Comparison of left ventricular shape by gated SPECT imaging in diabetic and nondiabetic patients with normal myocardial perfusion: A propensity score analysis

Diabetes mellitus induces structural and functional cardiac alterations that can result in heart failure. Left ventricular (LV) shape is a dynamic component of cardiac geometry influencing its contractile function. However, few data are available comparing LV shape index in diabetic and nondiabetic patients without overt coronary artery disease after balancing for coronary risk factors. We studied 1168 patients with normal myocardial perfusion and normal LV ejection fraction on stress gated single-photon emission computed tomography (SPECT) imaging. To account for differences in baseline characteristics between diabetic and nondiabetic patients, we created a propensity score-matched cohort considering clinical variables, coronary risk factors, and stress type. Before matching, diabetic patients were older, had higher prevalence of male gender and coronary risk factors, and higher end-diastolic and end-systolic LV shape index. After matching, all clinical characteristics were comparable between diabetic and nondiabetic patients, but diabetic patients still had higher end-diastolic and end-systolic LV shape index (both P < .001). At multivariable linear regression analysis, diabetes was a strong predictor of end-systolic LV shape index in the overall study population and in the propensity-matched cohort. Diabetic patients have higher values of LV shape index compared to nondiabetic patients also after balancing clinical characteristics by propensity score analysis. Shape indexes assessment by gated SPECT may be useful for identifying early LV remodeling in patients with diabetes. La Diabetes Mellitus induce alteraciones cardiacas a nivel estructural y funcional que pueden resultar en insuficiencia cardiaca. La forma ventricular izquierda (VI) es un componente dinámico de la geometría cardiaca que influye en su función contráctil. Sin embargo, existen pocos datos disponibles que comparen el Índice de Forma VI en pacientes diabéticos y no diabéticos sin enfermedad arterial coronaria después de equilibrar los factores de riesgo coronario. Estudiamos 1168 pacientes con perfusión miocárdica normal así como fracción de eyección del ventrículo izquierdo normal en la fase de estrés del gated SPECT. Para establecer las diferencias en las características basales entre pacientes diabéticos y no diabéticos, se creó una cohorte de puntuación de propensión teniendo en cuenta las variables clínicas, factores de riesgo coronario y tipo de estrés. Antes del emparejamiento, l