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Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance.

Mather AN, Crean A, Abidin N, Worthy G, Ball SG, Plein S, Greenwood JP - J Cardiovasc Magn Reson (2010)

Bottom Line: Clinical outcome data were collected at 18 months median follow-up.Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).This may, in part, account for their adverse prognosis following AMI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiovascular and Neuronal Remodelling, University of Leeds, Leeds, UK.

ABSTRACT

Background: Improved outcomes for normoglycemic patients suffering acute myocardial infarction (AMI) over the last decade have not been matched by similar improvements in mortality for diabetic patients despite similar levels of baseline risk and appropriate medical therapy. Two of the major determinants of poor outcome following AMI are infarct size and left ventricular (LV) dysfunction.

Methods: Ninety-three patients with first AMI were studied. 22 patients had diabetes mellitus (DM) based on prior history or admission blood glucose ≥ 11.1 mmol/l. 13 patients had dysglycemia (admission blood glucose ≥ 7.8 mmol/l but < 11.1 mmol/l) and 58 patients had normoglycemia (admission blood glucose < 7.8 mmol/l). Patients underwent cardiac magnetic resonance (CMR) imaging at index presentation and median follow-up of 11 months. Cine imaging assessed LV function and late gadolinium contrast-enhanced imaging was used to quantify infarct size. Clinical outcome data were collected at 18 months median follow-up.

Results: Patients with dysglycemia and DM had larger infarct sizes by CMR than normoglycemic patients; at baseline percentage LV scar (mean (SD)) was 23.0% (10.9), 25.6% (12.9) and 15.8% (10.3) respectively (p = 0.001), and at 11 months percentage LV scar was 17.6% (8.9), 19.1% (9.6) and 12.4% (7.8) (p = 0.017). Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).

Conclusions: Patients with dysglycemia or diabetes mellitus sustain larger infarct sizes than normoglycemic patients, as determined by CMR. This may, in part, account for their adverse prognosis following AMI.

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Related in: MedlinePlus

Graph demonstrating the peak CK levels according to glycemic status. The error bars represent the 95% confidence intervals. (CK = creatine kinase).
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Figure 3: Graph demonstrating the peak CK levels according to glycemic status. The error bars represent the 95% confidence intervals. (CK = creatine kinase).

Mentions: Patients with dysglycemia and DM had larger infarct sizes as determined by LGE-CMR, than those with normoglycemia, both at baseline (mean (SD)% LV scar 23.0 (10.9), 25.6 (12.9) and 15.8 (10.3) respectively; overall p = 0.001) and at 11 months after presentation (mean (SD)% LV scar 17.6 (8.9), 19.1 (9.6) and 12.4 (7.8) respectively; overall p = 0.017) (Figure 2). This was reflected in the peak CK measurements following AMI which were significantly higher in the dysglycemia and DM groups than the normoglycemia group (mean (SD) 2141 (1302), 2722 (1841) and 1542 (1151) U/l respectively; overall p = 0.003) (Figure 3). A greater proportion of patients with dysglycemia (12/13 (92%)) and diabetes mellitus (21/22 (95%)) had transmural infarctions (defined as >75% transmural extent of scar) when compared to patients with normoglycemia (44/58 (76%)). However, these difference were not significant (overall p = 0.09). Similarly, there were no significant differences in the proportions of patients with MO between the three groups (dysglycemia (6/13 (46%)) vs. diabetes (10/22 (45%)) vs. normoglycemia (19/58 (33%)), overall p = 0.10).


Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance.

Mather AN, Crean A, Abidin N, Worthy G, Ball SG, Plein S, Greenwood JP - J Cardiovasc Magn Reson (2010)

Graph demonstrating the peak CK levels according to glycemic status. The error bars represent the 95% confidence intervals. (CK = creatine kinase).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984576&req=5

Figure 3: Graph demonstrating the peak CK levels according to glycemic status. The error bars represent the 95% confidence intervals. (CK = creatine kinase).
Mentions: Patients with dysglycemia and DM had larger infarct sizes as determined by LGE-CMR, than those with normoglycemia, both at baseline (mean (SD)% LV scar 23.0 (10.9), 25.6 (12.9) and 15.8 (10.3) respectively; overall p = 0.001) and at 11 months after presentation (mean (SD)% LV scar 17.6 (8.9), 19.1 (9.6) and 12.4 (7.8) respectively; overall p = 0.017) (Figure 2). This was reflected in the peak CK measurements following AMI which were significantly higher in the dysglycemia and DM groups than the normoglycemia group (mean (SD) 2141 (1302), 2722 (1841) and 1542 (1151) U/l respectively; overall p = 0.003) (Figure 3). A greater proportion of patients with dysglycemia (12/13 (92%)) and diabetes mellitus (21/22 (95%)) had transmural infarctions (defined as >75% transmural extent of scar) when compared to patients with normoglycemia (44/58 (76%)). However, these difference were not significant (overall p = 0.09). Similarly, there were no significant differences in the proportions of patients with MO between the three groups (dysglycemia (6/13 (46%)) vs. diabetes (10/22 (45%)) vs. normoglycemia (19/58 (33%)), overall p = 0.10).

Bottom Line: Clinical outcome data were collected at 18 months median follow-up.Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).This may, in part, account for their adverse prognosis following AMI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiovascular and Neuronal Remodelling, University of Leeds, Leeds, UK.

ABSTRACT

Background: Improved outcomes for normoglycemic patients suffering acute myocardial infarction (AMI) over the last decade have not been matched by similar improvements in mortality for diabetic patients despite similar levels of baseline risk and appropriate medical therapy. Two of the major determinants of poor outcome following AMI are infarct size and left ventricular (LV) dysfunction.

Methods: Ninety-three patients with first AMI were studied. 22 patients had diabetes mellitus (DM) based on prior history or admission blood glucose ≥ 11.1 mmol/l. 13 patients had dysglycemia (admission blood glucose ≥ 7.8 mmol/l but < 11.1 mmol/l) and 58 patients had normoglycemia (admission blood glucose < 7.8 mmol/l). Patients underwent cardiac magnetic resonance (CMR) imaging at index presentation and median follow-up of 11 months. Cine imaging assessed LV function and late gadolinium contrast-enhanced imaging was used to quantify infarct size. Clinical outcome data were collected at 18 months median follow-up.

Results: Patients with dysglycemia and DM had larger infarct sizes by CMR than normoglycemic patients; at baseline percentage LV scar (mean (SD)) was 23.0% (10.9), 25.6% (12.9) and 15.8% (10.3) respectively (p = 0.001), and at 11 months percentage LV scar was 17.6% (8.9), 19.1% (9.6) and 12.4% (7.8) (p = 0.017). Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).

Conclusions: Patients with dysglycemia or diabetes mellitus sustain larger infarct sizes than normoglycemic patients, as determined by CMR. This may, in part, account for their adverse prognosis following AMI.

Show MeSH
Related in: MedlinePlus