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Published on: March 27, 2018
Iron Deficiency Might Impair the Recovery of Left Ventricular Function after Surgical Revascularization in Diabetic
Yifeng Nan1, Xieraili Tiemuerniyazi1, Yangwu Song1
1Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Insights
Preoperative iron deficiency (ID) in type 2 diabetes mellitus patients undergoing coronary artery bypass grafting (CABG) is linked to poorer early recovery of left ventricular systolic function. This finding highlights the importance of iron status in cardiac surgery outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Micronutrient Metabolism
Background:
- Iron deficiency (ID) is a prevalent public health issue with known impacts on cardiovascular disease prognosis.
- Limited data exists on the specific effects of preoperative ID on patients undergoing cardiac surgery.
- This study focuses on type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the influence of preoperative iron deficiency on the prognosis of T2DM patients undergoing CABG.
- To assess the impact of ID on the recovery of left ventricular systolic function post-CABG.
- To identify specific patient subgroups where ID may have a more pronounced effect on recovery.
Main Methods:
- Prospective recruitment of T2DM patients undergoing CABG from the GUIDEME study.
- Grouping patients based on the presence or absence of preoperative iron deficiency.
- Defining the primary endpoint as significant improvement in ejection fraction (EF) 3-6 months post-surgery (≥5% increase).
- Utilizing univariable and multivariable logistic regression to analyze the association between ID and EF improvement.
Main Results:
- A total of 302 patients were included; no perioperative deaths occurred.
- The incidence of significant EF improvement was higher in the non-ID group (25.4% vs. 12.9%, p=0.015).
- Preoperative ID was a significant negative predictor for EF improvement in both univariable (OR 0.44) and multivariable (OR 0.43) analyses.
- Subgroup analysis indicated ID negatively impacted EF recovery in patients <60 years, males, with EF <60%, and those undergoing on-pump CABG.
Conclusions:
- Preoperative iron deficiency may impair early recovery of left ventricular systolic function in T2DM patients after CABG.
- The negative impact of ID on EF recovery appears more pronounced in specific subgroups: younger patients (<60 years), males, those with lower baseline EF (<60%), and on-pump CABG procedures.
- These findings suggest that optimizing iron status before CABG in T2DM patients could be crucial for better postoperative cardiac function recovery.
Background:
Iron deficiency (ID) is one of the most common micronutrient deficiencies affecting public health. Studies show that ID affects the prognosis of patients with heart disease, including heart failure, coronary artery disease and myocardial infarction. However, there is limited information regarding the impact of ID on patients undergoing cardiac surgery. This study aimed to evaluate the influence of preoperative ID on the prognosis of type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG).
Methods:
In the Glycemic control using mobile-based intervention in patients with diabetes undergoing coronary artery bypass to promote self-management (GUIDEME) study, patients with T2DM undergoing CABG were prospectively recruited. In this study, only those patients with preoperative iron metabolism results were enrolled. Patients were grouped based on the presence of preoperative ID. The primary endpoint was defined as the significant improvement of follow-up ejection fraction (EF) compared to postoperative levels (classified according to the 75th percentile of the change, and defined as an improvement of greater than or equal to 5%). Univariable logistic regression was performed to explore the potential confounders, followed by multiple adjustment.
Results:
A total of 302 patients were enrolled. No deaths were observed during the study period. A higher incidence of the primary endpoint was observed in the ID group (25.4% vs 12.9%, p = 0.015). The postoperative and follow-up EF were similar beween the two groups. In the regression analysis, ID was noticed to be a strong predictor against the significant improvement of EF in both univariable (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.22-0.86, p = 0.017) and multivariable (OR: 0.43, 95% CI: 0.24-0.98, p = 0.043) logistic regression. In the subgroup analysis, ID was a predictor of significant improvement of EF in age 60 years, male, EF 60%, and on-pump CABG patients.
Conclusions:
In T2DM patients undergoing CABG, ID might negatively affect the early recovery of left ventricular systolic function in terms of recovery of EF 3-6 months after surgery, especially in patients age 60 years, males, EF 60% and in those undergoing on-pump CABG.
