| Background:Myocardial ischemia lead to cardiac remodeling, both of them will damage cardiac function. Effective revascularization can improve abnormal heart function, reduce the occurrence of major cardiovascular events and improve patients' living quality. Percutaneous coronary intervention (PCI) is an effective and widely used tool for the treatment of revascularization. The lesions of coronary artery were often serious in coronary heart disease patients combined with cardiac insufficiency. The intervention of complete revascularization may not be successful in these patients. Because the irreversible dysfunction of cardiac muscle and microvascular, coupled with the left ventricular remodeling, a large part of patients'cardiac function has not been significantly improved after revascularization.Diabetes significantly increase the morbidity and mortality of cardiovascular disease. It is the major risk factors for heart failure. Multi-vessel coronary artery disease and diffuse artery disease were existed wildly in Diabetes patients. The configuration of coronary artery lesions was complexity. There has no adequate collateral circulation ischemia area. Diabetic patients with coronary heart disease often have poor long-term prognosis.Echocardiography is a safe non-invasive, accurate and reliable evaluation of heart function.Based on above, we prospectively studied a cohort of patients with cardiac insufficiency who received PCI. Compare the changes of cardiac function in the cardiac insufficiency patients with unstable angina and those with non-ST-segment elevation myocardial infarction after percutaneous coronary intervention. Analysis the factors that affect cardiac function changes, observed the occurrence of cardiovascular events, guiding the clinical diagnosis and treatment of coronary heart disease.Methods:Measurement the left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), diastolic mitral valve orifice early peak flow velocity (E), peak early diastolic mitral annulus velocity (Ea), peak late diastolic mitral annulus velocity (Aa), application of these indicators of left ventricular function and size by echocardiography 1 day before, 1 month after and 6 months after the interventional treatment. Follow up the patients for a long term to observe the changes of cardiac function and the outcome of major heart vascular events. All data were analysised by software SPSS13.0, P value<0.05 as statistically significant.Results:A total of 243 cases was in final study (128 patients with diabetes),158 cases (82 cases of diabetes) to the intervention. The level of LVEF in the patients received the intervention was continued rising from baseline to 1 month after and from 1 month after to 6 month after PCI, whatever the diabetes mellitus patients or previous myocardial infarction ones(P<0.05). On the contrary, the patients who have not received intervention, the levels of LVEF was continued decreasing (P<0.05).6 months after,74.7% patients received PCI showed significant cardiac functional recovery (>10% ejection fraction increase compared with baseline). The factors which impact heart function improvement include:female (P=0.033), CCS I andâ…¡level (P=0.015), nitrates drugs (P=0.021).6 months after,17.1% patients who received the intervention showed left ventricular remodeling (>20% end-diastolic volume increase compared with baseline). The factors affect left ventricular remodeling include:multi-vessel disease (P=0.027), aldosterone receptor antagonist (P=0.033), baseline LVEDV (P<0.001). The level of Ea/Aa was continued rising from baseline to 1 month after and from 1 month after to 6 month after PCI, for patients without diabetes and myocardial infarction (P<0.05). The Ea/Aa levels appeared lower in the 6 months after PCI in patients with diabetes (P<0.05). For all patients not received PCI, the levels of Ea/Aa were sustained reductions (P<0.05). The risk of cardiovascular events for PCI group was significantly lower than non-PCI group (RR0.384,95% CI 0.272-0.542, P<0.001). In PCI group, compare with non-diabetic ones diabetic patients has higher risk to cardiovascular events (RR0.495, 95% CI 0.26-0.94, P=0.034).Conclusion:PCI can improve heart function for unstable angina and non-ST-segment elevation myocardial infarction with cardiac dysfunction, but can not prevent the development of left ventricular remodeling. The innovation is diabetes has no significant effect on cardiac function recovery and left ventricular remodeling, but prevented the improvement of diastolic function, and diabetes patients has a higher risk of cardiovascular events related to worse diastolic function, whereas it is irrelevant between heart function and left ventricular remodeling.
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