背景:应激性高血糖,这与急性心肌梗死(AMI)患者的不良预后有关,可以使用应激性高血糖率(SHR)来确定。使用心脏磁共振(CMR)诊断的左心室功能受损和微血管阻塞(MVO)也已被证明与AMI患者的不良预后有关,并有助于危险分层。然而,目前尚无关于急性ST段抬高型心肌梗死(ASTEMI)患者空腹SHR与左心室功能和MVO相关性的研究.因此,本研究旨在研究空腹SHR对ASTEMI患者左心室功能和整体变形的累加效应,并探讨空腹SHR与MVO之间的关系。
方法:在初次经皮冠状动脉介入治疗(PPCI)后初次入院(3-7天)连续接受CMR的患者纳入本研究。基础临床,生物化学,获得和CMR数据,并在按空腹SHR三元率分组的所有患者中进行比较:SHR1:SHR<0.85;SHR2:0.85≤SHR<1.01;SHR3:SHR≥1.01。Spearman’srho(r)用于评估空腹SHR与左心室功能之间的关系,心肌劳损,以及MVO的程度。采用多元线性回归分析评价所有AMI患者左心室功能和心肌应变损害的影响因素。进行了单变量和多变量回归分析,以研究空腹SHR与AMI患者以及AMI和糖尿病(DM)患者中MVO的存在和程度之间的相关性。
结果:本研究共纳入357例ASTEMI患者。SHR2和SHR3的左心室射血分数(LVEF)和左心室整体功能指数(LVGFI)明显低于SHR1。与SHR1和SHR2组相比,SHR3的左心室应变较低,表现为总体径向(GRS),全局圆周(GCS),和全球纵向(GLS)菌株。空腹SHR与LVEF呈负相关,LVGFI,GRS(r=-0.252;r=-0.261;r=-0.245;均P<0.001)与GCS(r=0.221)和GLS(r=0.249;均P<0.001)呈正相关。多元线性回归分析显示空腹SHR是LVEF受损的独立决定因素,LVGFI,GRS,和GLS。此外,校正协变量后的多变量回归分析表明,空腹SHR与AMI患者以及AMI和DM患者的MVO的存在和程度相关。
结论:使用PPCI成功治疗的ASTEMI患者的空腹SHR与心脏功能和MVO受损独立相关。在AMI和DM患者中,空腹SHR是MVO存在和程度的独立决定因素。
BACKGROUND: Stress hyperglycemia, which is associated with poor prognosis in patients with acute myocardial infarction (AMI), can be determined using the stress hyperglycemia ratio (SHR). Impaired left ventricular function and microvascular obstruction (MVO) diagnosed using cardiac magnetic resonance (CMR) have also been proven to be linked to poor prognosis in patients with AMI and aid in risk stratification. However, there have been no studies on the correlation between fasting SHR and left ventricular function and MVO in patients with acute ST-segment elevation myocardial infarction (ASTEMI). Therefore, this
study aimed to investigate the additive effect of fasting SHR on left ventricular function and global deformation in patients with ASTEMI and to explore the association between fasting SHR and MVO.
METHODS: Consecutive patients who underwent CMR at index admission (3-7 days) after primary percutaneous coronary intervention (PPCI) were enrolled in this
study. Basic clinical, biochemical, and CMR data were obtained and compared among all patients grouped by fasting SHR tertiles: SHR1: SHR < 0.85; SHR2: 0.85 ≤ SHR < 1.01; and SHR3: SHR ≥ 1.01. Spearman\'s rho (r) was used to assess the relationship between fasting SHR and left ventricular function, myocardial strain, and the extent of MVO. Multivariable linear regression analysis was performed to evaluate the determinants of left ventricular function and myocardial strain impairment in all patients with AMI. Univariable and multivariable regression analyses were performed to investigate the correlation between fasting SHR and the presence and extent of MVO in patients with AMI and those with AMI and diabetes mellitus (DM).
RESULTS: A total of 357 patients with ASTEMI were enrolled in this
study. Left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI) were significantly lower in SHR2 and SHR3 than in SHR1. Compared with SHR1 and SHR2 groups, left ventricular strain was lower in SHR3, as evidenced by global radial (GRS), global circumferential (GCS), and global longitudinal (GLS) strains. Fasting SHR were negatively correlated with LVEF, LVGFI, and GRS (r = - 0.252; r = - 0.261; and r = - 0.245; all P<0.001) and positively correlated with GCS (r = 0.221) and GLS (r = 0.249; all P <0.001). Multivariable linear regression analysis showed that fasting SHR was an independent determinant of impaired LVEF, LVGFI, GRS, and GLS. Furthermore, multivariable regression analysis after adjusting for covariates signified that fasting SHR was associated with the presence and extent of MVO in patients with AMI and those with AMI and DM.
CONCLUSIONS: Fasting SHR in patients with ASTEMI successfully treated using PPCI is independently associated with impaired cardiac function and MVO. In patients with AMI and DM, fasting SHR is an independent determinant of the presence and extent of MVO.