Homocysteine as a determinant of left ventricular ejection fraction in patients with diabetes.
BACKGROUND
A link between homocysteine (Hcy) and left ventricular ejection fraction (LVEF) emerged from recent studies but was yet not explored specifically in diabetic patients. This study aimed to assess the relationship between LVEF and Hcy in a cohort of adults with diabetes.


METHODS
LVEF was determined through the measure of left ventricular end-diastolic/end-systolic volumes in 409 consecutive asymptomatic patients with diabetes who underwent stress myocardial perfusion imaging. Clinical and biological parameters which were determinants of LVEF in univariate analyses with p<0.15 were included in a multivariate analysis.


RESULTS
In univariate analyses, factors significantly associated with a LVEF<55% were gender [women vs. men, odds ratio (OR)=0.22 (0.13; 0.38)], peripheral arterial disease [OR=2.49 (1.34; 4.62)], active smoking [OR=1.97 (1.16; 3.33)], silent myocardial ischemia (SMI) [OR=2.19 (1.25; 3.86)], the highest vs. the lowest tertile of creatinine [OR=2.08 (1.17; 3.68)], of albuminuria [OR=2.22 (1.27; 3.90)] and of Hcy [OR=1.83 (1.07; 3.13)]. No relationship was observed between blood pressure and decrease in LVEF. In the multivariate analysis, female gender was confirmed as being protective for having a LVEF<55%. Presence of SMI [OR=2.20 (1.14; 4.23)] and Hcy ≥15 μmol/L [OR=1.81 (1.06; 3.07)] were the two remaining significant factors associated with an increased relative risk of having LVEF<55%. A trend was only observed for the criteria active smokers.


CONCLUSIONS
This study highlights an inverse relationship between Hcy and LVEF in patients with diabetes, independent of age, gender, SMI, smoking, blood pressure, renal function, folates, vitamin B12, lipid parameters and hepatic enzymes.
Laboratoire de Biochimie, CHU Montpellier, Montpellier, France.
Stephanie
S
Badiou
Anne-Marie
AM
Dupuy
Isabelle
I
Jaussent
Ariane
A
Sultan
Denis
D
Mariano-Goulart
Jean-Paul
JP
Cristol
Antoine
A
Avignon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000503:physiopathology*; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016277:Ventricular Function, Left
D015415:Biomarkers; D006710:Homocysteine