impact of diabetes mellitus on myocardial reperfusion and left ventricular remodelling in patients with acute myocardial infarction treated with primary coronary intervention

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1. Abstract 1.1. Background:  Diabetes Mellitus (DM) in patients after acute Myocardial Infarction (MI) has been shown to be a strong predictor of short-and long-term mortality. It has also been recognized that DM is associated with an increased rate of post-infarction heart failure. 1.2. Aim of the Study:  To evaluate the impact of diabetes mellitus on myocardial reperfusion after primary PCI in patients with acute myocardial infarction utilizing, resolution of ST- segment elevation and Myocardial Blush Grade (MBG) and to evaluate the impact of diabetes mellitus on left ventricular remodelling using 2-D speckle tracking. 1.3. Methods:  The study population consisted of 100 patients with anterior STEMI (50 diabetics and 50 non-diabetic) all patients underwent 1ry PCI. Conventional 2D echocardiography to asses LVEF, EDV and ESV and speckle tracking echocardiography to asses LV global longitudinal strain and global circumferential strain was done within 72 hr of admission and after 3 months later and patients with LV remodelling, i.e. an increase >20% in LV End-Diastolic Volume (LVEDV), were identified. 1.4. Results:  No significant difference was found regarding baseline clinical, angiographic and echocardiographic characteristics except in MBG3 (18% vs. 54 % p=0.001), MBG1 (32% vs. 8 % p=0.003), complete ST segment resolution (18% vs. 48 % p=0.001) and Absent ST segment resolution (28% vs. 10% p=0.022) between diabetics and non-diabetics respectively. Despite a similar incidence of LV remodelling in DM and non-DM groups (22% vs. 16%, p=0.444), The 19 patients with LV remodelling had significantly more impaired LVEDV (99.84 ± 19.24vs. 125.11 ± 19.96, p=0.001), and LV global longitudinal strain (GLS) (-11.47 ± 1.34%vs. -10.61 ± 2.15%, p=0.021). Change in end diastolic volume showed the strongest correlation with the GLS (P= 0.042, r = 0.473) and apical circumferential strain (P=0.028, r=0.014). Furthermore, apical circumferential strain demonstrated the highest diagnostic accuracy: area under the Receiver Operating Characteristic (ROC) curve, with sensitivity 84.2% and specificity 88.9%, using a cut-off value >-11.7% and GLS with sensitivity 89.5% and specificity 65.4%, using a cut-off value >-12.5 % for prediction of LV remodelling. 1.5. Conclusion:  Despite worse microvascular reperfusion and ST segment resolution in STEMI patients with diabetes, the incidence of LV remodelling was similar compared to non-DM patients and LV apical CS and GLS is a predictive parameter of future adverse remodelling. 2. Keywords: Diabetes mellitus; Myocardial infarction; Myocardial reperfusion; Primary coronary intervention

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