Impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction and type 2 diabetes
10.3760/cma.j.issn.1008-6315.2019.03.001
- VernacularTitle:血糖变异性对2型糖尿病合并急性ST段抬高心肌梗死患者左心功能的影响
- Author:
Xiuxiu YANG
1
;
Quanming ZHAO
;
Gong SU
Author Information
1. 首都医科大学附属北京安贞医院心内科 100029
- Keywords:
Glycemic variability;
Glucose excursion;
Diabetic mellitus,type2;
Acute ST-segment elevation myocardial infarction;
Left ventricular function
- From:
Clinical Medicine of China
2019;35(3):193-198
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction (STEMI) and type 2 diabetes.Methods Three hundred and three patients with type 2 diabetes and first STEMI between May 2014 and December 2016 in Beijing Anzhen Hospital,Capital Medical University were seclected continuously.All participants' continuous glucose monitoring system (CGMS) parameters,echocardiogram and biochemical characteristics were measured at baseline.According to the level of mean amplitude of glycemic excursion (MAGE) which is the gold indicator to present glycemic variability patients were classified into low MAGE group (n=182) and high MAGE group (n =117).Impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction and type 2 diabetes were analysed.Results (1) Cardiac function evaluation:The level of left ventricular ejection fraction (LVEF) were significantly lower in high MAGE group than in low MAGE group ((43.8± 7.2) vs.(52.3± 8.5) ％,t =4.912,P＜ 0.001).There were significant differences between the two groups in Killip classification (x2 =49.931,P＜ 0.001).(2) Pearson correlation analysis shows that LVEF negatively correlated with the levels of MAGE(r=-0.367,P＜0.001),postprandial glucose excursion (PPGE) (r=-0.274,P=0.003),Hemoglobin A1c(HbA1c) (r=-0.238,P =0.010),serum highsensitive C-reactive protein (hs-CRP) via logarithmic transformation (r =-0.245,P =0.008) and fasting plasma glucose (FPG) (r =-0.229,P =0.021).Killip classification positively correlated with the levels of MAGE (r =0.301,P ＜ 0.001),PPGE (r =0.228,P =0.022),hs-CRP via logarithmic transformation (r =0.234,P =0.019),H bA 1 c (r =0.195,P =0.041) and FPG (r =0.193,P =0.045).(3) Multiple stepwise regression analysis and multivariate Logistic regression analysis indicated that the level of MAGE was independent risk factor of LVEF (t =-2.279,P =0.005,95％ CI(-3.160 -0.219)) and the level of MAGE was an independent risk factor of Killip classification (Waldx2 =5.673,OR=1.665,95％CI(1.095-2.534),P=0.017).Conclusion Glycemic variability is associated with the presence and severity of left ventricular function in patients with STEMI and type 2 diabetes.
