Azzarelli A, Dini F L, Cristofani R, Giaconi A, Rossi A M, Volterrani C, Lunardi M, Bernardi D
Unitá Operativa di Cardiologia, Ospedale San Francesco, Barga, Lucca, Italy.
Coron Artery Dis. 1995 Aug;6(8):629-34. doi: 10.1097/00019501-199508000-00007.
Aging and diabetes mellitus have been recognized as strong predictors of heart failure in patients with acute myocardial infarction. The aim of this study was to assess, by echocardiography, the influence of aging and non-insulin-dependent diabetes mellitus on the changes of left ventricular parietal kinesis in patients with acute myocardial infarction over the 6 months after hospitalization.
The study population consisted of 82 patients (42 male, 40 female) aged 70 years, consecutively admitted to coronary care unit with acute myocardial infarction from January 1991 to May 1993. They were divided into two groups: group 1 comprised 36 patients with non-insulin-dependent diabetes mellitus, aged 78.8 +/- 6.02 years, 17 men and 19 women; group 2 comprised 46 patients without diabetes aged 78.7 +/- 6.9 years, 25 men and 21 women. Echocardiography was performed at admission to the unit (T0), at discharge (T1), and after 6 months of follow-up (T2). The echocardiographic wall motion score index was calculated by considering the number of akinetic and dyskinetic left ventricular wall segments. Fatal and non-fatal incidents of heart failure were also considered and a multivariate analysis was applied to identify the clinical and instrumental parameters that were independent predictors of wall motion score index changes and heart failure events.
At T1 the two groups were comparable in localization of acute myocardial infarction, previous myocardial infarction, creatinine kinase serum peak, ECG score and wall motion score index. A statistically significant reduction in akinesia (P < 0.001) was observed in group 2 at T1 and T2, but was not seen in group 1. At T2 the difference in wall motion score index between the groups became significant (P < 0.05). The occurrence of heart failure was significantly higher in group 1 than in group 2 either during hospitalization (P < 0.03) or during follow-up (P < 0.004). The multivariate analysis identified non-insulin-dependent diabetes mellitus as an independent predictor of lacking recovery in LV kinesis (P < 0.01) and of heart failure development (P < 0.001).
In elderly patients with non-insulin-dependent diabetes mellitus lack of recovery in wall motion score index after acute myocardial infarction seems to be an important factor, with a higher heart failure prevalence adversely affecting the in-hospital and long-term outcome. Non-insulin-dependent diabetes mellitus appears to be an important factor related to this unfavorable outcome.
衰老和糖尿病已被公认为急性心肌梗死患者发生心力衰竭的有力预测因素。本研究旨在通过超声心动图评估衰老和非胰岛素依赖型糖尿病对急性心肌梗死患者住院后6个月内心室壁运动变化的影响。
研究对象为1991年1月至1993年5月连续入住冠心病监护病房的82例70岁患者（男42例，女40例），均为急性心肌梗死。他们被分为两组：第1组包括36例非胰岛素依赖型糖尿病患者，年龄78.8±6.02岁，男17例，女19例；第2组包括46例无糖尿病患者，年龄78.7±6.9岁，男25例，女21例。在入院时（T0）、出院时（T1）和随访6个月后（T2）进行超声心动图检查。通过考虑左心室壁运动减弱和运动障碍节段的数量来计算超声心动图壁运动评分指数。还考虑了心力衰竭的致命和非致命事件，并进行多变量分析以确定壁运动评分指数变化和心力衰竭事件的独立预测临床和仪器参数。
在T1时，两组在急性心肌梗死的部位、既往心肌梗死、肌酸激酶血清峰值、心电图评分和壁运动评分指数方面具有可比性。在T1和T2时，第2组运动减弱有统计学意义的降低（P<0.001），但第1组未观察到。在T2时，两组之间壁运动评分指数的差异变得显著（P<0.05）。第1组在住院期间（P<0.03）或随访期间（P<0.004）发生心力衰竭的比例显著高于第2组。多变量分析确定非胰岛素依赖型糖尿病是左心室运动缺乏恢复（P<0.01）和心力衰竭发生（P<0.001）的独立预测因素。
在老年非胰岛素依赖型糖尿病患者中，急性心肌梗死后壁运动评分指数缺乏恢复似乎是一个重要因素，心力衰竭患病率较高对住院和长期预后产生不利影响。非胰岛素依赖型糖尿病似乎是与这种不良预后相关的重要因素。
