See Article by Asleh et al

As outcomes of left ventricular assist device (LVAD) therapy for advanced systolic heart failure (HF) have improved, focus shifts from identification and exclusion of patients with high-risk features toward finding opportunities to modify such risks and maximize event-free survival on LVAD support. Diabetes mellitus (DM) is one such feature, but existing literature has neither fully defined the risk presented by this comorbidity nor the best strategies for management. This is critical because DM is a common problem and HF pathogenesis. Independent of coronary artery disease and hypertension, DM may cause cardiomyopathy, and >40% of patients hospitalized for decompensated HF have DM.¹ We are challenged when we consider these patients for advanced HF therapies. In this issue of Circulation: Heart Failure, Asleh et al² present a detailed analysis of their single-center experience with DM and LVAD outcomes. They have added to the literature evidence that DM is associated with an increased rate of all-cause mortality and major adverse events during LVAD support. Specifically, a retrospective analysis of 341 consecutive adult patients undergoing predominantly destination therapy LVAD implant from 2007 to 2016 was performed. This experience totaled almost a decade and thus saw changes in devices, changes in device implant philosophy, and undoubtedly, changes in patient selection. Although the study experienced all the usual limitations of a retrospective cohort design, including incomplete evaluation of the impact of type 1 versus type 2 DM, duration of DM, short- and long-term treatment strategies, and the role of micro- and macrovascular DM complications, these real-world studies can provide valuable insight into optimal patient selection and management practices. The authors remind us that the International Society for Heart and Lung Transplantation patient selection guidelines considers DM presence to be important but focuses on patients with poor glycemic …

参见Asleh等人的文章

随着左心室辅助设备（LVAD）治疗晚期收缩性心力衰竭（HF）的结果有所改善，重点从识别和排除高危患者转向寻找机会来改变此类风险并最大程度地提高LVAD的无事件生存率支持。糖尿病（DM）就是其中之一，但是现有文献既没有完全定义这种合并症带来的风险，也没有最佳的治疗策略。这很关键，因为DM是一个常见问题，也是HF的发病机理。与冠心病和高血压无关，DM可能引起心肌病，并且因代偿性HF住院的患者中有40％以上患有DM。¹当我们考虑将这些患者用于晚期HF治疗时，我们面临挑战。在本期循环：心力衰竭，Asleh等²介绍他们对DM和LVAD结果的单中心经验的详细分析。他们为文献提供了证据，证明DM与LVAD支持期间全因死亡率和主要不良事件发生率增加有关。具体而言，对2007年至2016年间341例主要接受目的地疗法LVAD植入的成年患者进行了回顾性分析。这项经验总计将近十年，因此看到了设备的变化，设备植入原理的变化，以及毫无疑问的患者选择的变化。尽管该研究经历了回顾性队列设计的所有常规限制，包括对1型与2型DM的影响，DM的持续时间，短期和长期治疗策略以及微血管和大血管DM的作用的不完整评估并发症 这些现实世界的研究可以为最佳患者选择和管理实践提供有价值的见解。作者提醒我们，国际心脏和肺移植协会患者选择指南认为DM的存在很重要，但主要针对血糖不良的患者……