Wang Shaoping, Borah Bijan J, Cheng Shujuan, Li Shiying, Zheng Ze, Gu Xiaoyan, Gong Ming, Lyu Yi, Liu Jinghua
Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.
Front Cardiovasc Med. 2021 Sep 27;8:751474. doi: 10.3389/fcvm.2021.751474. eCollection 2021.
To investigate the association between diabetes mellitus (DM) and ejection fraction (EF) improvement following revascularization in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Revascularization may improve outcomes of patients with LV dysfunction by improvement of EF. However, the determinants of EF improvement have not yet been investigated comprehensively. A cohort study (No. ChiCTR2100044378) of patient with repeated EF measurements after revascularization was performed. All patients had baseline EF ≤40%. Patients who had EF reassessment 3 months after revascularization were enrolled. Patients were categorized into EF unimproved (absolute increase in EF ≤5%) and improved group (absolute increase in EF >5%). A total of 974 patients were identified. 573 (58.8%) had EF improved. Patients with DM had greater odds of being in the improved group (odds ratio [OR], 1.42; 95% CI, 1.07-1.89; = 0.014). 333 (34.2%) patients with DM had a greater extent of EF improvement after revascularization (10.5 ± 10.4 vs. 8.1 ± 11.2%; = 0.002) compared with non-diabetic patients. The median follow-up time was 3.5 years. DM was associated with higher risk of overall mortality (hazard ratio [HR], 1.46; 95% CI, 1.02-2.08; = 0.037). However, in EF improved group, the risk was similar between diabetic and non-diabetic patients (HR, 1.36; 95% CI, 0.80-2.32; = 0.257). Among patients with reduced EF, DM was associated with greater EF improvement after revascularization. Revascularization in diabetic patients might partially attenuate the impact of DM on adverse outcomes. Our findings imply the indication for revascularization in patients with LV dysfunction who present with DM.
探讨冠心病（CAD）合并左心室（LV）功能障碍患者血管重建术后糖尿病（DM）与射血分数（EF）改善之间的关联。血管重建术可能通过改善EF来改善LV功能障碍患者的预后。然而，EF改善的决定因素尚未得到全面研究。对血管重建术后重复测量EF的患者进行了一项队列研究（编号ChiCTR2100044378）。所有患者的基线EF≤40%。纳入血管重建术后3个月进行EF重新评估的患者。患者被分为EF未改善组（EF绝对增加≤5%）和改善组（EF绝对增加>5%）。共确定了974例患者。573例（58.8%）EF得到改善。DM患者处于改善组的几率更高（优势比[OR]，1.42；95%可信区间，1.07 - 1.89；P = 0.014）。与非糖尿病患者相比，333例（34.2%）DM患者血管重建术后EF改善程度更大（10.5±10.4 vs. 8.1±11.2%；P = 0.002）。中位随访时间为3.5年。DM与总体死亡风险较高相关（风险比[HR]，1.46；95%可信区间，1.02 -
