Cited by 286Cardiovascular Function and Risk FactorsHeart Failure Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

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Prognostic impact of diabetes mellitus in patients with heart failure according to the etiology of left ventricular systolic dysfunction

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Dries, Daniel L, Sweitzer, Nancy K, Drazner, Mark H, Stevenson, Lynne W, Gersh, Bernard J·2001·Journal of the American College of Cardiology

DOI 10.1016/s0735-1097(01)01408-5

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Abstract

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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Authors: Dries, D. L., Sweitzer, N. K., Drazner, M. H., Stevenson, L. W., & Gersh, B. J.
Affiliations: The University of Texas Southwestern Medical Center (US)
Brigham and Women's Hospital (US)
Mayo Clinic (US)
Corresponding author: Dries, Daniel L
ORCID: Sweitzer, Nancy K
Drazner, Mark H
Stevenson, Lynne W
Gersh, Bernard J
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2001-08
Volume: 38
Issue: 2
Pages: 421-428
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/s0735-1097(01)01408-5
OpenAlex: W2110103927
Cited by: 286
References: 19
Citations by year: 2026: 1 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 9 · 2021: 3 · 2020: 17 · 2019: 9 · 2018: 17 · 2017: 9 · 2016: 12 · 2015: 9 · 2014: 11 · 2013: 9 · 2012: 12
FWCI: 10.96
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 4367 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: diabetes mellitus, heart failure, left ventricular systolic dysfunction, ischemic cardiomyopathy, non-ischemic cardiomyopathy, all-cause mortality, heart failure progression, revascularization, myocardial glucose utilization, insulin, SOLVD trial
MeSH terms: Coronary Artery Bypass, Female, Heart Failure, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Systole, Cohort Studies, Survival Rate, Myocardial Ischemia, Ventricular Dysfunction, Left, Diabetes Complications

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Prognostic impact of diabetes mellitus in patients with heart failure according to the etiology of left ventricular systolic dysfunction

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