Nan Yifeng, Tiemuerniyazi Xieraili, Song Yangwu, Chen Liangcai, Yang Ziang, Zhang Shicheng, Feng Wei
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Rev Cardiovasc Med. 2023 Jul 17;24(7):209. doi: 10.31083/j.rcm2407209. eCollection 2023 Jul.
Iron deficiency (ID) is one of the most common micronutrient deficiencies affecting public health. Studies show that ID affects the prognosis of patients with heart disease, including heart failure, coronary artery disease and myocardial infarction. However, there is limited information regarding the impact of ID on patients undergoing cardiac surgery. This study aimed to evaluate the influence of preoperative ID on the prognosis of type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG).
In the Glycemic control using mobile-based intervention in patients with diabetes undergoing coronary artery bypass to promote self-management (GUIDEME) study, patients with T2DM undergoing CABG were prospectively recruited. In this study, only those patients with preoperative iron metabolism results were enrolled. Patients were grouped based on the presence of preoperative ID. The primary endpoint was defined as the significant improvement of follow-up ejection fraction (EF) compared to postoperative levels (classified according to the 75th percentile of the change, and defined as an improvement of greater than or equal to 5%). Univariable logistic regression was performed to explore the potential confounders, followed by multiple adjustment.
A total of 302 patients were enrolled. No deaths were observed during the study period. A higher incidence of the primary endpoint was observed in the ID group (25.4% vs 12.9%, = 0.015). The postoperative and follow-up EF were similar beween the two groups. In the regression analysis, ID was noticed to be a strong predictor against the significant improvement of EF in both univariable (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.22-0.86, = 0.017) and multivariable (OR: 0.43, 95% CI: 0.24-0.98, = 0.043) logistic regression. In the subgroup analysis, ID was a predictor of significant improvement of EF in age 60 years, male, EF 60%, and on-pump CABG patients.
In T2DM patients undergoing CABG, ID might negatively affect the early recovery of left ventricular systolic function in terms of recovery of EF 3-6 months after surgery, especially in patients age 60 years, males, EF 60% and in those undergoing on-pump CABG.
缺铁（ID）是影响公众健康的最常见的微量营养素缺乏症之一。研究表明，缺铁会影响心脏病患者的预后，包括心力衰竭、冠状动脉疾病和心肌梗死。然而，关于缺铁对接受心脏手术患者的影响的信息有限。本研究旨在评估术前缺铁对接受冠状动脉旁路移植术（CABG）的2型糖尿病（T2DM）患者预后的影响。
在“使用移动干预控制糖尿病患者冠状动脉旁路移植术中血糖以促进自我管理（GUIDEME）”研究中，前瞻性招募了接受CABG的T2DM患者。在本研究中，仅纳入那些有术前铁代谢结果的患者。根据术前是否存在缺铁对患者进行分组。主要终点定义为与术后水平相比，随访射血分数（EF）有显著改善（根据变化的第75百分位数分类，定义为改善大于或等于5%）。进行单变量逻辑回归以探索潜在的混杂因素，然后进行多重调整。
共纳入302例患者。研究期间未观察到死亡病例。缺铁组主要终点的发生率较高（25.4%对12.9%，P = 0.015）。两组术后和随访时的EF相似。在回归分析中，发现缺铁在单变量（比值比[OR]：0.44，95%置信区间[CI]：0.22 - 0.86，P = 0.017）和多变量（OR：0.43，95% CI：0.24 - 0.98，P = 0.043）逻辑回归中都是EF显著改善的有力预测因素。在亚组分析中，缺铁是年龄≥60岁、男性、EF≥60%以及体外循环下CABG患者EF显著改善的预测因素。
在接受CABG的T2DM患者中，缺铁可能在术后3 - 6个月EF恢复方面对左心室收缩功能的早期恢复产生负面影响，尤其是在年龄≥60岁、男性、EF≥60%以及接受体外循环下CABG的患者中。
