Is There a Sweet Spot for Left Ventricular Assist Devices and Diabetes Mellitus?
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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 …