应激性高血糖比值与首次急性 ST 段抬高型心肌梗死左心室重构相关。
The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction.
机构信息
Department of Cardioloy, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
出版信息
BMC Cardiovasc Disord. 2021 Feb 4;21(1):72. doi: 10.1186/s12872-021-01889-8.
BACKGROUND
Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling.
METHODS
We recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively.
RESULTS
In the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = -9.825, 95% CI -15.168 to -4.481, p < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p = 0.007).
CONCLUSIONS
In the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.
背景
ST 段抬高型心肌梗死（STEMI）后左心室负性重构被认为是预后不良的主要原因。但 STEMI 后左心室负性重构的易患因素和潜在机制仍不完全清楚。本研究主要评估了应激高血糖比值（SHR）与左心室负性重构之间的关系。
方法
本研究共纳入 127 例首次、前壁、急性 STEMI 患者。所有入组患者均根据 SHR 水平中位数（1.191）分为两组。入院后 24 小时内及 STEMI 后 6 个月行超声心动图检查，测量左心室射血分数（LVEF）、左心室舒张末期直径（LVEDD）和左心室收缩末期直径（LVESD）。通过计算 LVEF、LVEDD 和 LVESD 在梗死后 6 个月与基线 LVEF、LVEDD 和 LVESD 的差值，得到超声心动图参数（ΔLVEF、ΔLVEDD、ΔLVESD）的变化。
结果
本研究中，SHR 的平均值为 1.22±0.25，两组之间 SHR 有显著差异（1.05（0.95，1.11）比 1.39（1.28，1.50），p<0.0001）。STEMI 后 6 个月的整体 LVEF 在 SHR 低组明显高于 SHR 高组（59.37±7.33 比 54.03±9.64，p=0.001）。此外，SHR 低组的整体 LVEDD（49.84±5.10 比 51.81±5.60，p=0.040）和 LVESD（33.27±5.03 比 35.38±6.05，p=0.035）在 STEMI 后 6 个月时也较低。最重要的是，经过多变量线性回归分析校正后，SHR 仍与 ΔLVEF（β=-9.825，95%CI-15.168 至-4.481，p<0.0001）、ΔLVEDD（β=4.879，95%CI1.725 至 8.069，p=0.003）和 ΔLVESD（β=5.079，95%CI1.421 至 8.738，p=0.007）相关。
结论
本研究首次证明，SHR 与 STEMI 后左心室负性重构显著相关。
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