Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic patients with STEMI
Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic patients with STEMI
复制标题
糖尿病 STEMI 患者每次访视空腹血糖变异性与左心室不良重构相关
DOI：
10.1186/s12933-020-01112-6
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发表时间：
2020
影响因子：
9.3
通讯作者：
Wang Xiao Qun
中科院分区：
文献类型：
--
作者：
Yang Chen Die;Shen Ying;Ding Feng Hua;Yang Zhen Kun;Hu Jian;Shen Wei Feng;Zhang Rui Yan;Lu Lin;Wang Xiao Qun
背景2型糖尿病（T2 DM）患者发生ST段抬高型心肌梗死（STEMI）后心血管预后较差。心肌梗死后引起的左室逆向重构（LVAR）是心力衰竭发展的主要病理过程。在本研究中，我们试图调查访视间空腹血糖（FPG）变异性是否是STEMI后T2 DM患者LVAR的潜在预测因子。方法2014年1月至2018年12月，在瑞金医院连续入组接受直接经皮冠状动脉介入治疗的T2 DM伴STEMI患者，并随访约12个月。通过超声心动图评估基线和12个月随访期间左心室几何和功能参数的变化。分析LVAR（定义为左心室舒张末期容积（LVEDV）指数增加20%）的发生率及其与访视间FPG变异性的关系。构建多变量回归模型，以检验FPG变异性对梗死后LVAR.ResultsA的预测价值，共有437例2型糖尿病和STEMI患者被纳入最终分析。在平均12.4 ± 1.1个月的随访期间，LVAR的发生率为20.6%，LVEDV指数平均增大为3.31 ± 14.4 mL/m2，FPG变异系数（CV）较高的患者（P= 0.002）显著增加，与基线血糖水平无关。在多变量分析中，FPG变异性与校正传统风险因素、基线HbA 1c以及随访期间平均FPG后的梗死后LVAR发生率独立相关（FPG CV的最高与最低三分位数的OR：3.021 [95% CI 1.081-8.764]）。通过其他两种测量方法评估FPG变异性，包括标准差（SD）和变异性独立于平均值（Vim），产生了类似的结果。结论这项研究表明，访视至访视FPG变异性是STEMI.Trial registrationTrials编号，NCT 02089360;于2014年3月17日注册的T2 DM患者LVAR发生率的独立预测因子。
BackgroundPatients 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.MethodsFrom 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.ResultsA 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.ConclusionsThis study suggests that visit-to-visit FPG variability is an independent predictor of incidence of LVAR in T2DM patients with STEMI.Trial registrationTrials number, NCT02089360; registered on March 17,2014.