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Diabetes is an independent predictor of right ventricular dysfunction post ST-elevation myocardial infarction.

Roifman I, Ghugre N, Zia MI, Farkouh ME, Zavodni A, Wright GA, Connelly KA - Cardiovasc Diabetol (2016)

Bottom Line: Of 99 patients for which RV data was available, 40 had RVD and 59 did not.Patients with DM were significantly more likely to have RVD when compared to those without diabetes (45 vs 22 %, p = 0.03).No other major cardiovascular risk factors were independently associated with the presence of RVD.

View Article: PubMed Central - PubMed

Affiliation: Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. idan.roifman@mail.utoronto.ca.

ABSTRACT

Background: Diabetes mellitus (DM) is estimated to become the 7th leading cause of death by 2030. Right ventricular dysfunction (RVD) complicating ST elevation myocardial infarction (STEMI) is independently associated with a higher mortality; however the relationship between DM and RVD is currently unknown. The purpose of this study was to determine whether DM is an independent predictor for the presence of right ventricular dysfunction (RVD) post STEMI.

Methods: 106 patients post primary PCI for STEMI were enrolled in the study. Cardiac MRI was performed within 48-72 h after admission in order to assess ventricular function. Statistical analysis consisted initially of descriptive statistics including Chi square, Fisher's exact, or the Wilcoxon rank sum as appropriate. Subsequently, logistic regression analysis was performed to determine independent predictors of RVD.

Results: The median age in the study was 58 years (IQR 53, 67). 30 % of the patients had diabetes. Of 99 patients for which RV data was available, 40 had RVD and 59 did not. Patients with DM were significantly more likely to have RVD when compared to those without diabetes (45 vs 22 %, p = 0.03). There was no significant difference in age, hypertension, smoking status, dyslipidemia, serum creatinine or peak CK levels between the two groups. After adjusting for other factors, presence of DM remained an independent predictor for the presence of RV dysfunction (OR 2.78, 95 % CI 1.12, 6.87, p = 0.03). Amongst diabetic patients, those with HbA1C ≥ 7 % had greater odds of having RVD vs those with HbA1C < 7 % (OR 5.58 (1.20, 25.78), p = 0.02).

Conclusions: The presence of DM conferred an approximately threefold greater odds of being associated with RVD post STEMI. No other major cardiovascular risk factors were independently associated with the presence of RVD.

No MeSH data available.


Related in: MedlinePlus

Example of the contouring of the left (red) and right (yellow) ventricular endocardium in one of the patients in our study during end-diastole (a) and end systole (b)
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Fig1: Example of the contouring of the left (red) and right (yellow) ventricular endocardium in one of the patients in our study during end-diastole (a) and end systole (b)

Mentions: CVI-42 version 4.1.8 software (Circle Cardiovascular Imaging, Calgary, Alberta, Canada) was used to contour the left and right ventricles and derive volumes and ejection fractions. Studies were contoured by a level 3 Society for Cardiovascular Magnetic Resonance (SCMR) trained physician according to the most recent guideline recommendations [16]. Specifically, the endocardial contours of the left and right ventricle were manually traced at end-diastole and end-systole in all cine studies. For the right ventricle, the pulmonary valve was visualized and contours were included up to but not above this level. Trabeculations of the right ventricle were ignored and a smooth endocardial border was drawn for each slice (see Fig. 1). LV and RV stroke volumes were within 10 % of each other in the studies thus providing confirmation of our results (given that none of the patients had significant intra or extra-cardiac shunts).Fig. 1


Diabetes is an independent predictor of right ventricular dysfunction post ST-elevation myocardial infarction.

Roifman I, Ghugre N, Zia MI, Farkouh ME, Zavodni A, Wright GA, Connelly KA - Cardiovasc Diabetol (2016)

Example of the contouring of the left (red) and right (yellow) ventricular endocardium in one of the patients in our study during end-diastole (a) and end systole (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4759780&req=5

Fig1: Example of the contouring of the left (red) and right (yellow) ventricular endocardium in one of the patients in our study during end-diastole (a) and end systole (b)
Mentions: CVI-42 version 4.1.8 software (Circle Cardiovascular Imaging, Calgary, Alberta, Canada) was used to contour the left and right ventricles and derive volumes and ejection fractions. Studies were contoured by a level 3 Society for Cardiovascular Magnetic Resonance (SCMR) trained physician according to the most recent guideline recommendations [16]. Specifically, the endocardial contours of the left and right ventricle were manually traced at end-diastole and end-systole in all cine studies. For the right ventricle, the pulmonary valve was visualized and contours were included up to but not above this level. Trabeculations of the right ventricle were ignored and a smooth endocardial border was drawn for each slice (see Fig. 1). LV and RV stroke volumes were within 10 % of each other in the studies thus providing confirmation of our results (given that none of the patients had significant intra or extra-cardiac shunts).Fig. 1

Bottom Line: Of 99 patients for which RV data was available, 40 had RVD and 59 did not.Patients with DM were significantly more likely to have RVD when compared to those without diabetes (45 vs 22 %, p = 0.03).No other major cardiovascular risk factors were independently associated with the presence of RVD.

View Article: PubMed Central - PubMed

Affiliation: Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. idan.roifman@mail.utoronto.ca.

ABSTRACT

Background: Diabetes mellitus (DM) is estimated to become the 7th leading cause of death by 2030. Right ventricular dysfunction (RVD) complicating ST elevation myocardial infarction (STEMI) is independently associated with a higher mortality; however the relationship between DM and RVD is currently unknown. The purpose of this study was to determine whether DM is an independent predictor for the presence of right ventricular dysfunction (RVD) post STEMI.

Methods: 106 patients post primary PCI for STEMI were enrolled in the study. Cardiac MRI was performed within 48-72 h after admission in order to assess ventricular function. Statistical analysis consisted initially of descriptive statistics including Chi square, Fisher's exact, or the Wilcoxon rank sum as appropriate. Subsequently, logistic regression analysis was performed to determine independent predictors of RVD.

Results: The median age in the study was 58 years (IQR 53, 67). 30 % of the patients had diabetes. Of 99 patients for which RV data was available, 40 had RVD and 59 did not. Patients with DM were significantly more likely to have RVD when compared to those without diabetes (45 vs 22 %, p = 0.03). There was no significant difference in age, hypertension, smoking status, dyslipidemia, serum creatinine or peak CK levels between the two groups. After adjusting for other factors, presence of DM remained an independent predictor for the presence of RV dysfunction (OR 2.78, 95 % CI 1.12, 6.87, p = 0.03). Amongst diabetic patients, those with HbA1C ≥ 7 % had greater odds of having RVD vs those with HbA1C < 7 % (OR 5.58 (1.20, 25.78), p = 0.02).

Conclusions: The presence of DM conferred an approximately threefold greater odds of being associated with RVD post STEMI. No other major cardiovascular risk factors were independently associated with the presence of RVD.

No MeSH data available.


Related in: MedlinePlus