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Increased mortality of diabetics after acute myocardial infarction attributed to diffusely impaired left ventricular
G Kouvaras1, D Cokkinos, M Spyropoulou
1Cardiology Department, Tzanio Hospital, Piraeus, Greece.
Insights
Diabetic patients experienced higher in-hospital mortality after acute myocardial infarction (AMI). Impaired left ventricular function in diabetics suggests underlying diabetic cardiomyopathy contributes to increased left ventricular failure (LVF) risk.
Area of Science:
- Cardiology
- Diabetology
- Internal Medicine
Background:
- Acute myocardial infarction (AMI) poses significant risks, with outcomes potentially differing in diabetic populations.
- Understanding risk factors and complications in diabetic patients post-AMI is crucial for improving patient care.
Purpose of the Study:
- To compare in-hospital outcomes and left ventricular function in diabetic versus non-diabetic patients following their first AMI.
- To investigate potential underlying mechanisms for increased mortality and complications in diabetic patients post-AMI.
Main Methods:
- Retrospective analysis of 548 patients admitted for their first AMI, comparing 98 diabetics to 450 non-diabetics.
- Echocardiographic assessment of left ventricular function (EPSS, EF, FS) in a subset of 125 patients (25 diabetics, 100 non-diabetics).
- Analysis of mortality rates, causes of death (LVF), and prevalence of comorbidities like obesity and family history.
Main Results:
- Diabetic patients were younger, had a higher proportion of females, and exhibited significantly higher in-hospital mortality (30% vs. 16%).
- Diabetics showed a higher incidence of mortality due to left ventricular failure (LVF) and complete A-V block.
- Echocardiography revealed significantly more impaired myocardial contractility (EPSS, EF, FS) in diabetic patients, despite similar affected myocardial mass.
Conclusions:
- Diabetic patients face a substantially higher risk of mortality and LVF after AMI, independent of the extent of myocardial damage.
- Impaired left ventricular function in diabetics post-AMI may be attributed to latent diabetic cardiomyopathy, possibly due to small vessel disease or metabolic disorders.
- These findings highlight the need for targeted management strategies for diabetic patients experiencing acute myocardial infarction.
Abstract:
Five hundred and forty-eight patients who sustained their first acute myocardial infarction (AMI) were admitted to the coronary care unit (CCU). Ninety-eight of them were known diabetics. The diabetic patients were younger, 50 +/- 12 vs. 64 +/- 18 years of age (p less than 0.05), and the proportion of females in their group was higher than in the nondiabetics, 44% vs. 33.4% (p less than 0.05). The in hospital mortality rate was 30% for diabetics and 16% for nondiabetics (p less than 0.001). Diabetics had a higher percentage of mortality caused by left ventricular failure (LVF) (p less than 0.025) and a tendency for more frequent complete A-V block (p less than 0.01) compared to nondiabetics. Obesity and a positive family history for coronary heart disease were more prevalent in the diabetic group (both p less than 0.01). The echocardiographic assessment of left ventricular function, performed in 125 consecutively admitted patients (25 diabetics and 100 nondiabetics) on the 3rd-5th post-infarct day, showed that the indices of myocardial contractility, that is, E point septal separation (EPSS), ejection fraction (EF) and fractional shortening (FS) were far more impaired in diabetics than in nondiabetics (p less than 0.01, p less than 0.005, p less than 0.005, respectively). No significant difference was found in the prevalence of dyskinetic, akinetic and hypokinetic segments between the two categories of patients, suggesting no difference in the amount of myocardial mass affected by the AMI. Our results indicate that the increased incidence of LVF developed in diabetics after an AMI compared to nondiabetics may be caused by other factors, probably some form of latent diabetic cardiomyopathy as a result of either small vessel disease or metabolic disorder.