Comparison of Changes in Global Longitudinal Peak Systolic Strain After ST-Segment Elevation Myocardial Infarction in Patients With Versus Without Diabetes Mellitus.
Global longitudinal strain (GLS) measured by 2-dimensional longitudinal speckle-tracking echocardiography may be a more sensitive measure of left ventricular (LV) mechanics than conventional LV ejection fraction (EF) to characterize adverse post-ST-segment elevation myocardial infarction (STEMI) remodeling. The aim of the present evaluation was to compare changes in LV GLS in patients with versus without diabetes after the first STEMI. Patients with first STEMI and diabetes (n = 143; age 64 ± 12 years; 68% men; 50% left anterior descending artery as culprit vessel) and 290 patients with first STEMI and without diabetes matched on age, gender, and infarct location were included. LV volumes and function and 2-dimensional LV GLS were measured after primary percutaneous coronary intervention (baseline) and at 6-month follow-up. At baseline, patients with and without diabetes had similar LVEF (46.8 ± 0.7% vs 48.0 ± 0.5%, p = 0.19) and infarct size (peak cardiac troponin T: 3.1 [1.2 to 6.5] vs 3.7 [1.3 to 7.3] μg/l, p = 0.10; peak creatine phosphokinase:1,120 [537 to 2,371] vs 1,291 [586 to 2,613] U/l, p = 0.17), whereas LV GLS was significantly more impaired in diabetic patients (-13.7 ± 0.3% vs -15.3 ± 0.2%, p <0.001). Although diabetic patients showed an improvement in LVEF over time similar to nondiabetic patients (52.0 ± 0.8% vs 53.1 ± 0.6%, p = 0.25), GLS remained more impaired at 6-month follow-up compared with nondiabetic patients (-15.8 ± 0.3% vs -17.3 ± 0.2%, p <0.001). After adjusting for clinical and echocardiographic characteristics, diabetes was independently associated with changes in GLS from baseline to 6-month follow-up (β 1.41, 95% confidence interval 0.85 to 1.96, p <0.001). In conclusion, after STEMI, diabetic patients show more impaired LV GLS at both baseline and follow-up compared with a matched group of patients without diabetes, despite having similar infarct size and LVEF at baseline and follow-up.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Georgette E
GE
Hoogslag
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Rachid
R
Abou
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Emer
E
Joyce
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Helèn
H
Boden
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Vasileios
V
Kamperidis
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Madelien V
MV
Regeer
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Philippe J
PJ
van Rosendael
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Martin J
MJ
Schalij
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Jeroen J
JJ
Bax
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Nina Ajmone
NA
Marsan
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: v.delgado@lumc.nl.
Victoria
V
Delgado
D000368:Aged; D017130:Angioplasty; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D048909:Diabetes Complications / Q000503:physiopathology*; D004452:Echocardiography; D054459:Elasticity Imaging Techniques; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013599:Systole; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; D020107:Troponin T; D003402:Creatine Kinase