AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Novel Guideline-Directed Medical Therapy and Ventricular Arrhythmia Risk in Diabetes with Non-Ischemic Cardiomyopathy
By Han D, Heist EK, Gleva M et al.
Introduction: The Analysis of Both Sex and Device Specific Factors on Outcomes in Patients with Non-Ischemic Cardiomyopathy (BIO-LIBRA) study studied contemporary outcomes implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT-D) in non-ischemic cardiomyopathy (NICM) patients with guideline-directed medical therapy (GDMT) including SGLT2 inhibitor (SGLT2i) and ARNI. However, the risk of ventricular arrhythmias (VT/VF) was not assessed by diabetes and novel GDMT. Objective: We aimed to examine the risk of VT/VF/Death by diabetes and novel GDMTs in NICM patients with ICD or CRT-D. Methods: We included 1000 patients from BIO-LIBRA, enrolling 336 (34%) patients with diabetes, further stratified by SGLT2i or ARNI use. Rates of VT/VF and death alone were assessed by Kaplan-Meier analyses. Multivariate Cox-proportional analyses were performed to assess the risk of the primary endpoint of VT/VF or death alone by diabetes and by novel GDMTs. Results: Patients with diabetes prescribed SGLT2i had the lowest rate of VT/VF compared to no SGLT2i (Figure A, 3% vs. 10%, log-rank p=0.023), linked to an 80% lower risk of VT/VF (HR=0.20, CI=0.03-1.50, p=0.12). Patients without diabetes had similar rates and risk of VT/VF with or without SGLT2i (Fig. A, HR=1.00, CI=0.14-7.43). Patients with diabetes and ARNI had a lower rate of death compared to no ARNI (Figure B, 8% vs. 17%, log-rank p=0.03) with a significant, 54% lower risk of death (HR=0.58, CI:0.36-0.94, p=0.025). Patients without diabetes had similar rates and risk of Death with or without ARNI as patients with diabetes and ARNI. Similar findings were found for VT/VF/death, but not for VT/VF only in patients with ARNI. Conclusion: Among NICM patients, the use of novel GDMT, SGLT2i was linked to a lower rate of VT/VF, while the use of ARNI was linked to a significantly lower risk of death in patients with diabetes, highlighting the importance of incorporating these new medications into their treatment regimen prior to an ICD or CRT-D implantation to improve outcomes.