Høfsten Dan E, Løgstrup Brian B, Møller Jacob E, Pellikka Patricia A, Egstrup Kenneth
Department of Medical Research, Funen Hospital, Svendborg, Denmark.
JACC Cardiovasc Imaging. 2009 May;2(5):592-9. doi: 10.1016/j.jcmg.2009.03.007.
We studied the influence of abnormal glucose metabolism on left ventricular (LV) function and prognosis in 203 patients with acute myocardial infarction.
Abnormal glucose metabolism is associated with increased mortality after acute myocardial infarction. This appears to be particularly attributable to an increased incidence of post-infarction congestive heart failure. A relationship between glucose metabolism and LV function could potentially explain this excess mortality.
In patients without known diabetes, glucose metabolism was determined using an oral glucose tolerance test before discharge. LV function was assessed using echocardiographic measurements (LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, restrictive diastolic filling pattern, early transmitral flow velocity to early diastolic mitral annular velocity ratio [E/e'], and left atrial volume index) and by measuring plasma N-terminal pro-B-type natriuretic peptide levels.
After adjustment for age and gender, a linear relationship between the degree of abnormal glucose metabolism was observed for each marker of LV dysfunction (p(trend) < 0.05) with the exception of left atrial volume index (p = 0.10). During a median follow-up of 21 months, 32 patients died, and 39 patients met the secondary end point of death or hospitalization for heart failure. After adjustment for differences in LV function, as well as other relevant characteristics, newly detected, as well as known diabetes were independent predictors of both all-cause mortality (hazard ratios [HR]: 4.2 [95% confidence interval (CI): 1.1 to 17.1] and HR: 5.7 [95% CI: 1.3 to 25.2], respectively), and the composite of death or hospitalization for heart failure (HR: 4.3 [95% CI: 1.2 to 15.6] and HR: 5.8 [95% CI: 1.5 to 22.3], respectively). Comparable nonsignificant trends were observed for patients with impaired glucose tolerance.
Although perturbations in glucose metabolism were linearly associated with impairment of LV function in the early phase of acute myocardial infarction, this relationship alone did not explain the excess mortality in patients with newly detected or known diabetes.
我们研究了203例急性心肌梗死患者中糖代谢异常对左心室（LV）功能及预后的影响。
急性心肌梗死后糖代谢异常与死亡率增加相关。这似乎尤其归因于梗死后充血性心力衰竭发生率的增加。糖代谢与左心室功能之间的关系可能解释了这种额外的死亡率。
在无已知糖尿病的患者中，出院前通过口服葡萄糖耐量试验测定糖代谢情况。使用超声心动图测量（左心室舒张末期容积、左心室收缩末期容积、左心室射血分数、限制性舒张充盈模式、二尖瓣早期血流速度与二尖瓣环早期舒张速度比值[E/e']以及左心房容积指数）并测量血浆N末端B型利钠肽原水平来评估左心室功能。
在调整年龄和性别后，除左心房容积指数外（p = 0.10），观察到糖代谢异常程度与每种左心室功能障碍标志物之间存在线性关系（p趋势<0.05）。在中位随访21个月期间，32例患者死亡，39例患者达到死亡或因心力衰竭住院的次要终点。在调整左心室功能差异以及其他相关特征后，新检测出的糖尿病以及已知糖尿病均是全因死亡率（风险比[HR]：分别为4.2[95%置信区间（CI）：1.1至17.1]和HR：5.7[95%CI：1.3至25.2]）以及死亡或因心力衰竭住院的复合终点（HR：分别为4.3[95%CI：1.2至15.6]和HR：5.8[95%CI：1.5至22.3]）的独立预测因素。糖耐量受损患者观察到类似的非显著趋势。
虽然在急性心肌梗死早期糖代谢紊乱与左心室功能损害呈线性相关，但仅这种关系并不能解释新检测出或已知糖尿病患者的额外死亡率。
