Cardiac remodeling in the acute period of Q-myocardial infarction, complicated by acute heart failure and hyperglycemia
DOI:
https://doi.org/10.14739/2310-1237.2019.1.166236Keywords:
myocardial infarction, acute heart failure, hyperglycemiaAbstract
The aim was to study structural, geometric and functional heart reconstruction in acute period of Q-myocardial infarction (Q-MI) complicated by acute heart failure (AHF) and hyperglycemia (HG).
Materials and methods. The study included 139 patients in acute period of Q-MI complicated by AHF. On admission, HG was diagnosed in 108 patients: 23 cases of type 2 diabetes in history, 34 – stress HG, 26 – impaired glucose tolerance (IGT), 25 – first identified diabetes. The level of glycemia and glycemic profile (GP) were determined in patients, the standard deviation and the coefficient of GP variation were calculated, the heart structural, geometric and functional parameters were measured.
Results. The increase by16 % in ESD and 29 % in the systolic PAP, the decrease by 17 % in SV, 20 % in SI and 25 % in LVEF were revealed in the Killip 2 group comparing with the Killip 1 group. The decrease in LA size by 8 %, LVMI by 16 %, MVE by 18 %, E/A by 46 %, the increase in LVEF by 10 % and IVRT by 11 % comparing with the Killip 3 group were observed. The increase in the size of LA by 11 %, ESD by 20 %, LVMI by 24 %, MVE by 24 %, E/A by 45 % and the systolic PAP by 39 %, and the decrease in SV by 18 %, LVEF by 32 % were detected in the Killip 3 group comparing with the Killip 1 group. The increase in EDD by 9 %, ESD by 6 %, systolic PAP by 18 % and the decrease in LVEF by 17 % were defined in patients with stress HG comparing with the patients with normal glycaemia. The group with stress HG showed the increase in EDD by 10 %, ESD by 5 % and the decrease in LVEF by 15 % comparing with the group with normal glycemia. There were the increase in the size of LA by 12 % and the decrease of LVEF by 20 % in the group with the first identified diabetes comparing with the patients with normal glycaemia. There was an increase in the size of LA by 10 %, IVS by 13 % comparing with the stress HG group; IVS by 13 % comparing with the group with IGT. The group of type 2 diabetes demonstrated the increase in the size of LA by 8 %, ESD by 15 %, and the systolic PAP by 29 %, and the decrease in LVEF by 19 % comparing with patients with normal glycaemia; the increase in the size of LA by 5 % comparing with the stress HG group. There was a significant positive relationship between the level of HG on admission and the size of LA (r = +0.23), ESD (r = +0.27), LVMI (r = +0.25) and a negative relationship with the LVEF (r = -0.23), P < 0.05. A significant positive correlation between the standard deviation of the GP and the size of the LA (r = +0.27), EDD (r = +0.20), ESD (r = +0.23), LVMI (r = +0.32) and a negative relationship with LVEF (r = -0.20), P < 0.05 were determined. A significant positive correlation between the coefficient of variation of the GP and the size of the LA (r = +0.24), the EDD (r = +0.25), the ESD (r = +0.24), LVMI (r = + 0.36) and negative correlation with LVEF (r = -0.22), P < 0.05 were found. The eccentric hypertrophy of the left ventricle developed significantly more often in the group with stress HG and type 2 diabetes in history, comparing with the group with normal glycemia.
Conclusions. The increasing of the average blood glucose level, standard deviation and coefficient of GP variation, LA size, ESD, LVMI, and systolic PAP and the decreasing of SI and LVEF were observed in patients with acute Q myocardial infarction and hyperglycemia on admission with the elevation of AHF grade. The study revealed the increase in MVE, E / A ratios and a decrease in IVRT in the Killip 3 group, which indicates the predominance of type 2 diastolic dysfunction comparing with Killip 1 and Killip 2. The patients with hyperglycemia on admission, systolic dysfunction of the left ventricle and pulmonary hypertension, and the patients with stress hyperglycemia and type 2 diabetes in the history demonstrate the eccentric hypertrophy significantly more often than patients with normal glycemia. The Q-MI cardiac remodeling is influenced by the increasing level of glycemia, standard deviation and coefficient of variation of GP on the background of AHF, which is manifested in LVEF decreasing and the increasing of the heart chambers size and left ventricular myocardial mass.
References
Nichols, M., Townsend, N., Scarborough, P., & Rayner, M. (2014) Cardiovascular disease in Europe 2014: epidemiological update. European Heart Journal, 35(42), 2929–2933. doi: 10.1093/eurheartj/ehu299
Krzysztofik, J. M., Sokolski, M., Kosowski, M., Zimoch, W., Lis, A., Klepuszewski, M., et al. (2017) Acute heart failure in patients admitted to the emergency department with acute myocardial infarction. Kardiol Pol., 75(4), 306–315. doi: 10.5603/KP.a2016.0178
Ametov, А. S., Pugovkina, Y. V., & Chernikova, N. A. (2016) Upravlenie giperglikemiej pri ostrom koronarnom sindrome [Management of hyperglycemia in acute coronary syndrome. Issues and solutions]. Medicinskij sovet, 3, 98–104. [in Russian].
Smirnova, E. S., Grigorenko, E. A., & Mitkovskaya, N. P. (2017) Stressovaya giperglikemiya u pacientov s ostrym krupnoochagovym infarktom miokarda [Stress-induced hyperglycemia in patients with acute myocardial infarction]. Viesci Nacyyanal'naj akade'mii navuk Belarusi. Seryya medycynskikh navuk, 4, 60–69. [in Russian].
Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I. B., et al. (2009) American association of clinical endocrinologists and American diabetes association consensus statement on inpatient glycemic control. Diabetes Care, 32(6), 1119–1131 doi: 10.2337/dc09-9029
(2006) Report of a WHO/IDF consultation. Definition and diagnosis of diabetes and intermediate hyperglycaemia. Retrieved from https://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/
Tracy, T. S., & Dace, T. L. (2012) Glycemic Variability: Looking Beyond the A1C. Diabetes Spectrum, 25(3), 149–153. doi: 10.2337/diaspect.25.3.149
Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1–39.e14. doi: 10.1016/j.echo.2014.10.003
Koraćević, G., Vasiljević, S., Velicković-Radovanović, R., Sakac, D., Obradović, S., Damjanović, M., et al. (2014) Stress hyperglycemia in acute myocardial infarction. Vojnosanit Pregl, 71(9), 858–869. doi: 10.2298/VSP121103017K
Kholmatova, K. K., & Dvoryashina, I. V. (2014) Prognosticheskoe znachenie urovnej glikemii, zarеgestrirovannykh u pacientov s infarktom miokarda pri postuplenii [Рrognostic value of blood glucose levels, detected in patients with myocardial infarction on admission]. Arhiv'' vnutrennej mediciny, 1(15), 25–29. [in Russian].
Ishihara, M. (2012) Acute hyperglycemia in patients with acute myocardial infarction. Circulation Journal, 76(3), 563–571. doi: 10.1253/circj.CJ-11-1376
Ota, S., Tanimoto, T., Orii, M., Hirata, K., Shiono, Y., Shimamura, K., et al. (2015) Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction. Journal of Cardiology, 65(4), 272–277. doi: 10.1016/j.jjcc.2014.10.013
Smirnova, E. S., & Galickaya, S. S. (2014) Giperglikemiya u pacientov s infarktom miokarda s pod''emom segmenta ST: laboratornye i instrumental'nye kharakteristiki. [Hyperglycemia in patients with myocardial infarction with ST-segment elevation: laboratory and instrumental characteristics]. Fundamental'naya nauka v sovremennoj medicine 2014. Proceedings of the Conference young scientists. (pp. 142–149). Minsk. [in Russian].
Jensen, C. J., Eberle, H. C., Nassenstein, K., Schlosser, T., Farazandeh, M., Naber, C. K., et al. (2011) Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. Clin. Res. Cardiol., 100(8), 649–59. doi: 10.1007/s00392-011-0290-7.
Parkhomenko, O. M., Kornatzkiy, Yu. V., Kozhukhov, S. M., Guryeva, O. S., Lutay, Ya. M., & Irkin, O. I. (2013) Stresova hiperhlikemiia ta aktyvatsiia systemnoho zapalennia yak skladovi rozvytku hostroi sertsevoi nedostatnosti u patsiientiv iz hostrym infarktom miokarda z elevatsiieiu sehmenta ST i zberezhenoiu fraktsiieiu vykydu livoho shlunochka [Stress hyperglycemia and activation of systemic inflammation as a counterparts of the acute heart failure onset in patients with with ST-segment elevation acute myocardial infarction and preserved left ventricular ejection fraction]. Ukrainskyi medychnyi chasopys, 1(93), 158–163. [in Ukrainian].
Panova, E. I. (2009) Korrigiruemye i nekorrigiruemye faktory neblagopriyatnogo techeniya i otdalennykh iskhodov infarkta miokarda u bol'nykh sakharnym diabetom 2-go tipa [Correctable and non-corrective factors of unfavorable course and long-term outcome of myocardial infarction in patients with type 2 diabetes mellitus]. Mezhdunarodnyj e'ndokrinologicheskij zhurnal, 5(23) Retrieved from http://www.mif-ua.com/archive/article/10078 [in Russian].
Alejnik, O. N. (2010) Diastolicheskaya disfunkciya levogo zheludochka pri infarkte miokarda:aspekty optimizacii diagnostiki i lecheniya s uchetom displazii soedinitel'noj tkani (Avtoref. dis…kand. med. nauk). [Left ventricular diastolic dysfunction in myocardial infarction: the aspects of optimization of diagnosis and treatment based on connective tissue dysplasia]. (Extended abstract of candidate’s thesis).Stavropol'. [in Russian]
Poprygo, M. V., & Mardanov, B. U. (2015) Znachenie giperglikemii v ostrom periode infarkta miokarda: rezul'taty klinicheskogo issledovaniya [Features of the hospital course of myocardial infarction in patients with impaired glucose metabolism]. Mezhdunarodnyj zhurnal serdca i sosudistykh zabolevanij, 3(7), 31–38. [in Russian]
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).