Abstract
Type 2 diabetes predicts outcome following acute myo-cardial infarction (AMI). Since underlying mechanics are incompletely understood, we investigated left ventricular (LV) and left atrial (LA) pathophysiological changes and their prognostic implications using cardiovascular magnetic resonance (CMR). Consecutive patients (N 5 1,147; n 5 265 with diabetes, n 5 882 without diabetes) un-derwent CMR 3 days after AMI. Analyses included LV ejection fraction (LVEF); global longitudinal strain (GLS) and circumferential and radial strains; LA reservoir, conduit, and booster pump strains; and infarct size, edema, and microvascular obstruction. Predefined end points were major adverse cardiovascular events (MACE) within 12 months. Patients with diabetes had impaired LA reservoir (19.8% vs. 21.2%, P < 0.01) and conduit (7.6% vs. 9.0%, P < 0.01) strains but not ventricular function or myocardial damage. They were at higher risk of MACE than patients without diabetes (10.2% vs. 5.8%, P < 0.01), with most MACE occurring in patients with LVEF ‡35%. While LVEF (P 5 0.045) and atrial reservoir strain (P 5 0.024) were independent predic-tors of MACE in patients without diabetes, GLS was in patients with diabetes (P 5 0.010). Considering patients with diabetes and LVEF ‡35% (n 5 237), GLS and LA reservoir strain below median were significantly associated with MACE. In conclusion, in patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above that of LVEF.
| Original language | English |
|---|---|
| Journal | Diabetes |
| Volume | 69 |
| Issue number | 7 |
| Pages (from-to) | 1540-1548 |
| Number of pages | 9 |
| ISSN | 0012-1797 |
| DOIs | |
| Publication status | Published - 07.2020 |
Funding
AIDA STEMI and TATORT NSTEMI were registered with ClinicalTrials.gov and approved by the ethics committees of the participating sites. This CMR-Feature Tracking (FT) study was supported by a grant from the German Center for Cardiovascular Research and conducted according to the Declaration of Helsinki. Patients gave written informed consent for study participation. Clinical patient characteristics including information on diagnosed DM were obtained by a structured interview at admission. Funding. This study was funded by Deutsches Zentrum für Herz-Kreislaufforschung (German Center for Cardiovascular Research). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. S.J.B., T.S., H.T., I.E., and A.S. designed the study protocol. S.J.B., J.T.K., T.S., T.L., J.-L.N., and A.K. performed data acquisition. S.J.B., J.T.K., and A.S. performed statistical analyses. S.J.B., J.T.K., I.E., and A.S. drafted the manuscript. R.E., J.L., S.K., G.H., M.G., and H.T. revised the manuscript and participated in the scientific discussion during the study. All authors read and approved the final manuscript. I.E. and A.S. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
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