Abstract 6246: Impact of Dysglycemia on Left Ventricular Functional Reserve in Acute Myocardial Infarction

Abstract

Background Abnormal glucose metabolism is common in patients with acute myocardial infarction (AMI), and is associated with excess morbidity and mortality. The reason for this is unclear but could be associated with an unfavourable effect on left ventricular (LV) functional reserve. Methods Low-dose dobutamine stress echocardiography (LDDE) was performed in 165 consecutive patients during admission for AMI. Peak early diastolic mitral annular velocity (E′), peak systolic mitral annular velocity (S′), and LV ejection fraction (LVEF) were measured at rest and during low dose dobutamine infusion. Glucose metabolism was assessed using an oral glucose tolerance test in patients without a previous diagnosis of diabetes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were also measured. Results After adjustment for age, gender, hypertension, atrial fibrillation, peak troponin-T levels, diastolic blood pressure, heart rate, and body mass index, an inverse association between glucose metabolism and LV function was observed for E′ ( P =.005) and S′ ( P =.008) when measured during LDDE, but not when measured at rest (E′: P =.10; S′: P =.22). Neither rest nor stress LVEF was significantly associated with the degree of dysglycemia (rest: P =.67; LDDE: P =.19). All parameters measured during LDDE were significant predictors of NT-proBNP levels after adjustment for resting values (all variables: P <.05). Conclusions In patients with a recent AMI, abnormal glucose metabolism is associated with impaired LV function during LDDE but not at rest; this is suggestive of depressed functional reserve.