Impact of glycemic status on left ventricular systolic function in patients with acute coronary syndrome

Abstract

Background: Diabetes mellitus (DM) and left ventricular systolic dysfunction (LVSD) commonly coexist; increasing morbidity and mortality among patients. The aim of this study is to detect the correlation between the glycemic status of patients presenting by acute coronary syndrome (ACS) and left ventricular global and regional systolic function. Method: The study included 510 patients presenting by ACS and referred for coronary angiography. In addition to routine laboratory tests, Glycated hemoglobin (HbA1C) level, as a marker of chronic glycemic status, was measured. Every patient was subjected to transthoracic echocardiographic study with accurate evaluation of left ventricular systolic function by both m-mode and biplane Simpson's method, in addition to calculation of regional wall motion score index (RWMSI). The whole study population was divided into two groups; diabetic and non-diabetic based on cutoff point of HbA1C value 6.5%. The non-diabetic group was subdivided into two groups; high risk and low risk based on cutoff point of HbA1C value 5.7% Results: Sixty four percent of the studied population had DM. The mean HbA1C level was 7.6 ± 2.2%. The mean left ventricular ejection fraction (LVEF) was 54 ± 11 and mean RWMSI was 1.3 ± 0.3. There was significant negative correlation between the HbA1C level and the LVEF (r = -0.101, p < 0.022). There was significant positive correlation between HbA1C level and RWMSI (r = 0.109, p < 0.014). The non-diabetic high risk group had lower LVEF and higher RWMSI than the low risk group (p < 0.041 and p < 0.002 respectively). Conclusion: Chronic hyperglycemia in patients with uncontrolled DM may be a risk factor for developing LVSD in patients presenting by ACS. Glycated hemoglobin level may predict LVSD in patients with ACS. Non-diabetic patients who are at higher risk of developing DM have higher incidence of LVSD.