Background Diabetes mellitus (DM) is a risk factor for morbidity and mortality in patients with heart failure. The effect of DM on post–left ventricular assist device (LVAD) implantation outcomes is unclear. This study sought to investigate whether patients with DM had worse outcomes than patients without DM after LVAD implantation and whether LVAD support resulted in a better control of DM.

Methods and Results We retrospectively reviewed 341 consecutive adults who underwent implantation of LVAD from 2007 to 2016. Patient characteristics and adverse events were studied and compared between patients with and without DM. One hundred thirty-one patients (38%) had DM. Compared with patients without DM, those with DM had higher rates of ischemic cardiomyopathy, LVAD implantation as destination therapy, and increased baseline body mass index. In a proportional hazards (Cox) model with adjustment for relevant covariates and median follow-up of 16.1 months, DM was associated with increased risk of all-cause mortality (hazard ratio, 1.73; 95% confidence interval: 1.18–2.53; P=0.005) and increased risk of nonfatal LVAD-related complications, including a composite of stroke, pump thrombosis, and device infection (hazard ratio, 2.1; 95% confidence interval: 1.35–3.18; P=0.001). Preoperative hemoglobin A1c was not significantly associated with mortality or adverse events among patients with DM. LVAD implantation resulted in a remarkable decrease in hemoglobin A1c levels (7.4±1.9 pre-LVAD versus 6.0±1.5 and 6.3±1.4 after 3 and 12 months post-LVAD, respectively; P<0.0001) and a significant reduction in requirements of DM medications.

Conclusions DM is associated with increased rates of all-cause mortality and major adverse events despite favorable glycemic control after LVAD implantation.

背景技术糖尿病（DM）是心力衰竭患者发病和死亡的危险因素。DM对左心室辅助装置（LVAD）植入结局的影响尚不清楚。这项研究旨在调查在LVAD植入后DM患者是否比没有DM患者具有更差的结局，以及LVAD支持是否能更好地控制DM。

方法和结果我们回顾性分析了2007年至2016年间341例接受LVAD植入的成人。研究了患者的特征和不良事件，并对有无DM的患者进行了比较。一百一十三例（38％）患有糖尿病。与没有DM的患者相比，患有DM的患者具有更高的缺血性心肌病发生率，LVAD植入作为目的地疗法以及基线体重指数增加。在比例风险（Cox）模型中，对相关协变量进行了调整，中位随访时间为16.1个月，DM与全因死亡率的风险增加相关（风险比，1.73； 95％置信区间：1.18–2.53；P= 0.005）和非致命性LVAD相关并发症（包括中风，泵血栓形成和器械感染的综合风险）增加（危险比，2.1； 95％置信区间：1.35-3.18；P = 0.001）。DM患者的术前血红蛋白A1c与死亡率或不良事件无显着相关性。LVAD植入导致血红蛋白A1c水平显着下降（LVAD之前3个月和12个月后分别为7.4±1.9和6.0±1.5和6.3±1.4; P <0.0001），并且DM药物的需求量显着降低。

结论尽管LVAD植入后血糖控制良好，但DM与全因死亡率增加和主要不良事件有关。