血糖水平升高对ST段抬高型心肌梗死患者心脏功能的影响：血糖变化作为一种预后生物标志物

Impact of elevated glucose levels on cardiac function in STEMI patients: glucose delta as a prognostic biomarker.

作者信息

Garcia Bernardo F, Fonseca Francisco A, Izar Maria C, Szarf Gilberto, Galhardo Attilio, Pinto Ibraim M, Caixeta Adriano M, Barbosa Adriano P, Bianco Henrique T

机构信息

Cardiology Division, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Brazilian Network of Collaboration and Knowledge Advancement On Severe Hypertriglyceridemia - Hypertri Brazil Network, Casa Dos Raros, Porto Alegre, Brazil.

出版信息

Diabetol Metab Syndr. 2025 Jun 10;17(1):203. doi: 10.1186/s13098-025-01738-0.

DOI:10.1186/s13098-025-01738-0

PMID:40490774

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12150584/

Abstract

BACKGROUND

Elevated glucose levels have emerged as a significant prognostic factor following acute myocardial infarction (AMI).

OBJECTIVE

This study aimed to evaluate glycemic parameters associated with infarct size and left ventricular function.

RESEARCH DESIGN AND METHODS

A total of 244 patients with ST-segment elevation myocardial infarction (STEMI) treated using a pharmacoinvasive strategy were included. Glucose delta was calculated as the difference between mean glucose levels estimated from glycated hemoglobin (HbA1c) and serum glucose levels collected at hospital admission. Infarct size and left ventricular ejection fraction (LVEF) were assessed 30 days post-infarction using cardiac magnetic resonance (CMR) imaging.

RESULTS

Higher glucose delta values were significantly associated with reduced LVEF and larger infarct size, regardless of diabetes diagnosis. Differences in infarcted ventricular mass were noted between diabetic and non-diabetic patients above specific thresholds: (18.62 ± 11.0 g) vs. (16.24 ± 13.17 g), p = 0.019, with an effect size of 0.55. The receiver operating characteristic curve yielded an area under the curve (AUC) of 0.65 (95% CI 0.57-0.72).

CONCLUSIONS

In STEMI patients undergoing pharmacoinvasive treatment, a higher glycemic delta was associated with greater infarct size and lower LVEF. This straightforward glycemic parameter provides valuable prognostic insight for both diabetic and non-diabetic populations.

摘要

背景

血糖水平升高已成为急性心肌梗死（AMI）后一个重要的预后因素。

目的

本研究旨在评估与梗死面积和左心室功能相关的血糖参数。

研究设计与方法

纳入了总共244例采用药物介入策略治疗的ST段抬高型心肌梗死（STEMI）患者。血糖差值的计算方法是糖化血红蛋白（HbA1c）估算的平均血糖水平与入院时采集的血清葡萄糖水平之间的差值。在心肌梗死后30天，使用心脏磁共振（CMR）成像评估梗死面积和左心室射血分数（LVEF）。

结果

无论糖尿病诊断情况如何，较高的血糖差值均与较低的LVEF及较大的梗死面积显著相关。在特定阈值以上，糖尿病患者和非糖尿病患者梗死心室质量存在差异：（18.62±11.0克）对（16.24±13.17克），p = 0.019，效应大小为0.55。受试者工作特征曲线的曲线下面积（AUC）为0.65（95%可信区间0.57 - 0.72）。