title: Utility of Cardiac Magnetic Resonance to assess association between admission hyperglycemia and myocardial damage in patients with reperfused ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  to investigate the association between admission hyperglycemia and myocardial damage in patients with ST-segment elevation myocardial infarction (STEMI) using Cardiac Magnetic Resonance (CMR).
  
  
  METHODS
  We analyzed 113 patients with STEMI treated with successful primary percutaneous coronary intervention. Admission hyperglycemia was defined as a glucose level >/= 7.8 mmol/l. Contrast-enhanced CMR was performed between 3 and 7 days after reperfusion to evaluate left ventricular function and perfusion data after injection of gadolinium-DTPA. First-pass images (FP), providing assessment of microvascular obstruction and Late Gadolinium Enhanced images (DE), reflecting the extent of infarction, were investigated and the extent of transmural tissue damage was determined by visual scores.
  
  
  RESULTS
  Patients with a supramedian FP and DE scores more frequently had left anterior descending culprit artery (p = 0.02 and <0.001), multivessel disease (p = 0.02 for both) and hyperglycemia (p < 0.001). Moreover, they were characterized by higher levels of HbA1c (p = 0.01 and 0.04), peak plasma Creatine Kinase (p < 0.001), left ventricular end-systolic volume (p = 0.005 and <0.001), and lower left ventricular ejection fraction (p = 0.001 and <0.001). In a multivariate model, admission hyperglycemia remains independently associated with increased FP and DE scores.
  
  
  CONCLUSIONS
  Our results show the existence of a strong relationship between glucose metabolism impairment and myocardial damage in patients with STEMI. Further studies are needed to show if aggressive glucose control improves myocardial perfusion, which could be assessed using CMR.
authors.affiliation: Unité d'IRM, CHU Hôpital d'enfants, Boulevard du Maréchal de Lattre de Tassigny, 21034 Dijon, France. alexandre.cochet@neuf.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cochet
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Alain
authors.initials: A
authors.lastname: Lalande
authors.forename: Isabelle
authors.initials: I
authors.lastname: L'huillier
authors.forename: Paul M
authors.initials: PM
authors.lastname: Walker
authors.forename: Claude
authors.initials: C
authors.lastname: Touzery
authors.forename: Bruno
authors.initials: B
authors.lastname: Verges
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Wolf
authors.forename: François
authors.initials: F
authors.lastname: Brunotte
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA