Impact of diastolic dysfunction on the development of heart failure in diabetic patients after acute myocardial infarction.
BACKGROUND
Diabetes is often associated with an abnormal diastolic function. However, there are no data regarding the contribution of diastolic dysfunction to the development of heart failure (HF) in diabetic patients after acute myocardial infarction.


RESULTS
A total of 1513 patients with acute myocardial infarction (417 diabetic) underwent echocardiographic examination during the index hospitalization. Severe diastolic dysfunction was defined as a restrictive filling pattern (RFP) based on E/A ratio >1.5 or deceleration time <130 ms. The primary end points of the study were readmission for HF and all-cause mortality. The frequency of RFP was higher in patients with diabetes (20 versus 14%; P=0.005). During a median follow-up of 17 months (range, 8 to 39 months), 52 (12.5%) and 62 (5.7%) HF events occurred in patients with and without diabetes, respectively (P<0.001). There was a significant interaction between diabetes and RFP (P=0.04) such that HF events among diabetic patients occurred mainly in those with RFP. The adjusted hazard ratio for HF was 2.77 (95%, CI 1.41 to 5.46) in diabetic patients with RFP and 1.21 (95% CI, 0.75 to 1.55) in diabetic patients without RFP. A borderline interaction (P=0.059) was present with regard to mortality (adjusted hazard ratio, 3.39 [95% CI, 1.57 to 7.34] versus 1.61 [95% CI, 1.04 to 2.51] in diabetic patients with and without RFP, respectively).


CONCLUSIONS
Severe diastolic dysfunction is more common among diabetic patients after acute myocardial infarction and portends adverse outcome. HF and mortality in diabetic patients occur predominantly in those with concomitant RFP.
Aronson
Doron
D
Department of Cardiology, Rambam Medical Center, Haifa, Israel. daronson@tx.technion.ac.il
Musallam
Anees
A
Lessick
Jonathan
J
Dabbah
Saleem
S
Carasso
Shemy
S
Hammerman
Haim
H
Reisner
Shimon
S
Agmon
Yoram
Y
Mutlak
Diab
D
D000368:Aged; D003920:Diabetes Mellitus; D003925:Diabetic Angiopathies; D005260:Female; D054144:Heart Failure, Diastolic / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000209:etiology* / Q000503:physiopathology