@article{17a6d05cbcd0435d858d0260bd3d798f,
title = "Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT",
abstract = "Aims: As patients with heart failure (HF) and concomitant diabetes carry a poor prognosis, this post-hoc subgroup analysis aimed to compare the outcomes of patients with and without diabetes randomized in the Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study. Methods and results: EchoCRT randomized patients with a QRS duration <130 ms and echocardiographic evidence of left ventricular dyssynchrony to CRT turned on (CRT=ON) vs. off (CRT=OFF) following device implantation. At study entry, 328 patients (40.5\%) had diabetes. The primary outcome (all-cause death or first hospitalization for worsening HF) occurred more frequently in patients with than without diabetes (32.6\% vs. 23\%, P = 0.003). A significant treatment interaction was observed for the primary outcome indicating a higher risk for CRT=ON vs. CRT-OFF in patients without [26.5\% vs. 19.8\%, hazard ratio (HR) 1.58, 95\% confidence interval (CI) 1.08–2.31] vs. with diabetes (31.4\% vs. 34\%; HR 0.86, 95\% CI 0.58–1.27; P for interaction 0.041). This effect was mainly driven by a lower rate in HF hospitalizations, but was only of borderline significance after multivariate adjustment (P = 0.063). The most pronounced effect was observed in patients with non-ischaemic cardiomyopathy, where a significantly reduced risk of reaching the primary endpoint for CRT=ON vs. CRT-OFF was observed in patients with (HR 0.27, P = 0.003) vs. patients without diabetes (HR 1.79, P = 0.038; P for interaction 0.005). No treatment interaction by diabetes diagnosis was found for mortality endpoints. Conclusion: In EchoCRT, HF patients with a narrow QRS complex and coexisting diabetes demonstrated a signal for less harm caused by CRT compared with patients without diabetes, which was driven by differences in hospitalizations owing to HF.",
keywords = "Cardiac resynchronization therapy, Diabetes, Heart failure, Narrow QRS",
author = "N{\"a}gele, \{Matthias P.\} and Jan Steffel and Michele Robertson and Singh, \{Jagmeet P.\} and Flammer, \{Andreas J.\} and Bax, \{Jeroen J.\} and Borer, \{Jeffrey S.\} and Kenneth Dickstein and Ian Ford and John Gorcsan and Daniel Gras and Henry Krum and Peter Sogaard and Johannes Holzmeister and Abraham, \{William T.\} and Josep Brugada and Frank Ruschitzka",
note = "Funding Information: This work received no specific funding. The EchoCRT trial was funded by Biotronik (Sponsor Study ID: G080067) and GE Healthcare. Conflict of interest: J.S. reports significant research grants from Bayer, Biosense Webster, Biotronik, Boston Scientific, Daiichi-Sankyo, Medtronic and St Jude Medical, modest consultant/advisory board funding from Amgen, Astra Zeneca, Atricure, Boehringer Ingelheim, Cook Medical, Novartis, Sanofi Aventis, and Sorin, significant consultant/advisory board funding from Bayer, Biosense Webster, Biotronik, Boston Scientific, Bristol-Myers Squibb, Daiichi-Sankyo, Medtronic, Pfizer, St Jude Medical, and Zoll; and modest funding as co-president CorXL. M.R. reports grants from Biotronik, during the conducting of the study. J.P.S., reports modest fees from St Jude Medical, Boston Scientific, Sorin, Medtronic, CardioInsight, and RespiCardia Inc. A.J.F. reports personal fees from Novartis, grants and personal fees from Bayer, personal fees from Abbott, and personal fees from Bristol-Myers Squibb, outside the submitted work. J.J.B. reports departmental grant support from GE Healthcare, Biotronik, Boston Scientific, Medtronic, Lantheus, Servier, and Edwards Lifesciences. J.S.B. reports significant fees from Servier, Novartis, Celladon, Amgen, Pfizer, Takeda USA, and BioMARIN, and modest fees from Cardiorentis and ARMGO. I.F. reports grants and personal fees from Biotronik, during the conducting of the study. J.G. reports grants from Biotronik during the conduct of the study and grants from Medtronic, outside the submitted work. D.G. reports personal fees from Medtronic, personal fees from Boston Scientific, personal fees from Saint Jude Medical, and personal fees from Biotronik outside the submitted work. H.K. reports personal fees from Biotronik. P.S. reports personal fees from Biotronik, grants from Bayer Health Care, grants from EBR systems, grants and personal fees from GE Health Care, and grants from St Jude Medical outside the submitted work. J.H. reports direct employment, options, and is a member of the board of Cardiorentis. J.B. reports personal fees from Biotronik, during the conducting of the study, and personal fees from Cardiorentis, AstraZeneca, Novartis, ARMGO, Celladon, Boehringer-Ingelheim, Abbott Laboratories, Sarepta, Amgen, Servier, from GSK, Pfizer, and Gilead outside the submitted work. W.T.A. reports grants and personal fees from Biotronik during the conducting of the study. F.R. reports grants and personal fees from Biotronik, during the conducting of the study, and personal fees from Servier and Cardiorentis outside the submitted work. M.P.N. and K.D. have no conflicts of interest to disclose. Publisher Copyright: {\textcopyright} 2016 The Authors. European Journal of Heart Failure {\textcopyright} 2016 European Society of Cardiology",
year = "2017",
month = jan,
day = "1",
doi = "10.1002/ejhf.655",
language = "English",
volume = "19",
pages = "80--87",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
number = "1",
}