Diabetes mellitus and cardiovascular mortality across the spectrum of aortic stenosis. (3rd October 2022)

• Record Type: Journal Article
• Authors: Coisne, A; Montaigne, D; Ninni, S; Lamblin, N; Lemesle, G; Delsart, P; Butruille, L; Decoin, R; Woitrain, E; Granada, J; Staels, B; Bauters, C
• Is Part Of: European heart journal. Volume 43(2022)Supplement 2
• Publication Date: 2022-10-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac544.1527
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Current data regarding the impact of diabetes mellitus (DM) on cardiovascular mortality in patients with aortic stenosis (AS) are restricted to severe AS or aortic valve replacement (AVR) trials. Purpose: To investigate cardiovascular mortality according to DM across the entire spectrum of AS outpatients. Methods: Between May 2016 and December 2017, patients with mild (peak aortic velocity=2.5–2.9m/s), moderate (3–3.9m/s) and severe (≥4m/s) AS graded by echocardiography were included during outpatient cardiology visits in the Nord-Pas-de-Calais region in France and followed-up for modes of death. Results: Among 2, 703 patients, 820 (30.3%) had DM, mean age was 76±10.8 years with 46.6% of women and a relatively high prevalence of underlying cardiovascular diseases. There were 200 cardiovascular deaths prior to AVR during the 2.1 years (IQR 1.4–2.7) follow-up period. In adjusted analyses, DM was significantly associated with cardiovascular mortality (HR=1.40, 95% CI 1.04–1.89; P=0.029). In mild or moderate AS, the cardiovascular mortality of diabetic patients was similar to that of nondiabetic patients (Figuer 1). In severe AS, DM was associated with higher cardiovascular mortality (HR=2.65, 95% CI 1.50–4.68; P=0.001). This was almost exclusively related to a higher risk of death from heart failure (HR=2.61, 95% CI 1.15–5.92; P=0.022) and sudden death (HR=3.33, 95% CI 1.28–8.67; P=0.014) (Figure 2). Conclusion: The effect of DM on cardiovascular mortality varied across AS severity. Despite no association between DM and outcomes in mild/moderate AS patients, DM was strongly associated with death from heart failure and sudden death in severe AS patients. Funding Acknowledgement: Type of funding sources: Public Institution(s). Main funding source(s): Fédération Française de Cardiologie