Department of Radiology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
Med-X Center for Informatics, Sichuan University, Chengdu, China.
Cardiovasc Diabetol. 2024 Jun 20;23(1):210. doi: 10.1186/s12933-024-02295-y.
Stress hyperglycemia occurs frequently in patients following acute myocardial infarction (AMI) and may aggravate myocardial stiffness, but relevant evidence is still lacking. Accordingly, this study aimed to examine the impact of admission stress hyperglycemia on left ventricular (LV) myocardial deformation in patients following AMI.
A total of 171 patients with first AMI (96 with normoglycemia and 75 with hyperglycemia) underwent cardiac magnetic resonance (CMR) examination were included. AMI patients were classified according to admission blood glucose level (aBGL): < 7.8 mmol/L (n = 96), 7.8-11.1 mmol/L (n = 41) and ≥ 11.1 mmol/L (n = 34). LV strains, including global radial/circumferential/longitudinal peak strain (PS)/peak systolic strain rate (PSSR)/peak diastolic strain rate (PDSR), were measured and compared between groups. Further, subgroup analyses were separately conducted for AMI patients with and without diabetes. Multivariate analysis was employed to assess the independent association between aBGL and LV global PS in AMI patients.
LV global PS, PSSR and PDSR were decreased in radial, circumferential and longitudinal directions in hyperglycemic AMI patients compared with normoglycemic AMI patients (all P < 0.05). These differences were more obvious in patients with diabetes than those without diabetes. AMI patients with aBGL between 7.8 and 11.1 mmol/L demonstrated significant decreased radial and longitudinal PS, radial PSSR, and radial and longitudinal PDSR than those with aBGL < 7.8 mmol/L (all P < 0.05). AMI patients with aBGL ≥ 11.1 mmol/L showed significantly decreased PS, PSSR and PDSR in all three directions than those with aBGL < 7.8 mmol/L, and decreased longitudinal PSSR than those with aBGL between 7.8 and 11.1 (all P < 0.05). Further, aBGL was significantly and independently associated with radial (β = - 0.166, P = 0.003) and longitudinal (β = 0.143, P = 0.008) PS.
Hyperglycemia may exacerbate LV myocardial stiffness in patients experienced first AMI, leading to reduction in LV strains. aBGL was an independent indicator of impaired LV global PS in AMI patients. Blood glucose monitoring is more valuable for AMI patients with diabetes.
应激性高血糖在急性心肌梗死（AMI）后患者中经常发生，并且可能会加重心肌僵硬度，但相关证据仍然缺乏。因此，本研究旨在探讨入院时应激性高血糖对 AMI 后患者左心室（LV）心肌变形的影响。
共纳入 171 例首次发生 AMI 的患者（血糖正常 96 例，血糖升高 75 例），进行心脏磁共振（CMR）检查。根据入院时血糖水平（aBGL）将 AMI 患者分为三组：<7.8mmol/L（n=96）、7.8-11.1mmol/L（n=41）和≥11.1mmol/L（n=34）。测量并比较各组患者的 LV 应变，包括整体径向/环向/纵向峰值应变（PS）/收缩期峰值应变率（PSSR）/舒张期峰值应变率（PDSR）。此外，还分别对合并和不合并糖尿病的 AMI 患者进行亚组分析。采用多元分析评估 AMI 患者中 aBGL 与 LV 整体 PS 的独立相关性。
与血糖正常的 AMI 患者相比，血糖升高的 AMI 患者在径向、环向和纵向方向的 LV 整体 PS、PSSR 和 PDSR 降低（均 P<0.05）。在合并糖尿病的患者中，这些差异比不合并糖尿病的患者更为明显。aBGL 在 7.8-11.1mmol/L 的 AMI 患者的径向和纵向 PS、径向 PSSR 和径向及纵向 PDSR 明显低于 aBGL<7.8mmol/L 的患者（均 P<0.05）。aBGL≥11.1mmol/L 的 AMI 患者在所有三个方向的 PS、PSSR 和 PDSR 均明显低于 aBGL<7.8mmol/L 的患者，且纵向 PSSR 明显低于 aBGL 在 7.8-11.1mmol/L 的患者（均 P<0.05）。此外，aBGL 与径向（β=-0.166，P=0.003）和纵向（β=0.143，P=0.008）PS 呈显著独立相关。
高血糖可能会加重首次发生 AMI 患者的 LV 心肌僵硬度，导致 LV 应变降低。aBGL 是 AMI 患者 LV 整体 PS 受损的独立指标。血糖监测对合并糖尿病的 AMI 患者更有价值。
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