Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography
Maryam Nabati1, Leily Hadjiakhoundy2, Jamshid Yazdani3
1Fellowship of Echocardiography, Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Dr.mr.nabati@gmail.com.
Insights
Elevated glycated hemoglobin (HbA1c) levels, even without a diabetes diagnosis, are linked to subtle cardiac dysfunction, specifically increased post-systolic index (PSI), in patients without coronary artery disease (CAD). This highlights the cardiovascular risk associated with abnormal HbA1c.
Area of Science:
- Cardiology
- Endocrinology
- Biomarkers
Background:
- Glycated hemoglobin (HbA1c) is a key biomarker for diabetes diagnosis and risk assessment.
- Post-systolic index (PSI) measures subtle myocardial contractile dysfunction.
- Coronary artery disease (CAD) can impact cardiac function.
Purpose of the Study:
- To investigate the relationship between HbA1c levels and PSI in patients with non-apparent CAD.
- To determine if elevated HbA1c is associated with cardiac dysfunction independent of diabetes status.
Main Methods:
- Historical cohort study of 85 patients with preserved ejection fraction and no apparent CAD.
- Patients stratified by HbA1c levels (<5.7% vs. ≥5.7%).
- Speckle-tracking echocardiography to assess PSI and other cardiac parameters.
Main Results:
- Patients with HbA1c ≥5.7% exhibited significantly higher PSI, E/e' ratio, and A wave, and lower e' velocity compared to those with HbA1c <5.7%.
- The association between HbA1c and PSI was independent of other clinical factors.
- No significant differences were observed in other echocardiographic variables between groups.
Conclusions:
- Elevated HbA1c levels (≥5.7%) are associated with increased post-systolic index (PSI) in patients without apparent coronary artery disease.
- This suggests subclinical cardiac dysfunction linked to HbA1c, irrespective of a diabetes diagnosis.
- PSI's role as an indicator of adverse outcomes underscores the clinical significance of abnormal HbA1c levels in cardiovascular risk assessment.
Abstract:
Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.
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