Author + information
- Received September 19, 2019
- Revision received December 13, 2019
- Accepted December 18, 2019
- Published online February 26, 2020.
- Ankit Medhekar, MDa,
- Suresh Mulukutla, MDb,
- Floyd Thoma, BSb,
- Norman C. Wang, MD, MSb,
- Adithya Bhonsale, MDb,
- Krishna Kancharla, MDb,
- N.A. Mark Estes III, MDb,
- Sandeep K. Jain, MDb and
- Samir Saba, MDb,∗ ()
- aDepartment of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- bHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- ↵∗Address for correspondence:
Dr. Samir Saba, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, South Tower E352.6, Pittsburgh, Pennsylvania 15213.
Objectives This study examined the independent predictors of all-cause mortality, all hospitalizations, and cardiac hospitalizations in patients with mild-to-moderate cardiomyopathy (left ventricular ejection fractions [LVEFs] of 36% to 50%).
Background Patients with severe cardiomyopathy have high rates of death. Implantable cardioverter-defibrillators (ICDs) improve survival in this setting. It is not known whether the same applies to patients with mild-to-moderate cardiomyopathy.
Methods All patients with cardiomyopathy of any etiology seen at our institution between 2011 and 2017 were included. Baseline characteristics and outcomes were compared between patients with mild-to-moderate cardiomyopathy and severe cardiomyopathy (LVEF ≤35%).
Results Of the 18,003 patients with cardiomyopathy, 5,966 (33%) had a LVEF between 36% and 50%. Over a median follow-up of 3.35 years, 8,037 patients (45%) died and 11,056 (61%) were hospitalized for cardiac reasons. Independent predictors of all-cause mortality included older age (p < 0.001) and a history of diabetes mellitus (DM) (p = 0.005) or heart failure (p = 0.043). A higher baseline hemoglobin was protective (hazard ratio: 0.79; 95% confidence interval: 0.71 to 0.89; p < 0.001). Importantly, patients with a history of DM and mild-to-moderate cardiomyopathy had worse survival than those with severe cardiomyopathy and no DM (hazard ratio: 1.10; 95% confidence interval: 1.02 to 1.19; p = 0.010).
Conclusions A history of DM predicts mortality in patients with cardiomyopathy and is associated with worse outcome than the actual severity of cardiomyopathy. Patients with mild-to-moderate cardiomyopathy and DM may therefore benefit from the same life-saving therapies (e.g., ICDs) that are indicated for patients with severe cardiomyopathy. This finding needs to be verified in a prospective, randomized setting.
- diabetes mellitus
- left ventricular ejection fraction
- implantable defibrillators
Dr. Wang has been a consultant for Abbott; has been a research investigator for Boston Scientific; and has received fellowship support from Abbott and Medtronic. Dr. Estes has been a consultant for Abbott/St. Jude Medical, Medtronic, and Boston Scientific. Dr. Jain has received research support from Medtronic. Dr. Saba has received research support from Boston Scientific and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 19, 2019.
- Revision received December 13, 2019.
- Accepted December 18, 2019.
- 2020 American College of Cardiology Foundation
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