Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance.
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.
Division of Cardiovascular and Neuronal Remodelling, University of Leeds, Leeds, UK.
Adam N
AN
Mather
Andrew
A
Crean
Nik
N
Abidin
Gillian
G
Worthy
Stephen G
SG
Ball
Sven
S
Plein
John P
JP
Greenwood
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D018572:Disease-Free Survival; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D001786:Blood Glucose