Diabetes reduces left ventricular ejection fraction-irrespective of presence and extent of coronary artery disease

Abstract

Background: It is not clear whether diabetes reduces systolic left ventricular function (left ventricular ejection fraction, LVEF) irrespective of coronary artery disease (CAD). The aim of this study was to compare the LVEF between diabetic and non-diabetic patients with respect to the extent of CAD. Methods and results: Consecutive patients undergoing stress myocardial perfusion SPECT (MPS) were evaluated. MPS was interpreted using a 20-segment model with a five-point scale to define summed stress score (SSS), summed rest score, and summed difference score. LVEF was measured by gated SPECT and then compared with respect to diabetic status and SSS categories. Of 2635 patients, data of 2400 was available. Of these, 24% were diabetic, mean age was 64G11y, and 31% were female. Diabetics had a significantly lower LVEF compared with non-diabetics regardless of the extent of CAD: 53G13 and 55G13% respectively (PZ0.001). Diabetics and non-diabetics did not differ significantly in the distribution of SSS categories. Diabetes was an independent predictor of decreased LVEF (odds ratio 1.6, 95% confidence interval 1.2-2.0; P!0.001). Conclusion: Diabetics had a lower LVEF than non-diabetics. This difference could be demonstrated regardless of CAD extent and might in part explain their generally worse cardiac survival compared with non-diabetics on an epidemiological level. In addition, this finding points to discussed mechanisms other than CAD lowering LVEF in diabetics.

Prevalence of QT prolongation and associated LVEF changes in diabetic patients over a four-year retrospective time period

“…The LVEF reduction is seen and reached statistical significance in type 2 diabetes. Our finding is consistent with previous reports of reduced LVEF in diabetic patients regardless of the extent of coronary artery disease [27,28]. Our study observed in a subset of patient with DM (type 2 only) that demonstrated a concomitant developmental change in QTc and LVEF with an inverse relationship.…”

Silent diabetic cardiomyopathy in everyday practice: a clinical and echocardiographic study

“…DM was an important risk factor for progression from asymptomatic systolic dysfunction to symptomatic heart failure only in patients with ischemic cardiomyopathy [25]. However, Ehl et al showed that DM reduces LV ejection fraction, estimated by SPECT, irrespectively of the presence and extent of CAD and suggested that it might in part explain generally worse cardiac survival compared to non-diabetics [26]. …”

Comparison of 2-year clinical outcomes between diabetic versus nondiabetic patients with acute myocardial infarction after 1-month stabilization

“…[16] A previous large cohort study identified that reduced LV function was significantly associated with increased 1-month and 1-year mortality risk in patients with AMI. [7] Ehl et al [17] reported that DM patients exhibited a lower LVEF than non-DM patients regardless of CAD extent and suggested that this difference was associated with worse CV mortality in DM patients. The present study found that the incidence of LVEF <35% was significantly higher in DM patients despite the absence of significant differences in the incidence of multivessel disease and type B2/C lesions between the propensity-matched populations.…”