Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China.
Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Cardiovasc Diabetol. 2024 May 27;23(1):179. doi: 10.1186/s12933-024-02271-6.
Stress hyperglycemia, which is associated with poor prognosis in patients with acute myocardial infarction (AMI), can be determined using the stress hyperglycemia ratio (SHR). Impaired left ventricular function and microvascular obstruction (MVO) diagnosed using cardiac magnetic resonance (CMR) have also been proven to be linked to poor prognosis in patients with AMI and aid in risk stratification. However, there have been no studies on the correlation between fasting SHR and left ventricular function and MVO in patients with acute ST-segment elevation myocardial infarction (ASTEMI). Therefore, this study aimed to investigate the additive effect of fasting SHR on left ventricular function and global deformation in patients with ASTEMI and to explore the association between fasting SHR and MVO.
Consecutive patients who underwent CMR at index admission (3-7 days) after primary percutaneous coronary intervention (PPCI) were enrolled in this study. Basic clinical, biochemical, and CMR data were obtained and compared among all patients grouped by fasting SHR tertiles: SHR1: SHR < 0.85; SHR2: 0.85 ≤ SHR < 1.01; and SHR3: SHR ≥ 1.01. Spearman's rho (r) was used to assess the relationship between fasting SHR and left ventricular function, myocardial strain, and the extent of MVO. Multivariable linear regression analysis was performed to evaluate the determinants of left ventricular function and myocardial strain impairment in all patients with AMI. Univariable and multivariable regression analyses were performed to investigate the correlation between fasting SHR and the presence and extent of MVO in patients with AMI and those with AMI and diabetes mellitus (DM).
A total of 357 patients with ASTEMI were enrolled in this study. Left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI) were significantly lower in SHR2 and SHR3 than in SHR1. Compared with SHR1 and SHR2 groups, left ventricular strain was lower in SHR3, as evidenced by global radial (GRS), global circumferential (GCS), and global longitudinal (GLS) strains. Fasting SHR were negatively correlated with LVEF, LVGFI, and GRS (r = - 0.252; r = - 0.261; and r = - 0.245; all P<0.001) and positively correlated with GCS (r = 0.221) and GLS (r = 0.249; all P <0.001). Multivariable linear regression analysis showed that fasting SHR was an independent determinant of impaired LVEF, LVGFI, GRS, and GLS. Furthermore, multivariable regression analysis after adjusting for covariates signified that fasting SHR was associated with the presence and extent of MVO in patients with AMI and those with AMI and DM.
Fasting SHR in patients with ASTEMI successfully treated using PPCI is independently associated with impaired cardiac function and MVO. In patients with AMI and DM, fasting SHR is an independent determinant of the presence and extent of MVO.
应激性高血糖与急性心肌梗死（AMI）患者的预后不良相关，可通过应激性高血糖比值（SHR）来确定。心脏磁共振（CMR）诊断的左心室功能障碍和微血管阻塞（MVO）也已被证明与 AMI 患者的预后不良有关，并有助于风险分层。然而，目前还没有关于急性 ST 段抬高型心肌梗死（ASTEMI）患者空腹 SHR 与左心室功能和 MVO 之间相关性的研究。因此，本研究旨在探讨空腹 SHR 对 ASTEMI 患者左心室功能和整体变形的附加影响，并探讨空腹 SHR 与 MVO 之间的关系。
本研究纳入了在经皮冠状动脉介入治疗（PPCI）后指数入院（3-7 天）行 CMR 检查的连续患者。获取了基本的临床、生化和 CMR 数据，并根据空腹 SHR 三分位组对所有患者进行了比较：SHR1：SHR＜0.85；SHR2：0.85≤SHR＜1.01；SHR3：SHR≥1.01。使用 Spearman's rho（r）评估空腹 SHR 与左心室功能、心肌应变和 MVO 程度之间的关系。对所有 AMI 患者进行多变量线性回归分析，以评估左心室功能和心肌应变受损的决定因素。对 AMI 患者和 AMI 合并糖尿病（DM）患者进行单变量和多变量回归分析，以探讨空腹 SHR 与 MVO 的存在和程度之间的相关性。
本研究共纳入了 357 例 ASTEMI 患者。与 SHR1 组相比，SHR2 和 SHR3 组的左心室射血分数（LVEF）和左心室整体功能指数（LVGFI）明显降低。与 SHR1 和 SHR2 组相比，SHR3 组的左心室应变较低，表现为整体径向应变（GRS）、整体圆周应变（GCS）和整体纵向应变（GLS）。空腹 SHR 与 LVEF、LVGFI 和 GRS 呈负相关（r=-0.252；r=-0.261；r=-0.245；均 P＜0.001），与 GCS 呈正相关（r=0.221），与 GLS 呈正相关（r=0.249；均 P＜0.001）。多变量线性回归分析显示，空腹 SHR 是 LVEF、LVGFI、GRS 和 GLS 受损的独立决定因素。此外，调整协变量后的多变量回归分析表明，空腹 SHR 与 AMI 患者和 AMI 合并 DM 患者的 MVO 存在和程度相关。
成功接受 PPCI 治疗的 ASTEMI 患者的空腹 SHR 与心功能障碍和 MVO 有关。在 AMI 合并 DM 患者中，空腹 SHR 是 MVO 存在和程度的独立决定因素。
