Diabetes mellitus (DM) in patients after acute myocardial infarction
(MI) has been shown to be a strong predictor of short-and long-term
mortality. It has also been recognized that DM is associated with an
increased rate of post-infarction heart failure.
Aim of the study: To evaluate the impact of diabetes mellitus on
myocardial reperfusion after primary PCI in patients with acute
myocardial infarction utilizing, resolution of ST-segment elevation
and myocardial blush grade (MBG) and To evaluate the impact of
diabetes mellitus on left ventricular remodeling using 2-D speckle
tracking.
Methods: The study population consisted of 100 patients with
anterior STEMI (50 diabetic and 50 non diabetic) all patients
underwent 1ry PCI. Conventional 2D echocardiography to asses
LVEF, EDV and ESV and speckle tracking echocardiography to
asses LV global longitudinal strain and global circumferential strain
was done within 72 h of admission and after 3 months later and
patients with LV remodeling, i.e. an increase >20% in LV enddiastolic
volume (LVEDV), were identified.
Results: No significant difference was found regarding baseline
clinical, angiographic and echocardiographic characteristics except
in MBG3 (18% vs. 54% p = 0.001), MBG1 (32% vs. 8% p=0.003),
complete ST segment resolution (18% vs. 48% p=0.001) and
Absent ST segment resolution (28% vs. 10% p=0.022) between
diabetics and non diabetics respectively. Despite a similar incidence
of LV remodeling in DM and non DM groups (22% vs. 16%,
p=0.444), The 19 patients with LV remodeling had significantly
more impaired LVEDV (99.84 ± 19.24 vs. 125.11 ± 19.96, p=0.001),
and LV global longitudinal strain (GLS) (-11.47 ± 1.34% vs. -10.61
± 2.15%, p=0.021). Change in end diastolic volume showed
the strongest correlation with the GLS (P=0.042, r=0.473) and
apical circumferential strain (P=0.028, r=0.014). Furthermore,
apical circumferential strain demonstrated the highest diagnostic
accuracy: area under the receiver operating characteristic (ROC)
curve, with sensitivity 84.2% and specificity 88.9%, using a cutoff
value >-11.7% and GLS with sensitivity 89.5% and specificity
65.4%, using a cutoff value >-12.5% for prediction of LV remodeling.
Conclusion: Despite worse micro vascular reperfusion and ST
segment resolution in STEMI patients with diabetes, the incidence
of LV remodeling was similar compared to non-DM patients and LV
apical CS and GLS is a predictive param¬eter of future adverse
remodeling. |
