| Objective: Coronary heart disease is the most basic cause of heart failure, the patients of acute coronary syndrome occurred cardiac dysfunction easier, especially the patient of acute myocardial infarction, their diastolic function was demaged in the early period, However, the status of cardiac function is important for prognosis of the patients of coronary heart disease. That is why we should concern on the change of cardiac function of the patients who have acute coronary syndrome, and analyze which could affect their cardiac function. Studies have shown that diabetes was one of independent risk factors when Heart failure happened, the heart structure of the diabetes becomes hypertrophy in the patient , systolic and diastolic function are damaged at the same time, the diastolic dysfunction appeared earlier, but this has been existed when the patients on IGT status[1], there are nearly 80% patients with coronary heart disease have abnormal glucose regulation in China[2].The reports about the influence of abnormal glucose metabolism to the cardiac function of the acute coronary syndrome patients are seldom, therefore, the aim of our study was to analyze the general clinical data, fasting blood glucose, glucose after 2 hours by OGTT, serum brain natriuretic peptide(BNP),and echocardiography of 120 cases, then investigate the role of different levels of glucose metabolism on the early cardiac function of the acute coronary syndrome patients. We also can make a better job for the glucose management of the persons with coronary heart disease and improve their quality of life.Methods:?120 participants (79 males , 41 females) with Acute Coronary Syndrome were chosen in the Cardiology Department of the Second Hospital which belong to He Bei Medical University from July 2009 to December 2010,the patients were splitted into three groups with Normal Glucose Tolerance , Impaired Glucose Regulation and Type 2 Diabetes by OGTT test .All of them would be tested serum brain natriuretic peptide (BNP) through radioimmunoassay and be determined LVEF, E peak, A peak and E/A by echocardiography, then we would conduct comparative analysis among the groups according to the results of their BNP and echocardiography .The diagnosis of abnormal glucose metabolism was in line with the diagnostic standard which was proposed by American Coronary Society (ACC) and American Heart Association (AHA) in the year of 2003 . Removing conditions are thyroid, liver, kidney disease and other important organs disease , chronic wasting disease and malignant tumor , heart failure .All statistical analyses were performed using the SPSS13.0 program package. Date was expressed as the mean value±standard deviation ( x±s). Date among groups was compared analysis of variance. Sample rate was compared by Chi-square test. Analysis of risk factors of cardiac function with ACS was performed by multiple stepwise regression analysis, There is significance at p<0.05.Results:1 There are 32 diabetes in 120 cases of ACS patients, after tested by OGTT, 20 diabetes (DM) (22.73%), 22 cases of IGR (25%) and 46cases of normal glucose (NGT) (52.27%) were detected; The ratio of E/A was decreased while the increased of blood glucose, NGT (1.32±0.21),IGR (0.82±0.21),DM (0.70±0.23),p<0.05, there was statistically significant among three groups on p<0.05; BNP was increased with the raise of the worse of blood glucose, NGT (544.78±108.56)pg/ml, IGR (877.13±152.79)pg/ml , DM (1149.13v136.61)pg/ml, the comparison among three groups had extremely statistically significant , p<0.01; The LVEF had not shown any statistically significant differences among three groups, NGT (56.36±3.61)% , IGR (56.11±4.54)%, DM(55.56±3.85)% , p>0.05.2 Respectively, fasting plasma glucose and OGTT 2 hour plasma glucose as the dependent variable, other factors as independent variables in multiple linear regression analysis, the results showed that BNP, systolic blood pressure, low density lipoprotein, E / A value and diastolic blood pressure with a linear relationship, the standardized regression coefficients were: 0.636, 0.148, 0.321, -0.168, -0.205, (p<0.05); and 0.634, 0.118, 0.255, -0.228, -0.189, (p<0.05) . Standardized regression coefficients from the above can be drawn that relationship of BNP and fasting glucose and OGTT 2 hour glucose was most closely. Besides, we could obtain that it show a linear relationship among BNP, E/A ratio, fasting blood glucose and OGTT 2 hour plasma glucose after the linear regression analysis, and E / A ratio and BNP was negatively correlated , indicating that BNP decreased with the increase of diastolic function.Conclusion: This research was shown that the patients of ACS and Abnormal glucose metabolism whose bood glucose levels was cosely related to their crdiac function, and with the glucose level increased, the cardiac function was getting worse. Furthermore, there are numerous abnormal glucose metabolism potential in the patients of ACS, so we should pay more awareness of blood glucose management and further strengthen these patients with coronary heart disease, discover and treat in the early period, reverse or delay the progress from abnormal glucose metabolism to diabetes, thus we could improve the cardiac function and their prognosis further or improve their quality of life. |
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