Impact of Admission Hyperglycemia on Postmyocardial Infarction Left Ventricular Remodelling
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 7
Abstract
Objectives: This study aims to assess left ventricular (LV) remodelling in acute myocardial infarction (AMI) patients presented with admission hyperglycemia (AH) and to determine the association between AH and LV remodelling. Patients and Methods: We conducted a prospective cohort study and we analysed LV remodelling in 122 AMI patients. AH was defined as a glycemia on admission ≥ 140 mg/dl. We divided the patients according to the admission plasma glucose and history of diabetes into three groups: 45 euglycemic patients, 36 diabetic patients and 41 hyperglycemic non diabetic patients. Systematic echocardiographic study was performed at baseline and at 12 months later. Results: The changes in LV end-diastolic volume (LVEDV) from baseline to 12 months follow up was 4.86 ± 13.20 cm3 in euglycemic group, 86.47 ± 65.53cm3 in diabetics and 149.40 ± Lobna F Eltony et al JMSCR Volume 02 Issue 07 July 2014 Page 1759 JMSCR Volume||2||Issue||7||Page1758-1773||July 2014 2014 INTRODUCTION Patients either with or without a prior history of diabetes mellitus may present with hyperglycemia during acute myocardial infarction (AMI). Among patients with no prior history of diabetes, hyperglycemia during AMI may reflect previously undiagnosed diabetes, preexisting carbohydrate intolerance, stress-related hyperglycemia, or a combination of these[1]. Several studies have reported an association between elevated plasma glucose upon admission and subsequent increased adverse events, including congestive heart failure (CHF), cardiogenic shock, and death, but the mechanisms underlying this association are unknown [2].Among the pathophysiological mechanisms that may lead to an adverse prognosis after AMI is left ventricular (LV) remodelling. LV remodelling is a dynamic process that occurs in response to damage to the myocardium after AMI [3].Progressive LV dilation after AMI has been recognized as a strong predictor of heart failure and cardiovascular death [4].Several factors have been shown to influence LV remodelling; these include infarct size, anterior infarct location, or patency of the infarct-related artery [5]. Nian et al.[6]described an active inflammatory infiltrate in the peri-infarct area and in unaffected viable myocardium in patients with AMI.The inflammatory burden in the peri-infarct region is associated with worse short- and mid-term outcomes. This is because the inflammatory response in this region probably amplifies myocardial remodelling. Cytokines such as tumor necrosis factor α are elaborated soon after myocardial ischemic injury and can acutely regulate myocyte survival or 59.55cm3 in hyperglycemic nondiabetic patients (P=0.000 for all). When LV remodelling was defined as a ≥20% increase in LVEDV, it was observed in 17.1% in euglycemic patients, 91.7% in diabetics, and 100% in hyperglycemic nondiabetic patients (P=0.000 between euglycemic patients and both other groups, P=0.248 between diabetics and hyperglycemic nondiabetic patients).By multiple linear regression analysis, AH (P = 0.000), baseline segmental wall motion score (P =0.000), and partial reperfusion (P= 0.035) were independently associated with LV remodelling. By multiple logistic regression analysis, AH was an independent predictor of LV remodelling with adjusted Odd’s ratio=2.167(95%CI:2.001 2.333). Conclusions: We concluded that patients with admission hyperglycemia had a worse postmyocardial infarction LV remodelling than euglycemic patients, regardless of their diabetic status. Admission hyperglycemia was a major and independent predictor of postmyocardial LV remodelling.
Authors and Affiliations
Dr Salah A Argoon
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