HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marco Ranucci Marisa Di Donato Lorenzo Menicanti Permission Requests Google Scholar Articles by Castelvecchio, S. Articles by Menicanti, L. PubMed Articles by Castelvecchio, S. Articles by Menicanti, L. Related Collections Cardiac - other

---

Original Articles: Adult Cardiac

Diabetes Mellitus and Long-Term Outcome in Heart Failure Patients After Surgical Ventricular Restoration

^a Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
^b Department of Cardiothoracic and Vascular Anesthesia & ICU, IRCCS Policlinico San Donato, Milan, Italy
^c Department of Critical Care Medicine, University of Florence, Florence, Italy

Accepted for publication July 2, 2009.

^_* Address correspondence to Dr Castelvecchio, Department of Cardiac Surgery, IRCCS, Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, 20097, Italy (Email: castelvecchio.serenella{at}gmail.com).

Background: This study aimed to identify the impact of diabetes mellitus and related comorbidities on long-term survival of heart failure patients who had undergone surgical ventricular restoration. Surgical ventricular restoration is an optional therapeutic strategy for patients with ischemic dilated cardiomyopathy. Reported prognostic predictors for late morbidity and mortality are predominantly related to cardiac conditions, whereas the prognostic impact of comorbidities still needs to be defined.

Methods: A total of 329 patients (234 nondiabetic and 95 diabetic) who survived the surgical ventricular restoration operation were admitted to this study. Cardiac mortality follow-up data were collected. Actuarial survival curves were calculated for the two groups; differences between groups and the impact of other comorbidities were established using a log-rank test and a Cox regression analysis.

Results: The mean follow-up time was 44 months. Diabetic patients had a significantly worse survival rate: at 5 years, their survival rate was 81%, versus 89% for nondiabetic patients (p = 0.019). Other comorbidities significantly associated with the survival rate were chronic renal failure, New York Heart Association class, and liver dysfunction. Diabetic patients without comorbidities had a survival rate similar to that of nondiabetic patients. Diabetic patients with at least one comorbidity had a significantly worse outcome. Diabetic patients with chronic renal failure had a 5-year survival rate of 40%, versus 85% for nondiabetic patients (p = 0.002).

Conclusions: Noncomplicated diabetes has no negative impact on long-term survival after surgical ventricular restoration. Conversely, complicated diabetes, namely the presence of chronic renal failure, carries a long-term cardiac mortality risk that is four times higher than the risk for nondiabetic patients.