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. 2024 Jul 16;13(14):e032936.
doi: 10.1161/JAHA.123.032936. Epub 2024 Jul 11.

Impact of Diabetes and Glycemia on Cardiac Improvement and Adverse Events Following Mechanical Circulatory Support

Christos P Kyriakopoulos  1   2 , Iosif Taleb  1   2 , Eleni Tseliou  1   2 , Konstantinos Sideris  1 , Rana Hamouche  2 , Eleni Maneta  1   2 , Marisca Nelson  1 , Ethan Krauspe  1 , Sean Selko  1 , Joseph R Visker  2 , Elizabeth Dranow  1 , Matthew L Goodwin  1 , Rami Alharethi  1 , Omar Wever-Pinzon  1   2 , James C Fang  1 , Josef Stehlik  1 , Craig H Selzman  1   2 , Thomas C Hanff  1 , Stavros G Drakos  1   2
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Impact of Diabetes and Glycemia on Cardiac Improvement and Adverse Events Following Mechanical Circulatory Support

Christos P Kyriakopoulos et al. J Am Heart Assoc. .

Abstract

Background: Type 2 diabetes is prevalent in cardiovascular disease and contributes to excess morbidity and mortality. We sought to investigate the effect of glycemia on functional cardiac improvement, morbidity, and mortality in durable left ventricular assist device (LVAD) recipients.

Methods and results: Consecutive patients with an LVAD were prospectively evaluated (n=531). After excluding patients missing pre-LVAD glycated hemoglobin (HbA1c) measurements or having inadequate post-LVAD follow-up, 375 patients were studied. To assess functional cardiac improvement, we used absolute left ventricular ejection fraction change (ΔLVEF: LVEF post-LVAD-LVEF pre-LVAD). We quantified the association of pre-LVAD HbA1c with ΔLVEF as the primary outcome, and all-cause mortality and LVAD-related adverse event rates (ischemic stroke/transient ischemic attack, intracerebral hemorrhage, gastrointestinal bleeding, LVAD-related infection, device thrombosis) as secondary outcomes. Last, we assessed HbA1c differences pre- and post-LVAD. Patients with type 2 diabetes were older, more likely men suffering ischemic cardiomyopathy, and had longer heart failure duration. Pre-LVAD HbA1c was inversely associated with ΔLVEF in patients with nonischemic cardiomyopathy but not in those with ischemic cardiomyopathy, after adjusting for age, sex, heart failure duration, and left ventricular end-diastolic diameter. Pre-LVAD HbA1c was not associated with all-cause mortality, but higher pre-LVAD HbA1c was shown to increase the risk of intracerebral hemorrhage, LVAD-related infection, and device thrombosis by 3 years on LVAD support (P<0.05 for all). HbA1c decreased from 6.68±1.52% pre-LVAD to 6.11±1.33% post-LVAD (P<0.001).

Conclusions: Type 2 diabetes and pre-LVAD glycemia modify the potential for functional cardiac improvement and the risk for adverse events on LVAD support. The degree and duration of pre-LVAD glycemic control optimization to favorably affect these outcomes warrants further investigation.

Keywords: diabetes; heart assist device; heart failure; left ventricular assist device; myocardial recovery; reverse remodeling.

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Figures

Figure 1
Figure 1. Flow diagram for inclusion and exclusion of patients.
HbA1c indicates glycated hemoglobin; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; and T2DM, type 2 diabetes mellitus.
Figure 2
Figure 2. Association of pre‐LVAD HbA1c with left ventricular functional improvement (absolute LVEF change: LVEF post‐LVAD−LVEF pre‐LVAD) at a univariable level.
HbA1c indicates glycated hemoglobin; LVAD: left ventricular assist device; and LVEF, left ventricular ejection fraction.
Figure 3
Figure 3. Main effects between pre‐LVAD HbA1c and left ventricular functional improvement (absolute LVEF change: LVEF post‐LVAD−LVEF pre‐LVAD) in nonischemic and ischemic patients with HF.
HbA1c indicates glycated hemoglobin; HF, heart failure; LVEDD, left ventricular end‐diastolic diameter; and LVEF, left ventricular ejection fraction.
Figure 4
Figure 4. HbA1c values pre‐ and post‐LVAD support.
The bars represent mean values and the caps the SD. HbA1c indicates glycated hemoglobin; and LVAD, left ventricular assist device.
See this image and copyright information in PMC

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