Diabetes Associated With Greater Ejection Fraction Improvement After Revascularization in Patients With Reduced Ejection Fraction

Shaoping Wang; Bijan J Borah; Shujuan Cheng; Shiying Li; Ze Zheng; Xiaoyan Gu; Ming Gong; Yi Lyu; Jinghua Liu

doi:10.3389/fcvm.2021.751474

Diabetes Associated With Greater Ejection Fraction Improvement After Revascularization in Patients With Reduced Ejection Fraction

Front Cardiovasc Med. 2021 Sep 27:8:751474. doi: 10.3389/fcvm.2021.751474. eCollection 2021.

Authors

Shaoping Wang^{1

2}, Bijan J Borah^{2

3}, Shujuan Cheng¹, Shiying Li¹, Ze Zheng¹, Xiaoyan Gu⁴, Ming Gong⁵, Yi Lyu⁶, Jinghua Liu¹

Affiliations

¹ Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.
³ Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
⁴ Department of Echocardiography, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁵ Department of Cardiovascular Surgery, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁶ Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, China.

Abstract

Objectives: To investigate the association between diabetes mellitus (DM) and ejection fraction (EF) improvement following revascularization in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Background: Revascularization may improve outcomes of patients with LV dysfunction by improvement of EF. However, the determinants of EF improvement have not yet been investigated comprehensively. Method: A cohort study (No. ChiCTR2100044378) of patient with repeated EF measurements after revascularization was performed. All patients had baseline EF ≤40%. Patients who had EF reassessment 3 months after revascularization were enrolled. Patients were categorized into EF unimproved (absolute increase in EF ≤5%) and improved group (absolute increase in EF >5%). Results: A total of 974 patients were identified. 573 (58.8%) had EF improved. Patients with DM had greater odds of being in the improved group (odds ratio [OR], 1.42; 95% CI, 1.07-1.89; P = 0.014). 333 (34.2%) patients with DM had a greater extent of EF improvement after revascularization (10.5 ± 10.4 vs. 8.1 ± 11.2%; P = 0.002) compared with non-diabetic patients. The median follow-up time was 3.5 years. DM was associated with higher risk of overall mortality (hazard ratio [HR], 1.46; 95% CI, 1.02-2.08; P = 0.037). However, in EF improved group, the risk was similar between diabetic and non-diabetic patients (HR, 1.36; 95% CI, 0.80-2.32; P = 0.257). Conclusions: Among patients with reduced EF, DM was associated with greater EF improvement after revascularization. Revascularization in diabetic patients might partially attenuate the impact of DM on adverse outcomes. Our findings imply the indication for revascularization in patients with LV dysfunction who present with DM.

Keywords: diabetes mellitus; ejection fraction; heart failure; prognosis; revascularization.