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Clinical Research in Cardiology

, Volume 108, Issue 1, pp 39–47 | Cite as

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

  • 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 MangnerEmail author
Original Paper
  • 84 Downloads

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.

Keywords

Aortic stenosis Diabetes mellitus Gender TAVR Outcome 

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

Notes

Compliance with ethical standards

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.

Supplementary material

392_2018_1309_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 30 KB)
392_2018_1309_MOESM2_ESM.pptx (278 kb)
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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Axel Linke
    • 1
  • Florian Schlotter
    • 2
  • Stephan Haussig
    • 1
  • Felix J. Woitek
    • 1
  • Georg Stachel
    • 2
  • Jennifer Adam
    • 2
  • Robert Höllriegel
    • 1
  • Anna Lindner
    • 2
  • Friedrich W. Mohr
    • 3
  • Gerhard Schuler
    • 2
  • Philipp Kiefer
    • 4
  • Sergey Leontyev
    • 4
  • Holger Thiele
    • 2
  • Michael A. Borger
    • 4
  • David Holzhey
    • 4
  • Norman Mangner
    • 1
    Email author
  1. 1.Department of Internal Medicine and Cardiology, Heart Center DresdenTechnical University of DresdenDresdenGermany
  2. 2.Department of Internal Medicine/Cardiology, Heart Center LeipzigUniversity HospitalLeipzigGermany
  3. 3.Leipzig Heart InstituteLeipzigGermany
  4. 4.Department of Cardiac Surgery, Heart Center LeipzigUniversity HospitalLeipzigGermany

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