Left Ventricular Dysfunction |
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