Diabetes mellitus (DM) is a major risk factor for heart failure (HF) and coronary artery disease (CAD). DM may cause structural changes involving the left ventricle (LV) systolic and diastolic function.
To compare patients who have diabetes and ischemic cardiomyopathy (ICM) to those with diabetic cardiomyopathy (DMCMP) regarding LV systolic function, diastolic function, in hospital long term and short-term mortality.
Ninety diabetic patients with heart failure and left ventricular ejection fraction (LVEF) ≤ 35%, admitted to Critical Care Medicine department Cairo University were divided into two groups based on coronary angiography results; group I (ICM) n = 48 patients and group II (DMCMP) n = 42 patients.
Group I patients had higher mean age (63 ± 7 years), (p = 0.004), Hypertension (p < 0.001) and dyslipidemia (p = 0.008) were significantly more present in group I compared to group II. No significant differences were found regarding LVEF, global longitudinal strain (GLS), E/A and E/É ratio in both groups. A significant difference in the wall motion score index (WMSI) in group I; (1.4 ± 0.4) versus group II; (1.1 ± 0.2), (p = 0.005) was found. In the study, 6 patients had a cardiogenic shock with no documented in-hospital mortality. At 6 months, statistically, significantly higher mortality rates were found in group I, (p = 0.006), while at one year there was no significant difference in the mortality between the two groups, (p = 0.077). In comparison of the survived and non-survived patients at 6 months and one year in group I (ICM) there was a significant difference in LVEF (40 ± 6% vs 23 ± 6%, p < 0.001), GLS (- 8.1 ± 2.4 vs - 4.6 ± 2.6, p = 0.007), E/A (1.25 ± 0.91 vs 1.8 ± 0.5, p = 0.038), E/É (11.68 ± 7.5 vs 21.3 ± 3.6, p = 0.001) respectively. In group ll (DMCMP) there was no documented mortality at 6 months follow up, however, at one year there was statistically significant difference in the mortality between survived and non-survived patients; the LVEF (35 ± 8% vs 25 ± 2%, p = 0.014), GLS (-7.9 ± 2.9% vs -5 ± 0.1%, p = 0.032), E/A (1.45 ± 0.8 vs 3.3 ± 0, p = 0.006) respectively. The E/É ratio in group ll was not significantly different between the groups (15.73 ± 5.3 vs 15 ± 1, p = 0.873).
The combination of cardiomyopathy and diabetes affects LV systolic and diastolic function; however; ischemic cardiomyopathy and diabetic cardiomyopathy had a similar systolic and diastolic function. Ischemic cardiomyopathy is associated with worse prognosis compared to diabetic cardiomyopathy.

Copyright: © 2019 Najjat Obaid, Samir El Hadidy, Mahmoud El Badry, Hassan Khaled.