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Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI

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Abstract

Background

Blood glucose level at admission in ST-segment elevation myocardial infarction (STEMI) is a predictor of heart failure and mortality. This study was performed to investigate the impact of hyperglycemia at admission in non-diabetic patients on infarct size, microvascular obstruction, and long-term outcome using contrast-enhanced magnetic resonance imaging (CMR) in patients with acute STEMI.

Methods

One hundred and seven consecutive patients (84 males; mean age 59.4 years ± 11.3 years) with a first acute STEMI successfully treated by primary PCI were included. Admission hyperglycemia was defined as blood glucose above 7.8 mmol/l. CMR was performed 3.6 days ± 1.9 days after admission on a 1.5-tesla MR system. The imaging protocol included single-shot steady-state free precession (SSFP) cine sequences for assessing segmental and global left ventricular (LV) function and microvascular obstruction (MVO)/late gadolinium enhancement (LGE) imaging immediately and 10 min after the administration of 0.2 mmol gadodiamide/kg of body weight using an inversion-recovery SSFP (IR-SSFP) sequence. A receiver operating characteristics analysis was used to detect the best cut-off point of microvascular obstruction that predicted myocardial infarction and death during follow-up.

Results

Of 107 patients, 37 (35%) had hyperglycemia on admission. Compared to normoglycemic patients, patients with admission hyperglycemia had a lower LV ejection fraction (38.6 ± 13.7% vs. 47.5 ± 12.2%, p < 0.001), greater ESV (88.8 ± 41.8 ml vs. 72.3 ml ± 35.1 ml, p = 0.01), greater infarct size (LGE% 21.1 ± 14.9% vs. 9.8 ± 8.7%, p < 0.001), and greater MVO (MVO% 9.6 ± 9.9% vs. 2.5 ± 4.3%, p < 0.001). Admission hyperglycemia was an independent predictor of the presence and extent of microvascular obstruction. Microvascular obstruction as a percentage of left ventricular mass was the only variable independently related to clinical outcome in a Cox proportional hazard model (Wald 18.78, HR 1.155, p < 0.001).

Conclusion

Hyperglycemia at admission in STEMI patients who are successfully treated by PCI is independently associated with the presence and extent of microvascular obstruction on contrast-enhanced CMR. Thus, microvascular obstruction as assessed by CMR may be a mechanism that relates admission hyperglycemia in acute STEMI to worse outcome.

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Acknowledgments

The authors are indebted to Steffen Schneider from the Institute for Myocardial Infarction Research, Ludwigshafen, Germany for his advice and assistance with statistical analysis. We would also like to thank CMR technologists Elke Brand and Christian Ratering. The authors thank Prof. A. Mügge and his team from the Department of Cardiology at Ruhr University Bochum for support and ongoing cooperation.

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Authors and Affiliations

  1. Department of Cardiology and Angiology, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany

    Christoph J. Jensen, Holger C. Eberle, Mani Farazandeh, Christoph K. Naber, Georg V. Sabin & Oliver Bruder

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Kai Nassenstein & Thomas Schlosser

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  1. Christoph J. Jensen
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Correspondence to Christoph J. Jensen.

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Jensen, C.J., Eberle, H.C., Nassenstein, K. et al. Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. Clin Res Cardiol 100, 649–659 (2011). https://doi.org/10.1007/s00392-011-0290-7

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  • DOI: https://doi.org/10.1007/s00392-011-0290-7

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