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Influence of diabetes mellitus on left ventricular function in patients undergoing coronary artery bypass grafting
Insights
Coronary artery bypass grafting (CABG) improved left ventricular function in patients without diabetes mellitus (DM). However, CABG did not improve left ventricular function in patients with DM, indicating potential inadequacy of this therapy for DM patients with severe dysfunction.
Area of Science:
- Cardiology
- Diabetology
- Cardiac Surgery
Background:
- Diabetes mellitus (DM) is a significant risk factor for cardiovascular disease.
- Patients with severe coronary artery disease (CAD) often undergo coronary artery bypass grafting (CABG).
- The impact of DM on left ventricular (LV) function post-CABG requires further investigation.
Purpose of the Study:
- To assess the effect of CABG on LV function in patients with severe CAD, comparing those with DM to those without DM.
- To evaluate whether DM influences the improvement of LV function after CABG.
Main Methods:
- Two-dimensional echocardiography was used to assess LV function (fractional shortening, LVDd) before and one year after CABG.
- A non-matched study compared 23 DM patients with 50 non-DM patients.
- A matched study compared 31 non-DM patients with similar baseline LV function to the DM group.
Main Results:
- Patients with DM had significantly lower fractional shortening and larger LVDd at baseline and one year post-CABG compared to non-DM patients.
- Significant improvement in fractional shortening was observed in non-DM patients but not in DM patients post-CABG.
- The rate of improvement in fractional shortening was significantly higher in non-DM patients than in DM patients.
Conclusions:
- Left ventricular dysfunction and impaired functional improvement were observed in patients with DM after CABG.
- CABG effectively improved LV function in non-DM patients with poor baseline function.
- CABG therapy may be inadequate for improving LV function in DM patients with severe baseline LV dysfunction.
Objectives:
Left ventricular function was assessed by two-dimensional echocardiography before and one year after coronary artery bypass grafting(CABG) in a series of patients with severe coronary artery disease with diabetes mellitus(DM) and without DM(non-DM).
Methods:
Twenty-three patients with DM and 50 patients without DM, all with no previous myocardial infarction, underwent two-dimensional echocardiography before CABG and one year after CABG, in a non-matched study. For a matched study, 31 patients without DM who had almost the same left ventricular function as DM patients at the baseline were selected to and compare the rate of improvement in left ventricular function between the DM group and the "matched" non-DM group.
Results:
In the non-matched study, patient characteristics were not significantly different between the 2 groups except for the incidence of congestive heart failure within one year before CABG, which was significantly higher in the DM group. Fractional shortening was significantly lower in the DM group at the baseline(p < 0.05) and also one year after CABG(p < 0.0001). Significant improvement in fractional shortening was seen in the non-DM group(p < 0.001), but not in the DM group. The left ventricular end-diastolic diameter(LVDd) was significantly larger in the DM group at the baseline(p < 0.01), and was still significantly larger in the DM group at one year after CABG(p < 0.01). No improvement in LVDd was seen in the DM group. In the matched study, fractional shortening of the non-DM group also showed significant improvement after CABG(p < 0.001). Moreover, the rate of improvement in fractional shortening was higher in the non-DM group than in the DM group(p < 0.05). LVDd tended to be larger in the DM group(p = NS).
Conclusions:
Left ventricular dysfunction and left ventricular impaired improvement were seen in the patients with DM, and CABG improved left ventricular function in the patients without DM with poor left ventricular function. These findings indicate that CABG therapy may be inadequate for improving left ventricular function in patients with DM and severe left ventricular dysfunction at the baseline.