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P2278Risk of life-threatening ventricular tachyarrhythmia events in diabetes patients with higher ejection fraction in MADIT-CRT


 
 
 Data on the risk of life-threatening ventricular tachyarrhythmia events in diabetes patients with mild heart failure (HF) and higher ejection fraction (LVEF) are not currently known.
 
 
 
 We aimed to assess the risk of life-threatening ventricular tachyarrhythmia events in mild HF patients with diabetes in patients with baseline LVEF ≤30% or >30%.
 
 
 
 We evaluated the risk of life-threatening VT/VF treated with shock in mild HF patients with diabetes, by those with LVEF ≤30% or >30%, enrolled in MADIT-CRT. Kaplan-Meier analysis and multivariate adjusted Cox regression models were utilized.
 
 
 
 Out of 542 mild HF patients with diabetes and VT/VF data, 206 (38%) had LVEF >30% and 336 (62%) had LVEF ≤30%. The 5-year cumulative probability of VT/VF treated with shock was 15% in patients with diabetes LVEF >30% as compared to the 15% probability in patients with diabetes and LVEF ≤30% (p=0.342 for the overall difference in event rates during follow-up) (Figure). In Cox models, the risk of VT/VF treated with shock was similar in diabetes patients with LVEF>30% and LVEF ≤30% (HR=0.88, 95% CI= 0.51–1.53, p=0.647) after adjustment for age, ischemic etiology, prior ventricular or atrial arrhythmia, and CRT-D-LBBB interaction. The risk of VT/VF treated with shock was similar regardless of LVEF in both CRT-D patients (HR=1.09, p=0.830) and ICD only patients (HR=0.67, p=0.345).
 
 
 
 
 Diabetes patients with an LVEF >30% are at similarly high risk of life-threatening ventricular tachyarrhythmias to patients with LVEF≤30%. Our findings highlight the need for further investigation and treatment of this uniquely high-risk patient cohort with a higher ejection fraction.
 
 
 
 MADIT-CRT was funded by an unrestricted research grant from Boston Scientific to the University of Rochester.
