Impact of glycosylated hemoglobin (HBA1C) on the extent of perfusion abnormalities and left ventricular dysfunction using gated myocardial perfusion imaging and clinical outcomes in diabetic patients

Fatima, Nosheen; Zaman, Maseeh uz; Baloch, Dad J; Bano, Maryam; Bano, Samreen; Bano, Naila; Bano, Nighat

doi:10.1097/mnm.0b013e32835fe2e0

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…The hs-TnT is an intrinsic myocyte protein, with myocyte turnover associated with its level, reflecting pathophysiological mechanisms, including cardiac cell death, apoptosis, and probably cardiomyocyte strain, and it correlates with CV risk factors, cardiac hypertrophy, and metabolic disorders [49,50]. HbA1c was found to be a predictor of coronary artery disease, left ventricular dysfunction [51,52], and LVH [32]. We confirmed the correlation of HbA1c with LVH in the current study.…”

Section: Clinical and Biochemical Factorssupporting

confidence: 81%

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals with Low Cardiovascular Risk

Chlabicz

Jamiołkowski

Paniczko

et al. 2020

JCM

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Background: Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events. The electrocardiography (ECG) has poor sensitivity, but it is commonly used to detect LVH. Aim: To evaluate the diagnostic efficacy of known ECG indicators to recognize LVH in subgroups with different cardiovascular risk levels. Methods: 676 volunteers were included. Results: We found that 10.2% of the analyzed population had LVH based on echocardiography. Individuals with LVH were older, had a higher body mass index, higher systolic blood pressure, lower heart rate, higher parameters of insulin resistance, higher cardiovascular risk, and android-type obesity. Variables that remained independently associated with LVH were QRS duration, left atrial volume index, troponin T, and hemoglobin A1c. The receiver operating characteristics (ROC) curve analysis of the Sokolow–Lyon index did not show a significant predictive ability to diagnose LVH in the whole study population including all cardiovascular risk classes. The ROC curves analysis of Cornell and Lewis indices showed a modest predictive ability to diagnose LVH in the general population and in a low cardiovascular class. Conclusions: There is a need for new, simple methods to diagnose LVH in the general population in order to properly evaluate cardiovascular risk and introduce optimal medical treatment of concomitant disease.

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Section: Clinical and Biochemical Factorssupporting

confidence: 81%

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals with Low Cardiovascular Risk

Chlabicz

Jamiołkowski

Paniczko

et al. 2020

JCM

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“…[ 27 ] Finally, HbA1c levels impact the extent of perfusion abnormalities and left ventricular dysfunction. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of glucose metabolism for non-ST-segment elevation infarction patients with diabetes mellitus and single concomitant chronic total occlusion following primary percutaneous coronary intervention

Xing

Zhang²,

Liu³

et al. 2017

Medicine

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Glucose metabolism status may play a predictive role in the severity of the complications among patients with type 2 diabetes mellitus (DM). However, few studies have focused on the prognostic value of glycosylated hemoglobin (HbA1c) and Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) in patients with DM, non-ST-segment elevation infarction (NSTEMI), and single concomitant chronic total occlusion (CTO) following primary percutaneous coronary intervention (PCI). Short- and long-term prognostic value of HbA1c and HOMA2-IR in patients with DM with NSTEMI and single CTO who received primary percutaneous transluminal coronary intervention (pPCI).Data from 202 patients with NSTEMI and single CTO in nonculprit vessels were included. The incidence of revascularization, cardiogenic shock, ischemic stroke, major bleeding (ie, cerebral hemorrhage or massive hemorrhage of gastrointestinal tract), and cardiac death were combined as composite end points (CEPs). HbA1c was measured on admission and at 12 and 24 weeks after discharge. HOMA2-IR was measured on admission and at 6 and 12 weeks after discharge. The mean value of HbA1c and HOMA2-IR was calculated to determine the impact on 2.5-year CEPs. All patients were assessed during hospitalization and followed for up to 2.5 years after discharge.Mean age was 62.4 ± 11.8 years and 76% were male. Previous MI, lower left ventricular ejection fraction, and higher HbA1c (hazard ratio [HR] = 1.216; 95% confidence interval [CI] = 1.023–1.445; P = .023) were independently associated with a poor prognosis at 2.5 years. Higher HbA1c and HOMA2-IR on admission was associated with CEPs during hospitalization. Mean HOMA2-IR prior to pPCI was associated with revascularization (HR = 1.129; 95% CI = 1.008–1.265; P = .036) and ischemic stroke (HR = 1.276; 95% CI = 1.044–1.560; P = .017) during the 2.5 years follow-up period.Glucose metabolism status reflected by HbA1c and HOMA2-IR may provide prognostic value to patients with NSTEMI, type 2 DM, and single concomitant CTO following PCI. Therefore, patients with NSTEMI, CTO, and poor glycemic control should be carefully evaluated prior to PCI.

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“…A number of studies have focused on the use of HbA1c levels for the prognosis of patients with diabetes ( 6 , 7 , 9 ). A meta-analysis of four randomized clinical trials ( 10 ), Action to Control Cardiovascular Risk in Diabetes (ACCORD) ( 11 ), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) ( 12 ), the UK Prospective Diabetes Study ( 13 ) and Veterans Affairs Diabetes Trial ( 14 ), found that all-cause and cardiovascular mortality did not increase in the intensive glycemic control group (target glycated hemoglobin ≤6.5%, fasting blood glucose <6.0 mmol/l or absolute HbA1c reduction 1.5%) compared with a non-intensive control group, with a median follow-up period from 3.4–5.6 years.…”

Section: Discussionmentioning

confidence: 99%

“…A study by Rocco et al demonstrated that HbA1c was an important predictor of symptomatic hemorrhage following thrombolysis for acute stroke. The results also suggested that hemorrhage following thrombolysis was a consequence of long-term vascular injury rather than of acute hyperglycemia, and that HbA1c may be a more effective predictor than acute blood glucose or a history of diabetes ( 7 ). However, the correlation of low HbA1c levels with coronary artery stenosis and prognosis is not yet clear.…”

Section: Introductionmentioning

confidence: 98%

Different levels of glycosylated hemoglobin influence severity and long-term prognosis of coronary heart disease patients with stent implantation

Wang

Yan

et al. 2014

Experimental and Therapeutic Medicine

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The aim of this study was to investigate the correlation between glycosylated hemoglobin (HbA1c) levels and the severity and long-term prognosis of coronary heart disease (CHD) with stent implantation. A total of 2,825 consecutive patients with stent implantation were stratified into three groups based on the levels of HbA1c: Low HbA1c group (group A, HbA1c ≤5.9% or 41 mmol/mol; n=1,035), moderate HbA1c group (group B, 5.9%< HbA1c <6.8% or 41< HbAlc <51 mmol/mol; n=1,025) and high HbA1c group (group C, HbA1c ≥6.8% or 51 mmol/mol; n=765). The impact of HbA1c on the Gensini score and the long-term prognosis of CHD with stent implantation were observed. After an average of 1 year of follow-up of the 2,825 patients in a hospital cohort, participants with low or high HbA1c had a higher risk of major adverse cardiac events (MACE) and target lesion revascularization (TLR) compared with participants with moderate HbA1c after adjusting for multiple potential confounders (hazard ratios for low HbAlc, 1.505 and 1.478, respectively, and for high HbAlc, 1.626 and 1.522, respectively). Analysis of HbA1c as a continuous variable showed that each 1% increase of HbA1c was significantly associated with decreased risks of MACE and TLR of 53.5 and 54.2%, respectively, in those with a low HbA1c level and with increased risks of MACE and TLR of 9.5 and 9.2%, respectively, in those with a moderate or high HbA1c level, suggesting a U-shaped association between HbA1c and the risk of MACE and TLR. In conclusion, HbA1c levels, either as a continuous variable or a categorical variable, have a U-shaped correlation with MACE and TLR in CHD patients with stent implantation, even after adjustment for multiple confounders.

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Impact of glycosylated hemoglobin (HBA1C) on the extent of perfusion abnormalities and left ventricular dysfunction using gated myocardial perfusion imaging and clinical outcomes in diabetic patients

Abstract: HBA1C is a reliable predictor of coronary artery disease and the magnitude of perfusion defects and LVD and the incidence of NFMIs are higher at an HBA1C level greater than 7.3%.

Cited by 5 publications

References 22 publications

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals with Low Cardiovascular Risk

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals with Low Cardiovascular Risk

Prognostic value of glucose metabolism for non-ST-segment elevation infarction patients with diabetes mellitus and single concomitant chronic total occlusion following primary percutaneous coronary intervention

Different levels of glycosylated hemoglobin influence severity and long-term prognosis of coronary heart disease patients with stent implantation

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