Background: Diabetic patients are at an increased risk of developing heart failure after myocardial infarction, particularly when left ventricular function is severely impaired. We aimed to investigate the influence of diabetes on the development of heart failure in a dynamically changing post-myocardial
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Background: Diabetic patients are at an increased risk of developing heart failure after myocardial infarction, particularly when left ventricular function is severely impaired. We aimed to investigate the influence of diabetes on the development of heart failure in a dynamically changing post-myocardial infarction population.
Methods: In 272 patients enrolled in the Healing and Early Afterload Reducing Therapy (HEART) trial, left ventricular volumes, ejection fraction, and infarct segment length were assessed by echocardiography on day 1, day 14 and day 90. Echocardiographic measures, as well as clinical outcomes, were compared between diabetics and non-diabetics.
Results: At presentation with myocardial infarction, diabetics (n = 56, 21%) demonstrated higher Killip class than non-diabetics (n = 216, 79%) despite similar infarct size. Changes in left ventricular size and function in the three months following infarction were similar in diabetics and non-diabetics. At one-year followup, diabetics demonstrated increased incidence of heart failure (29% versus 14%, p = 0.014) and total cardiovascular events (39% versus 19%, p = 0.002).
Conclusions: The coexistence of diabetes enhances the risk for developing heart failure after myocardial infarction even in patients with mild left ventricular dysfunction or preserved ejection fraction. This risk is independent of infarct size, ejection fraction, or subsequent ventricular remodeling.
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