Copyright © 2004 by the European Society of Cardiology.
Clinical research
Impact of diabetes mellitus on long-term survival in patients with congestive heart failure
a Hôpital Cardiologique, CHRU de Lille, Lille Cedex 59037, France
b Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
Received August 13, 2003;
revised December 8, 2003;
accepted January 15, 2004
* Corresponding author. Tel.: +33-3-20-44-50-45; fax: +33-3-20-44-48-81
E-mail address: cbauters{at}chru-lille.fr
See page 629 for the editorial comment on this article.1
Aims To test the hypothesis that diabetic status may be used as a prognostic indicator in heart failure (HF) patients.
Methods and results We studied 1246 consecutive patients with left ventricular dysfunction. All patients had a cardiopulmonary exercise test and an echocardiogram. Cardiac catheterisation was systematically performed to define HF aetiology. Twenty-two percent of the patients were diabetic (hypoglycaemic drugs or fasting blood glucose 
126 mg/dL); in diabetic patients, HF aetiology was ischaemic in 58% vs. 40% in non-diabetic patients (
).
Clinical follow-up (median 1200 days) was obtained for 1241 patients. There was a statistically significant effect of diabetes mellitus on cardiac survival that differed according to HF aetiology (interaction 
). Diabetes mellitus was an independent predictor of cardiovascular mortality in ischaemic patients (HR=1.54 [1.13; 2.09]; 
) but not in non-ischaemic patients (HR=0.65 [0.39; 1.07]; 
). When diabetic patients were defined as patients receiving hypoglycaemic drugs at baseline, diabetes mellitus remained an independent predictor of cardiovascular mortality in ischaemic patients (HR=1.43 [1.03; 1.98]; 
) while diabetes mellitus was associated with a statistically significant decrease in cardiovascular mortality in non-ischaemic patients (HR=0.46 [0.23; 0.88]; 
).
Conclusion The prognostic impact of diabetes mellitus in HF patients is markedly influenced by the underlying aetiology and is particularly deleterious in those with ischaemic cardiomyopathy.
Key Words: Diabetes mellitus • Heart failure • Ischaemia • Prognosis
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