Han Pei-Lun, Li Kang, Jiang Yu, Jiang Li, Tang Xin, Guo Ying-Kun, Li Yuan, Yang Zhi-Gang
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.
Quant Imaging Med Surg. 2025 Mar 3;15(3):2347-2361. doi: 10.21037/qims-24-1757. Epub 2025 Feb 18.
The relationship between stress hyperglycemia and left atrial (LA) abnormality and left atrioventricular coupling in patients with acute myocardial infarction (AMI) has not been fully explored. This study aimed to assess the additive effect of hyperglycemia on LA phasic function and to investigate the atrioventricular interaction in patients with AMI via cardiac magnetic resonance imaging (MRI).
This study comprised 120 patients with AMI with admission normoglycemia (aNGL), 88 patients with AMI and admission hyperglycemia (aHGL), and 70 age- and sex-matched controls. LA volume (LAV), LA ejection fraction (LAEF), and LA reservoir/conduit/contraction strain (εs/εe/εa) were measured and compared. Subgroup analysis was performed according to the presence of LA enlargement [LAE; defined as a maximum LAV index (LAVImax) >55 mL/m]. Univariate and multivariate linear regression analyses were employed to identify the independent factors related to LA phasic strains.
Compared with controls, patients with AMI had increased LAVI and decreased LAEF and LA strains (all P values <0.05), and the LA reservoir [LA total ejection fraction (LATEF) and εs] and conduit [LA passive ejection fraction (LAPEF) and εe] dysfunction was also present in those without LAE (all P values <0.05). Furthermore, εs and εe were significantly reduced in the aHGL group as compared with the aNGL group (both P values <0.001). After adjustments were made for confounding clinical factors, admission blood glucose level (aBGL) was independently and significantly associated with εs (β=-0.211; P=0.002) and εe (β=-0.215; P=0.001) in patients with AMI. After the introduction of left ventricular (LV) indicators into multivariable regression models, LV global longitudinal strain (GLS) was significantly associated with εs (β=-0.467; P<0.001) and εe (β=-0.455; P<0.001).
Hyperglycemia was found to exacerbate LA reservoir and conduit dysfunction in patients with AMI. aBGL and LV GLS were independent determinants of the εs and the εe, suggesting that attention should be paid not only to glucose monitoring but also to cardiac function indicators.
急性心肌梗死（AMI）患者应激性高血糖与左心房（LA）异常及左房室耦联之间的关系尚未得到充分研究。本研究旨在评估高血糖对LA相位功能的叠加效应，并通过心脏磁共振成像（MRI）研究AMI患者的房室相互作用。
本研究纳入120例入院时血糖正常（aNGL）的AMI患者、88例入院时血糖高（aHGL）的AMI患者以及70例年龄和性别匹配的对照者。测量并比较LA容积（LAV）、LA射血分数（LAEF）以及LA储存/管道/收缩应变（εs/εe/εa）。根据LA扩大（LAE；定义为最大LAV指数（LAVImax）>55 mL/m²）的情况进行亚组分析。采用单因素和多因素线性回归分析来确定与LA相位应变相关的独立因素。
与对照组相比，AMI患者的LAVI增加，LAEF和LA应变降低（所有P值<0.05），在无LAE的患者中也存在LA储存[LA总射血分数（LATEF）和εs]和管道[LA被动射血分数（LAPEF）和εe]功能障碍（所有P值<0.05）。此外，与aNGL组相比，aHGL组的εs和εe显著降低（两者P值<0.001）。在对混杂的临床因素进行校正后，入院血糖水平（aBGL）与AMI患者的εs（β=-0.211；P=0.002）和εe（β=-0.215；P=0.001）独立且显著相关。将左心室（LV）指标纳入多变量回归模型后，LV整体纵向应变（GLS）与εs（β=-0.467；P<0.001）和εe（β=-0.455；P<0.001）显著相关。
发现高血糖会加重AMI患者的LA储存和管道功能障碍。aBGL和LV GLS是εs和εe的独立决定因素，提示不仅应关注血糖监测，还应关注心功能指标。
