Abstract 1620: Impact of Diastolic Dysfunction on the Development of Heart Failure in Diabetic Patients After Acute Myocardial Infarction
Background: Diabetic patients (pts) are at increased risk for heart failure (HF) after acute myocardial infarction (AMI). The greater propensity for HF in diabetic pts may be due to left ventricular diastolic dysfunction. However, there is no data regarding the prevalence and clinical consequences of diastolic dysfunction in diabetic pts with AMI.
Methods: We studied 1513 pts after AMI (417 diabetic). Echocardiography was performed during hospital stay. Diastolic dysfunction was defined as a restrictive filling pattern (RFP) based on E/A ratio >1.5 or deceleration time <130 msec. The primary endpoint of the study was readmission for HF. Cox models were used to calculate hazard ratios (HR) for HF, adjusting for age, gender, hypertension, anterior infarction, ST-elevation infarction, Killip class, coronary revasculariza-tion, creatinine, and ejection fraction.
Results: The frequency of RFP was higher in pts with diabetes (20 vs. 14%; P=0.005). During a mean follow up of 18 months (range 6 to 39) 114 pts developed HF. There was a significant interaction between diabetes and RFP with regard to HF (P=0.04), such that the relationship between diabetes and HF was much stronger among pts with RFP (Figure⇓). In the whole study population, the HR for HF was 1.6 in diabetic compared with nondiabetic pts (95% CI 1.1 to 2.3; P=0.02). In stratified analyses, compared with nondiabetic pts, the adjusted HR for HF was 2.8 in diabetic pts with RFP (95% CI, 1.4 to 5.5; P=0.002) and 1.2 in diabetic pts without RFP (95% CI, 0.8 to 1.6; P=0.34).
Conclusion: Diabetic pts with AMI have a higher prevalence of RFP. The excess of HF events among diabetic pts occur predominantly in pts with concomitant RFP.