Top

Published in:

01-01-2019 | Original Paper

Gender-dependent association of diabetes mellitus with mortality in patients undergoing transcatheter aortic valve replacement

Authors: Axel Linke, Florian Schlotter, Stephan Haussig, Felix J. Woitek, Georg Stachel, Jennifer Adam, Robert Höllriegel, Anna Lindner, Friedrich W. Mohr, Gerhard Schuler, Philipp Kiefer, Sergey Leontyev, Holger Thiele, Michael A. Borger, David Holzhey, Norman Mangner

Published in: Clinical Research in Cardiology | Issue 1/2019

Abstract

Background

Diabetes mellitus (DM) is a risk factor for cardiovascular disease. However, its effect on procedural and follow-up performance after transcatheter aortic valve replacement (TAVR) remains controversial.

Methods and results

We performed an observational study of all consecutive patients treated with a transfemoral TAVR in a single-center cohort (n = 1818). All patients were stratified by diabetes status and gender. All-cause 3-year mortality was the primary endpoint. Male patients with DM were identified to have substantially increased 3-year mortality [125/314 (39.8%)] compared to males without DM [142/478 (29.7%), p < 0.01]. Male patients with DM had significantly higher 3-year mortality in comparison to female patients with (p < 0.01) or without DM (p < 0.01). There was no difference in 3-year mortality for female patients with [135/465 (29.0%)] and without DM [151/554 (27.3%); p = 0.70]. This increase in mortality in male DM patients was triggered by both cardiovascular and non-cardiovascular mortality. Furthermore, DM served as an independent predictor of 3-year mortality after TAVR selectively only in men. The interaction between male gender and diabetes mellitus was identified as an independent predictor of 3-year mortality [HR 1.88 (1.25; 2.82); p < 0.01]. DM did not affect 30-day mortality for the overall cohort and for males.

Conclusion

Males with DM are a high-risk subgroup of patients after TAVR and require close medical attention including aggressive therapy of modifiable risk factors. Intensified diabetes management may improve long-term survival after TAVR.

Available only for authorised users

Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J (2010) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375(9733):2215–2222. https://doi.org/10.1016/s0140-6736(10)60484-9 CrossRefPubMed

Katz R, Wong ND, Kronmal R, Takasu J, Shavelle DM, Probstfield JL, Bertoni AG, Budoff MJ, O’Brien KD (2006) Features of the metabolic syndrome and diabetes mellitus as predictors of aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis. Circulation 113(17):2113–2119. https://doi.org/10.1161/CIRCULATIONAHA.105.598086 CrossRefPubMed

Owens DS, Katz R, Takasu J, Kronmal R, Budoff MJ, O’Brien KD (2010) Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA). Am J Cardiol 105(5):701–708. https://doi.org/10.1016/j.amjcard.2009.10.071 CrossRefPubMedPubMedCentral

Otto CM, Prendergast B (2014) Aortic-valve stenosis–from patients at risk to severe valve obstruction. N Engl J Med 371(8):744–756. https://doi.org/10.1056/NEJMra1313875 CrossRefPubMed

Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF (2010) Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr 8:29. https://doi.org/10.1186/1478-7954-8-29 CrossRefPubMedPubMedCentral

Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (2014) Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2 (8):634–647. https://doi.org/10.1016/s2213-8587(14)70102-0 CrossRef

Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 376(14):1321–1331. https://doi.org/10.1056/NEJMoa1700456 CrossRef

Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374(17):1609–1620. https://doi.org/10.1056/NEJMoa1514616 CrossRefPubMed

Holmes DR Jr, Nishimura RA, Grover FL, Brindis RG, Carroll JD, Edwards FH, Peterson ED, Rumsfeld JS, Shahian DM, Thourani VH, Tuzcu EM, Vemulapalli S, Hewitt K, Michaels J, Fitzgerald S, Mack MJ (2015) Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT registry. J Am Coll Cardiol 66(25):2813–2823. https://doi.org/10.1016/j.jacc.2015.10.021 CrossRefPubMed

10.

Gerckens U, Tamburino C, Bleiziffer S, Bosmans J, Wenaweser P, Brecker S, Guo J, Linke A (2017) Final 5-year clinical and echocardiographic results for treatment of severe aortic stenosis with a self-expanding bioprosthesis from the ADVANCE Study. Eur Heart J. https://doi.org/10.1093/eurheartj/ehx295 CrossRefPubMedPubMedCentral

11.

Ando T, Takagi H, Briasoulis A, Umemoto T (2017) Does diabetes mellitus impact prognosis after transcatheter aortic valve implantation? Insights from a meta-analysis. J Cardiol. https://doi.org/10.1016/j.jjcc.2017.01.005 CrossRefPubMed

12.

Mina GS, Gill P, Soliman D, Reddy P, Dominic P (2017) Diabetes mellitus is associated with increased acute kidney injury and 1-year mortality after transcatheter aortic valve replacement: a meta-analysis. Clin Cardiol 40(9):726–731. https://doi.org/10.1002/clc.22723 CrossRefPubMed

13.

Sun Y, Liu X, He Y, Tang M, Zhu Q, Xu X, Guo D, Shi K, Hu P, Wang L, Kong H, Jiang J, Lin X, Xu Q, Gao F, Wang J (2017) Meta-analysis of impact of diabetes mellitus on outcomes after transcatheter aortic valve implantation. Am J Cardiol 119(4):623–629. https://doi.org/10.1016/j.amjcard.2016.10.048 CrossRefPubMed

14.

Saad M, Nairooz R, Pothineni NVK, Almomani A, Kovelamudi S, Sardar P, Katz M, Abdel-Wahab M, Bangalore S, Kleiman NS, Block PC, Abbott JD (2017) Long-term outcomes with transcatheter aortic valve replacement in women compared with men: evidence from a meta-analysis. JACC Cardiovasc Interv. https://doi.org/10.1016/j.jcin.2017.08.015 CrossRefPubMed

15.

Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodes-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 60(15):1438–1454. https://doi.org/10.1016/j.jacc.2012.09.001 CrossRefPubMed

16.

Sherif MA, Zahn R, Gerckens U, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Richardt G, Schneider S, Senges J, Brachmann J (2014) Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry. Clin Res Cardiol 103(8):613–620. https://doi.org/10.1007/s00392-014-0690-6 CrossRefPubMed

17.

Holmes DR Jr, Brennan J, Rumsfeld JS et al (2015) Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA 313(10):1019–1028. https://doi.org/10.1001/jama.2015.1474 CrossRefPubMed

18.

Farhan S, Baber U, Vogel B, Aquino M, Chandrasekhar J, Faggioni M, Giustino G, Kautzky-Willer A, Sweeny J, Shah S, Vijay P, Barman N, Moreno P, Kovacic J, Dangas G, Kini A, Mehran R, Sharma S (2017) Impact of diabetes mellitus on ischemic events in men and women after percutaneous coronary intervention. Am J Cardiol 119(8):1166–1172. https://doi.org/10.1016/j.amjcard.2016.12.035 CrossRefPubMed

19.

Rodes-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Osten M, Feindel CM, Natarajan MK, Velianou JL, Martucci G, DeVarennes B, Chisholm R, Peterson M, Thompson CR, Wood D, Toggweiler S, Gurvitch R, Lichtenstein SV, Doyle D, DeLarochelliere R, Teoh K, Chu V, Bainey K, Lachapelle K, Cheema A, Latter D, Dumesnil JG, Pibarot P, Horlick E (2012) Long-term outcomes after transcatheter aortic valve implantation: insights on prognostic factors and valve durability from the Canadian multicenter experience. J Am Coll Cardiol 60(19):1864–1875. https://doi.org/10.1016/j.jacc.2012.08.960 CrossRefPubMed

20.

Bleiziffer S, Bosmans J, Brecker S, Gerckens U, Wenaweser P, Tamburino C, Linke A (2017) Insights on mid-term TAVR performance: 3-year clinical and echocardiographic results from the CoreValve ADVANCE study. Clin Res Cardiol 106(10):784–795. https://doi.org/10.1007/s00392-017-1120-3 CrossRefPubMed

21.

Barbanti M, Latib A, Sgroi C, Fiorina C, De Carlo M, Bedogni F, De Marco F, Ettori F, Petronio AS, Colombo A, Testa L, Klugmann S, Poli A, Maffeo D, Maisano F, Aruta P, Gulino S, Giarratana A, Patane M, Cannata S, Imme S, Mangoni L, Rossi A, Tamburino C (2014) Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis: results from a large multicentre Italian research project. EuroIntervention 10(1):133–140. https://doi.org/10.4244/eijv10i1a20 CrossRefPubMed

Title: Gender-dependent association of diabetes mellitus with mortality in patients undergoing transcatheter aortic valve replacement
Authors: Axel Linke
Florian Schlotter
Stephan Haussig
Felix J. Woitek
Georg Stachel
Jennifer Adam
Robert Höllriegel
Anna Lindner
Friedrich W. Mohr
Gerhard Schuler
Philipp Kiefer
Sergey Leontyev
Holger Thiele
Michael A. Borger
David Holzhey
Norman Mangner
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 1/2019
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1309-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Gender-dependent association of diabetes mellitus with mortality in patients undergoing transcatheter aortic valve replacement

Abstract

Background

Methods and results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Correction to: Integrating basic science in academic cardiology training: two international perspectives on a common challenge

Polymer-free drug-coated coronary stents in diabetic patients at high bleeding risk: a pre-specified sub-study of the LEADERS FREE trial

Heart Valve Disease Awareness Survey 2017: what did we achieve since 2015?

Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves

Butterfly and reverse butterfly: usefulness of a resistance band to provoke exercise-induced arrhythmias during catheter ablation in a patient refractory to pharmacological stimulation

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page