Type 2 diabetes mellitus increases long-term mortality risk after isolated surgical aortic valve replacement

Abstract

BackgroundDiabetes mellitus (DM) adversely affects morbidity and mortality for major atherosclerosis-related cardiovascular diseases and is associated with increased risk for the development of aortic stenosis. Clinical data regarding the impact of DM on outcomes of patients undergoing aortic valve replacement (AVR) have revealed inconsistent results. The aim of the current study was to investigate and compare the impact of type 2 DM on short-, intermediate- and long-term mortality between DM and non-DM patients who undergo isolated AVR.MethodsWe performed an observational study in a large tertiary medical center over a 14-year period (2004–2018), which included all patients who had undergone isolated AVR surgery for the first time. Of the 1053 study patients, 346 patients (33%) had type 2 DM (DM group) and were compared with non-DM (non-DM group) patients (67%). Short-term (in-hospital), intermediate (1- and 3-years), and late (5- and 10-years) mortality were evaluated. Mean follow-up of was 69 ± 43 months.ResultsShort-term (in-hospital) mortality was similar between the DM compared with the non-DM group: 3.5% and 2.5% (p = 0.517). Intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 8.1% vs. 5.7% (p = 0.169) and 12.1% vs. 8.3% (p = 0.064) respectively. Long-term (5- and 10-year) mortality was significantly higher in the DM group, compared to the non-DM group: 19.4% vs. 12.9% (p = 0.007) and 30.3% vs. 23.5% (p = 0.020) respectively. Among the 346 DM patients, 55 (16%) were treated with insulin and 291 (84%) with oral antiglycemic medication only. Overall in-hospital mortality among insulin-treated DM patients was 7.3% compared with 2.7% among non insulin-treated DM patients (p = 0.201). Long-term mortality was higher in the subgroup of insulin-treated DM patients compared with the subgroup of non-insulin treated DM patients with an overall mortality rate of 36.4% vs. 29.2% (p = 0.039). Furthermore, predictors for late mortality included DM (HR 1.39 CI 1.03–1.86, p = 0.031) and insulin treatment (HR 1.76 CI 1.05–2.94, p = 0.033), as demonstrated after adjustment for confounders by multivariable analysis.ConclusionsType 2 DM is an independent predictor for long-term mortality after isolated AVR surgery.

Systemic proinflammatory−profibrotic response in aortic stenosis patients with diabetes and its relationship with myocardial remodeling and clinical outcome

“…In AS patients, diabetes is independently associated with an increase in both mid-term and long-term mortality in those undergoing AVR, as well as in those with asymptomatic AS patients managed conservatively [ 15 , 16 , 32 ]. Herein, we suggest the missing link between diabetes and outcome in AS by demonstrating the association between diabetes and myocardial fibrosis.…”

“…Moreover, the need for more intensive diabetes treatment as a marker of diabetes severity was associated with a greater degree of myocardial fibrosis and LV diastolic dysfunction, especially in insulin-treated diabetic patients. Previous studies have also shown that the prognosis of diabetic AS patients even after AVR are significantly worse especially in those treated with insulin [ 16 , 32 ]. This suggests that factors other than the stenotic valve in AS is responsible for the worse prognosis in diabetic AS patients and that relief of the stenotic valve may not be enough for optimal outcome.…”

Impact of type 2 diabetes mellitus on mid-term mortality for hypertrophic cardiomyopathy patients who underwent septal myectomy

“…However, the impact of DM on the clinical outcomes has been well studied in patients who underwent valve operations and coronary artery bypass. Many studies have reported that DM is associated with significantly worse outcomes after valve operations, and it is an independent predictor for long-term mortality after isolated aortic valve replacement [5,7,15]. In addition, previous studies have revealed that DM can increase the incidence of perioperative complications and heart failure and is an independent predictor of long-term mortality after coronary artery bypass [6,16,17].…”

“…It is an established risk factor for cardiovascular disease and increases the risk of cardiovascular mortality [4]. In addition, previous studies have reported that type 2 DM (T2DM) is associated with adverse cardiovascular events after coronary artery bypass and valve operations [5][6][7]. However, the effect of T2DM on clinical outcomes for HCM patients who had undergone septal myectomy is not well studied.…”

Depressed systemic arterial compliance and impaired left ventricular midwall performance in aortic stenosis with concomitant type 2 diabetes: a retrospective cross-sectional study

“…Degenerative aortic stenosis (AS), a disease of the elderly, frequently coexists with concomitant diseases including type 2 diabetes (T2DM) which amplifies the risk of adverse cardiovascular (CV) events in asymptomatic patients [1] and after surgical aortic valve replacement [2]. Regardless of associations with coronary artery disease (CAD) and hypertension, T2DM per se is a risk factor for heart failure (HF) [3–6], influencing left ventricular (LV) structure and function via multiple pathways, including large artery stiffening and direct effects on the myocardium with consequent enhanced LV hypertrophy and LV dysfunction [7–11].…”