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Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic
Chen Die Yang1, Ying Shen1, Feng Hua Ding1
1Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China.
Insights
Visit-to-visit fasting plasma glucose (FPG) variability predicts left ventricular adverse remodeling (LVAR) in type 2 diabetes mellitus (T2DM) patients post-ST-segment elevation myocardial infarction (STEMI). This finding aids in managing cardiovascular risk in diabetic patients after heart attack.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Diseases
Background:
- Type 2 diabetes mellitus (T2DM) patients face elevated cardiovascular risks post-ST-segment elevation myocardial infarction (STEMI).
- Left ventricular adverse remodeling (LVAR) is a primary driver of heart failure following myocardial infarction.
- The role of glycemic variability in post-STEMI cardiac outcomes in T2DM patients requires further investigation.
Purpose of the Study:
- To determine if visit-to-visit fasting plasma glucose (FPG) variability predicts LVAR in T2DM patients after STEMI.
- To assess the association between FPG variability and cardiac remodeling in this high-risk population.
Main Methods:
- A cohort of 437 T2DM patients with STEMI undergoing primary percutaneous coronary intervention were enrolled.
- Echocardiography assessed left ventricular remodeling (LVAR, defined as ≥20% increase in indexed LVEDV) at baseline and 12-month follow-up.
- Multivariate regression analyses examined the predictive value of FPG variability (using CV, SD, and VIM) for LVAR.
Main Results:
- The incidence of LVAR was 20.6% over a mean follow-up of 12.4 months.
- Higher FPG variability (coefficient of variance) was significantly associated with increased LVAR incidence (P=0.002), independent of baseline glycemic control.
- FPG variability independently predicted post-infarction LVAR (OR: 3.021 for highest vs. lowest tertile of CV).
Conclusions:
- Visit-to-visit FPG variability is an independent predictor of LVAR in T2DM patients following STEMI.
- Monitoring glycemic variability may offer a novel strategy for risk stratification and management of heart failure post-MI in diabetic patients.
Background:
Patients with type 2 diabetes mellitus (T2DM) are predisposed to poor cardiovascular outcomes after ST-segment elevation myocardial infarction (STEMI). Left ventricular adverse remodeling (LVAR) triggered upon myocardial infarction is recognized as the predominant pathological process in the development of heart failure. In the present study, we sought to investigate whether visit-to-visit fasting plasma glucose (FPG) variability is a potential predictor of LVAR in T2DM patients after STEMI.
Methods:
From January 2014 to December 2018 in Ruijin Hospital, T2DM patients with STEMI who underwent primary percutaneous coronary intervention were consecutively enrolled and followed up for ~ 12 months. The changes in left ventricular geometric and functional parameters between baseline and 12-month follow-up were assessed by echocardiography. The incidence of LVAR, defined as 20% increase in indexed left ventricular end-diastolic volume (LVEDV), and its relationship with visit-to-visit FPG variability were analyzed. Multivariate regression models were constructed to test the predictive value of FPG variability for post-infarction LVAR.
Results:
A total of 437 patients with type 2 diabetes and STEMI were included in the final analysis. During a mean follow-up of 12.4 ± 1.1 months, the incidence of LVAR was 20.6% and mean enlargement of indexed LVEDV was 3.31 ± 14.4 mL/m2, which was significantly increased in patients with higher coefficient variance (CV) of FPG (P = 0.002) irrespective of baseline glycemic levels. In multivariate analysis, FPG variability was independently associated with incidence of post-infarction LVAR after adjustment for traditional risk factors, baseline HbA1c as well as mean FPG during follow-up (OR: 3.021 [95% CI 1.081-8.764] for highest vs. lowest tertile of CV of FPG). Assessing FPG variability by other two measures, including standard deviation (SD) and variability independent of the mean (VIM), yielded similar findings.
Conclusions:
This study suggests that visit-to-visit FPG variability is an independent predictor of incidence of LVAR in T2DM patients with STEMI. Trial registration Trials number, NCT02089360; registered on March 17,2014.
