Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China.
Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, People's Republic of China.
Cardiovasc Diabetol. 2020 Sep 2;19(1):131. doi: 10.1186/s12933-020-01112-6.
Patients with type 2 diabetes mellitus (T2DM) are predisposed to poor cardiovascular outcomes after ST-segment elevation myocardial infarction (STEMI). Left ventricular adverse remodeling (LVAR) triggered upon myocardial infarction is recognized as the predominant pathological process in the development of heart failure. In the present study, we sought to investigate whether visit-to-visit fasting plasma glucose (FPG) variability is a potential predictor of LVAR in T2DM patients after STEMI.
From January 2014 to December 2018 in Ruijin Hospital, T2DM patients with STEMI who underwent primary percutaneous coronary intervention were consecutively enrolled and followed up for ~ 12 months. The changes in left ventricular geometric and functional parameters between baseline and 12-month follow-up were assessed by echocardiography. The incidence of LVAR, defined as 20% increase in indexed left ventricular end-diastolic volume (LVEDV), and its relationship with visit-to-visit FPG variability were analyzed. Multivariate regression models were constructed to test the predictive value of FPG variability for post-infarction LVAR.
A total of 437 patients with type 2 diabetes and STEMI were included in the final analysis. During a mean follow-up of 12.4 ± 1.1 months, the incidence of LVAR was 20.6% and mean enlargement of indexed LVEDV was 3.31 ± 14.4 mL/m, which was significantly increased in patients with higher coefficient variance (CV) of FPG (P = 0.002) irrespective of baseline glycemic levels. In multivariate analysis, FPG variability was independently associated with incidence of post-infarction LVAR after adjustment for traditional risk factors, baseline HbA1c as well as mean FPG during follow-up (OR: 3.021 [95% CI 1.081-8.764] for highest vs. lowest tertile of CV of FPG). Assessing FPG variability by other two measures, including standard deviation (SD) and variability independent of the mean (VIM), yielded similar findings.
This study suggests that visit-to-visit FPG variability is an independent predictor of incidence of LVAR in T2DM patients with STEMI. Trial registration Trials number, NCT02089360; registered on March 17,2014.
2 型糖尿病（T2DM）患者在发生 ST 段抬高型心肌梗死（STEMI）后易发生不良心血管结局。心肌梗死后的左心室不良重构（LVAR）被认为是心力衰竭发展的主要病理过程。本研究旨在探讨 T2DM 患者 STEMI 后随访间空腹血糖（FPG）变异性是否是 LVAR 的潜在预测因素。
连续纳入 2014 年 1 月至 2018 年 12 月在瑞金医院行直接经皮冠状动脉介入治疗的 T2DM 合并 STEMI 患者，并进行 12 个月的随访。通过超声心动图评估左心室几何和功能参数在基线和 12 个月随访时的变化。分析 LVAR 的发生率，定义为左心室舒张末期容积指数（LVEDV）增加 20%，及其与随访间 FPG 变异性的关系。构建多变量回归模型以检验 FPG 变异性对梗死后 LVAR 的预测价值。
共纳入 437 例 T2DM 合并 STEMI 患者，最终分析 437 例患者。平均随访 12.4±1.1 个月期间，LVAR 发生率为 20.6%，LVEDV 指数平均增大 3.31±14.4mL/m，FPG 变异系数（CV）较高的患者明显增大（P=0.002），无论基线血糖水平如何。多变量分析显示，在校正传统危险因素、基线 HbA1c 和随访期间平均 FPG 后，FPG 变异性与梗死后 LVAR 发生率独立相关（最高 vs. 最低 FPG CV 三分位 OR：3.021[95%CI 1.081-8.764]）。通过标准差（SD）和均值无关的变异（VIM）评估 FPG 变异性，得到了类似的结果。
本研究表明，T2DM 合并 STEMI 患者的随访间 FPG 变异性是 LVAR 发生率的独立预测因素。试验注册号，NCT02089360；注册于 2014 年 3 月 17 日。
