Admission glucose and left ventricular systolic function in non-diabetic patients with acute myocardial infarction

Abstract

Carbohydrate metabolism disorder in patients hospitalized due to acute ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. The association is even stronger in non-diabetic patients compared to the diabetics. Poor outcome of patients with elevated parameters of carbohydrate metabolism may be associated with negative impact of these disorders on left ventricular (LV) function. The aim of the study was to determine the impact of admission glycemia on LV systolic function in acute phase and 6 months after myocardial infarction in STEMI patients treated with primary angioplasty, without carbohydrate disorders. The study group consisted of 52 patients (9 female, 43 male) aged 35-74 years, admitted to the Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, due to the first STEMI treated with primary coronary angioplasty with stent implantation, without diabetes in anamnesis and carbohydrate metabolism disorders diagnosed during hospitalization. Echocardiography was performed in all patients in acute phase and 6 months after MI. Plasma glucose were measured at hospital admission. In the subgroup with glycemia ≥7.1 mmol/l, in comparison to patients with glycemia <7.1 mmol/l, significantly lower ejection fraction (EF) was observed in acute phase of MI (44.4 ± 5.4 vs. 47.8 ± 6.3 %, p = 0.04) and trend to lower EF 6 months after MI [47.2 ± 6.5 vs. 50.3 ± 6.3 %, p = 0.08 (ns)]. Higher admission glycemia in patients with STEMI and without carbohydrate metabolism disturbances, may be a marker of poorer prognosis resulting from lower LV ejection fraction in the acute phase and in the long-term follow-up.

Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

“…Biomarkers offer a desirable strategy for improving risk stratification and clinical decision making for STEMI patient management [7,19,50]. Our findings indicate that CRP provides useful information for the prediction of risk of post-STEMI LVSD and HF hospitalization, which enhances the overall prognostic value of already well-known risk factors (e.g., elevated BNP concentration, which is related to adverse clinical outcomes including reduced LVEF and increased rate of hospitalization for HF) [7,19,50,51]. Other biomarkers may also be potentially valuable for monitoring and predicting of HF development, for example ST2 protein [52].…”

Plasma dipeptidyl-peptidase-4 activity is associated with left ventricular systolic function in patients with ST-segment elevation myocardial infarction

“…PCI treatment paradoxically results in an increased number of patients at risk of LVSD and HF, with resultant poorer prognoses during short- and long-term follow-up 23 . It has been reported that in diastolic HF patients, DPP4a is positively associated with LV dysfunction 24 .…”

Four varieties of diabetes mellitus in acute myocardial infarction

“…Variable practice reflects directly the lack of consensus -some authors used to perform OGTT: as early as on the day one of hospitalization 47 , on the day three from the admission 34,48,49 ; on the day four of hospitalization 50 (the ESC guidelines also recommend delaying the test for 4 to 5 days after ACS to minimize the false positive results 51,52 ,because the results of OGTT could be somewhat falsified by stress hyperglycemia 52 ); from one to 3 days following the hospital discharge 53 ; from 7 to 28 days after ACS 25 ; or 3 months after discharge 42,46 .…”