Effect of Pretreatment With Pioglitazone on Reperfusion Injury in Diabetic Patients With Acute Myocardial Infarction

Kataoka, Yuki; Yagi, Nobuhito; Kokubu, Nobuaki; Kasahara, Yoichiro; Abe, Mitsuru; Otsuka, Yoritaka

doi:10.1253/circj.cj-11-0098

Cited by 18 publications

(9 citation statements)

References 38 publications

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“…Peroxisome proliferator-activated receptor γ (PPARγ), a ligand-inducible nuclear receptor belonging to the nuclear transcription factor superfamily, 5 is a representative example. Accumulating studies demonstrate that PPARγ can protect cardiomyocytes against I/R injury through regulating cardiac oxidative stress, 6 –8 inflammatory responses, 9 –11 glucose and lipid metabolism, 12 –14 and apoptosis. 15 –17 With respect to the underlying mechanisms, PPARγ plays an essential role in regulating gene expression (eg, glucose transporter-4 [GLUT-4], 12,13 adiponectin, 18 and nuclear factor κ B inhibitor α [IκBα] 19 ), influencing transcription factors (eg, nuclear factor κ B [NF-κB] 20 ), and modulating kinase signaling pathways (eg, protein kinase B [AKT], 12,21 c-Jun N-terminal kinase [JNK], 15 and extracellular signal-regulated kinase [ERK] 22 ).…”

Section: Introductionmentioning

confidence: 99%

The Role of Peroxisome Proliferator-Activated Receptor γ in Mediating Cardioprotection Against Ischemia/Reperfusion Injury

Zhong

Chen

Zhou

et al. 2017

J Cardiovasc Pharmacol Ther

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Myocardial infarction (MI) is a serious cardiovascular disease resulting in high rates of morbidity and mortality. Although advances have been made in restoring myocardial perfusion in ischemic areas, decreases in cardiomyocyte death and infarct size are still limited, attributing to myocardial ischemia/reperfusion (I/R) injury. It is necessary to develop therapies to restrict myocardial I/R injury and protect cardiomyocytes against further damage after MI. Many studies have suggested that peroxisome proliferator-activated receptor γ (PPARγ), a ligand-inducible nuclear receptor that predominantly regulates glucose and lipid metabolism, is a promising therapeutic target for ameliorating myocardial I/R injury. Thus, this review focuses on the role of PPARγ in cardioprotection during myocardial I/R. The cardioprotective effects of PPARγ, including attenuating oxidative stress, inhibiting inflammatory responses, improving glucose and lipid metabolism, and antagonizing apoptosis, are described. Additionally, the underlying mechanisms of cardioprotective effects of PPARγ, such as regulating the expression of target genes, influencing other transcription factors, and modulating kinase signaling pathways, are further discussed.

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Section: Introductionmentioning

confidence: 99%

The Role of Peroxisome Proliferator-Activated Receptor γ in Mediating Cardioprotection Against Ischemia/Reperfusion Injury

Zhong

Chen

Zhou

et al. 2017

J Cardiovasc Pharmacol Ther

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“…22,23) A preclinical study indicated that pioglitazone potentially ameliorates myocardial reperfusion injury, 24) but the clinical implications remain controversial. 25) Further studies are needed to determine whether reducing glucose fluctuations can provide positive results for STEMI patients undergoing reperfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Glucose Fluctuations and ST-Segment Resolution in Patients With ST-Elevation Acute Myocardial Infarction

et al. 2017

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This study was conducted to assess whether any relationships exist between glucose fluctuations and electrocardiographic surrogate markers of reperfusion injury in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).We prospectively studied 63 consecutive patients with STEMI undergoing primary PCI. Patients had either diabetes (n = 30), impaired glucose tolerance (n = 26), impaired fasting glucose (n = 1), or normal glucose tolerance (n = 6). STsegment resolution (STR, %) was measured using electrocardiograms recorded 60 minutes after PCI. STR was categorized as ≥ 30% and < 30%. Glucose fluctuations were assessed by the following parameters obtained from a continuous glucose monitoring system: mean amplitude of glucose excursion (MAGE, mg/dL); and area under curve with reference to mean blood glucose (AUC, mg/ dL/day).Both MAGE and AUC were significantly higher in STR < 30%. In univariate analysis, MAGE ≥ 70 mg/dL (OR = 17.0; 95%CI, 1.93-150.12; P < 0.01), AUC ≥ 20 mg/dL/day (OR = 10.9; 95%CI, 1.92-61.77; P < 0.01), and reperfusion arrhythmias (OR = 7.6; 95%CI, 1.32-44.29; P < 0.05) were significantly associated with suboptimal STR. Multiple logistic regression analysis showed only MAGE ≥ 70 mg/dL was predictive of suboptimal STR (OR = 22.5; 95%CI, 2.43-208.66, P < 0.01).Parameters of glucose fluctuations correlated with electrocardiographic surrogate markers of impaired myocardial salvage in STEMI after reperfusion therapy. Our results suggest that glucose fluctuations may represent a potential therapeutic target to reduce myocardial reperfusion injury in STEMI.

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“…The study population consisted of 53 patients who had undergone the non-beating cardiac operation because of prosthetic mitral valve replacement (MVR): 26 patients with STEIRI (17 females, 9 females; mean age: 56.7±10.5 years, range: 46-67 years) and 27 patients without STEIRI (16 females, 11 males; mean age: 55.4±10.7 years, range: 45-66 years). The diagnosis of STEIRI was based on STEIRI lasting ≥30 minutes, ST-segment elevation ≥2 mm (0.2mV) in at least two contiguous electrocardiography leads (6, 7). The control group consisted of 30 normal participants (17 females, 13 males; mean age: 52.8 ±9.7 years, range: 43-62 years).…”

Section: Methodsmentioning

confidence: 99%

A Comparison of the Performance of Myocardial Videodensitometry, Tissue Velocity Imaging and Tissue Tracking in Discrimination Between ST-Segment Elevation Ischemic Reperfusion Injury and Normal Reperfusion State After Non-Beating Cardiac Operation

Xiao

Yang

2014

Iran J Radiol

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Background:The timely diagnosis of presence or absence of reperfusion injury after cardiac operation is critical for the patient’s outcome. Whether transesophageal echocardiography (TEE) acquisition of regional grayscale intensity (TI), velocity, and displacement (D) after cardiac operation can discriminate between patients with ST-segment elevation ischemic reperfusion injury (STEIRI) and normal reperfusion state remains unknown.Objectives:In this study, we investigated whether these parameters can effectively reflect the situation of ST-segment elevation ischemic reperfusion injury (STEIRI) in patients after cardiac operation and which has a higher performance of discrimination between patients with and without STEIRI.Patients and Methods:The maximal and minimal grayscale intensity in the cardiac cycle [TI (max), TI (min)], the difference of TI (max) and TI (min) [TI (max-min)], the cyclic variation index of TI [TI (CVI)], the systolic velocity (Vs), the early diastolic velocity (Ve), the late diastolic velocity (Va) and the peak displacement in the cardiac cycle (D) at the lateral side of the mitral annulus were measured and compared between patients with and without STEIRI. The performance of these parameters in discriminating between patients with and without STEIRI was analyzed.Results:Compared with the patients without STEIRI, the patients with STEIRI had significantly smaller TI (max-min), TI (CVI), Vs, Ve, Va and D (P<0.05). With the use of these parameters as the criteria to distinguish patients with STEIRI from patients without STEIRI, the areas under the receiver operating characteristic curve were 0.86 for TI (max-min), 0.99 for TI (CVI), 0.89 for Vs, 0.71 for Ve, 0.85 for Va and 0.82 for D. For the best cut-off value of TI (CVI) of less than 34.45%, the sensitivity, specificity and accuracy for the prediction of patients with STEIRI were 94.74%, 97.05%, and 96.22%, respectively.Conclusion:The myocardial grayscale intensity, velocity and displacement can effectively reflect the situation of STEIRI in patients after cardiac operation, and TI (CVI) has a higher performance in discriminating between patients with and without STEIRI.

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Effect of Pretreatment With Pioglitazone on Reperfusion Injury in Diabetic Patients With Acute Myocardial Infarction

Abstract: Pretreatment with PIO in diabetic patients with AMI resulted in better myocardial perfusion with less reperfusion injury.

Cited by 18 publications

References 38 publications

The Role of Peroxisome Proliferator-Activated Receptor γ in Mediating Cardioprotection Against Ischemia/Reperfusion Injury

The Role of Peroxisome Proliferator-Activated Receptor γ in Mediating Cardioprotection Against Ischemia/Reperfusion Injury

Relationship Between Glucose Fluctuations and ST-Segment Resolution in Patients With ST-Elevation Acute Myocardial Infarction

A Comparison of the Performance of Myocardial Videodensitometry, Tissue Velocity Imaging and Tissue Tracking in Discrimination Between ST-Segment Elevation Ischemic Reperfusion Injury and Normal Reperfusion State After Non-Beating Cardiac Operation

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