EFFECT OF GLYCEMIC CONTROL ON KILLIP GRADING AND BNP LEVELS IN TYPE 2 DIABETES MELLITUS PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION
Keywords:Diabetes Mellitus, Type 2; Myocardial Infarction; Heart Failure; Echocardiography; Natriuretic Peptide, Brain
Introduction: Despite prompt management of acute myocardial infarction in diabetics, complications do occur. The objective of the present study was to assess level of stress on the post-infarction left ventricular myocardium and its association with glycemic control.
Materials & Methods: This descriptive study was conducted in Lady Reading Hospital (LRH) and Rehman Medical Institute (RMI) Peshawar from November 2014 to March 2015 on 196 known type 2 diabetics who received thrombolytic treatment inside first 12 hours of Myocardial Infarction (MI); demographic data, Killip Scale grading, and echocardiography were recorded and blood samples analyzed for HbA1c and BNP after informed consent and convenience sampling. Post-MI risk assessment and stratification were done by Killip Scale and plasma BNP levels. Based on glycemic control, there were: optimal glycemic control group (mean HbA1c â‰¤7%) and suboptimal glycemic control group (mean HbA1c >7%). Based on ejection fraction (EF), there were: Group I (severe LV dysfunction, EF<30%), Group 2 (moderate LV dysfunction, EF=30-44%), Group 3 (mild LV dysfunction, EF=45-54%) and Group 4 (preserved LV function, EFâ‰¥55%). Data were analyzed for descriptive statistics by SPSS 16.0.
Results: Significant differences of BNP values were found between optimal and suboptimal groups in EF group 1 (p=0.01), EF group 2 (p<0.001) and EF group 3 (p<0.001), but not in EF group 4 (p=0.50). Significant negative correlation was found between plasma BNP and EF (optimal control group: r=-0.8, p<0.001; suboptimal control group: r=-0.7, p<0.001).
Conclusion: Plasma BNP levels were elevated in suboptimal control group compared to optimal group and its rise was proportional to decrease of EF in both groups, accentuating the significance of BNP in post-MI patients.