Impact of glycemic status on left ventricular systolic function in patients with acute coronary syndrome

Yıl 2015, Cilt: 1 Sayı: 3, 58 - 63, 01.07.2015

Alaaeldin Abdelhady Amin Waleed Abdelsalam Ammar Azza Abdelmoniem Farrag

https://doi.org/10.5455/umj.20150924034203

Öz

Background: Diabetes mellitus DM and left ventricular systolic dysfunction LVSD commonly coexist; increasing morbidity and mortality among patients. The aim of this study is to detect the correlation between the glycemic status of patients presenting by acute coronary syndrome ACS and left ventricular global and regional systolic function. Method: The study included 510 patients presenting by ACS and referred for coronary angiography. In addition to routine laboratory tests, Glycated hemoglobin HbA1C level, as a marker of chronic glycemic status, was measured. Every patient was subjected to transthoracic echocardiographic study with accurate evaluation of left ventricular systolic function by both m-mode and biplane Simpson's method, in addition to calculation of regional wall motion score index RWMSI . The whole study population was divided into two groups; diabetic and non-diabetic based on cutoff point of HbA1C value 6.5%. The non-diabetic group was subdivided into two groups; high risk and low risk based on cutoff point of HbA1C value 5.7% Results: Sixty four percent of the studied population had DM. The mean HbA1C level was 7.6 ± 2.2%. The mean left ventricular ejection fraction LVEF was 54 ± 11 and mean RWMSI was 1.3 ± 0.3. There was significant negative correlation between the HbA1C level and the LVEF r = -0.101, p < 0.022 . There was significant positive correlation between HbA1C level and RWMSI r = 0.109, p < 0.014 . The non-diabetic high risk group had lower LVEF and higher RWMSI than the low risk group p < 0.041 and p < 0.002 respectively . Conclusion: Chronic hyperglycemia in patients with uncontrolled DM may be a risk factor for developing LVSD in patients presenting by ACS. Glycated hemoglobin level may predict LVSD in patients with ACS. Non-diabetic patients who are at higher risk of developing DM have higher incidence of LVSD.

Anahtar Kelimeler

Diabetes mellitus, glycated hemoglobin, ejection fraction, acute coronary syndrome

Kaynakça

• Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R et al. American Heart Association; American Diabetes Association: Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007, 115 (1): 114-126.
• Stolar MW, Chilton RJ: Type 2 diabetes, cardiovascular risk, and the link to insulin resistance. Clin Ther 2003; 25(B): B4-31.
• Mochizuki Y, Tanaka H, Matsumoto K, Sano H, Toki H, Shimoura H et al. Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus. Cardiovascular Diabetology 2015; 14: 37.
• American Diabetes Association. Glycemic targets. Sec. 6 In Standards of Medical Care in Diabetes-2015. Diabetes Care ; 38 (S1): S33 - S40.
• Bando YK, Murohara T.Diabetes-Related Heart Failure. Does Diabetic Cardiomyopathy Exist? Circ J 2014; 78:576-583.
• Matsushita K, Blecker S, Pazin-Filho A, Bertoni A, Chang PP, Coresh J et al. The association of hemoglobin A1c with incident heart failure among people without diabetes: The atherosclerosis risk in communities study. Diabetes 2010; 59: 2026.
• Banerjee D, Biggs ML, Mercer L, Mukamal K, Kaplan R, Barzilay J et al. Insulin resistance and risk of incident heart failure: Cardiovascular Health Study. Circ Heart Fail 2013; 6: 370.
• Witteles RM, Fowler MB. Insulin-resistant cardiomyopathy clinical evidence, mechanisms, and treatment options. J Am Coll Cardiol 2008; 51: 93 - 102.
• American Diabetes Association. Classification and diagnosis of diabetes. Sec. 2 In Standards of Medical Care in Diabetes- Diabetes Care 2015; 38 (S1): S8 – S16.
• Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr ; 28: 1 - 39. Tsai JP, Tian J, Wang WY, Ng AC. Glycated hemoglobin vs fasting plasma glucose as a predictor of left ventricular dysfunction after ST-elevation myocardial infarction. Can J Cardiol. 2015; 31 (1): 44 - 9
• Kumar S, Aneja GK, Trivedi A, Atam V, Singh A, Panwar NV et al. Glycosylated Hemoglobin (HbA1c) is a reliable Predictor of left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) in newly diagnosed type 2 diabetic patients of western Uttar Pradesh. Int. J. Sci. Res. Publ 2014; 4 (12): 1-7
• Abdul Razzaq MK, Rasheed JI, Mohmmad HS. The value of admission glucose and glycosylated hemoglobin in patients with acute coronary syndrome. IPMJ 2013; 12: 75 - 84.
• Mayorga MP, Gomez-Arbelafez D, Melgarejo E, Bravo MA, Martinez A, Gonzalez LA et al. Relationship between Glycated Hemoglobin and Left ventricular ejection fraction in Diabetes type 2 patients on their first acute myocardial infarction. Rev.fac.med 2014; 22 (2): 12-19.
• Pham I, Cosson E, Nguyen MT, Banu I, Genevois I, Poignard P et al. Evidence for a Specific Diabetic Cardio myopathy: An Observational Retrospective Echocardiographic Study in 656 Asymptomatic Type 2 Diabetic Patients. Int J Endocrinol 2015; 2015: 1-8.
• Ashraf MU, Zaheer MS, Rabbani MU, Ashraf J, Aslam M. Impact of HbA1C on Outcomes of Acute Coronary Syndrome in Non-Diabetic Patients. J Cardiol. Therap.2014; 2(3):110-114.
• Hİfsten DE, Lİgstrup BB, Mİller JE, Pellikka PA, Egstrup K. Abnormal Glucose Metabolism in Acute Myocardial Infarction: Influence on Left Ventricular Function and Prognosis. JACC: Cardiovascular imaging 2009; 2(5): 592-599.