Left ventricular size and function in patients with noninsulin-dependent diabetes and postinfarction total or subtotal coronary occlusions

The aim of this study was to establish the effects of postinfarction total or subtotal coronary occlusion on left ventricular remodeling in patients w ith noninsulin-dependent diabetes (NIDD) compared with the effects in posti nfarct nondiabetic patients. The authors selected 100 patients submitted to coronary angiography between 1 and 5 weeks after acute myocardial infarcti on (TO: 20.5 +/- 15.4 days) and classified into three groups: G1: NIDD with coronary occlusion/subocclusion (n=24), G2: controls with coronary occlusi on/subocclusion (n=43), G3: controls without coronary occlusion/subocclusio n (n=33). At time zero (TO) the following parameters were evaluated: end-sy stolic and end-diastolic volume indexes (ESVi, EDVi), ejection fraction (EF ), echocardiographic wall motion score index (WMI), presence of left ventri cular aneurysm, and triple-vessel coronary disease. The frequencies of majo r cardiovascular events were recorded during follow-up. Significantly great er ESVi and EDVi were noted in G2 compared with G3 (P<0.0001), while no sig nificant differences were observed between NIDD patients and controls. Alth ough left ventricular global and segmental dysfunctions were increased in d iabetics, controls with coronary occlusion/subocclusion presented more pron ounced EF reduction (P<0.0001 G2 vs G3) and higher elevation in WMI (P<0.00 5 G2 vs G3). Cardiac events during follow-up were elevated in G1 and G2, pa rticularly as regards the occurrence of congestive heart failure. The autho rs conclude that NIDD seems to influence in a positive way left ventricular remodeling associated with postinfarct total or subtotal coronary occlusio n.