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

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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.

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Abbreviations

DM:

Diabetes mellitus

TAVR:

Transcatheter aortic valve replacement

BMI:

Body mass index

CAD:

Coronary artery disease

NYHA:

New York Heart Association

STS:

Society of Thoracic Surgeons

PAD:

Peripheral artery disease

MI:

Myocardial infarction

CABD:

Coronary artery bypass grafting

PCI:

Percutaneous coronary intervention

CKD:

Chronic kidney disease

VARC:

Valve Academic Research Consortium

AR:

Aortic valve regurgitation

MR:

Mitral valve regurgitation

PPM:

Permanent pacemaker

ICD:

Implantable cardioverter/defibrillator

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    Authors and Affiliations

    1. Department of Internal Medicine and Cardiology, Heart Center Dresden, Technical University of Dresden, Fetscherstr. 76, 01307, Dresden, Germany

      Axel Linke, Stephan Haussig, Felix J. Woitek, Robert Höllriegel & Norman Mangner

    2. Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany

      Florian Schlotter, Georg Stachel, Jennifer Adam, Anna Lindner, Gerhard Schuler & Holger Thiele

    3. Leipzig Heart Institute, Leipzig, Germany

      Friedrich W. Mohr

    4. Department of Cardiac Surgery, Heart Center Leipzig, University Hospital, Leipzig, Germany

      Philipp Kiefer, Sergey Leontyev, Michael A. Borger & David Holzhey

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    Correspondence to Norman Mangner.

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    Conflict of interest

    Axel Linke: reports grants and personal fees from Medtronic, personal fees from St. Jude Medical, grants from Claret Medical, personal fees and other from Claret Medical, personal fees from Boston Scientific, personal fees from Bard, personal fees from Edwards, outside the submitted work. Florian Schlotter: No conflict of Interest. Stephan Haussig: No conflict of Interest. Felix J. Woitek: No conflict of Interest. Georg Stachel: No conflict of Interest. Jennifer Adam: No conflict of Interest. Robert Höllriegel: No conflict of Interest. Anna Lindner: No conflict of Interest. Friedrich W. Mohr: No conflict of Interest. Gerhard Schuler: No conflict of Interest. Philipp Kiefer: No conflict of Interest. Sergey Leontyev reports other from St. Jude Medical, other from Medtronic, outside the submitted work. Holger Thiele: No conflict of interest. Michael M. Borger: Speakers’ honoraria and consulting fees from Edwards Lifesciences, Medtronic, and CryoLife, outside the submitted work. David Holzhey reports other from Symetis, other from Medtronic, outside the submitted work. Norman Mangner: No conflict of Interest.

    Additional information

    Axel Linke and Florian Schlotter contributed equally to this work and should be regarded as shared first authors.

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    Supplemental Figure 1

    : Kaplan-Meier analyses for: a) 30-day survival; b) one-year survival; c) landmark analysis 30 days to one year after TAVR; d) three-year cardiovascular mortality; e) three-year non-cardiovascular mortality; four group comparison between non-diabetic females, diabetic females, non-diabetic males and diabetic males (PPTX 277 KB)

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    Linke, A., Schlotter, F., Haussig, S. et al. Gender-dependent association of diabetes mellitus with mortality in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 108, 39–47 (2019). https://doi.org/10.1007/s00392-018-1309-0

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