Abstract
BackgroundLeft ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling.MethodsWe recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively.ResultsIn the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p = 0.007).ConclusionsIn the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.
Highlights
Despite rapid development in reperfusion therapy, primary percutaneous coronary intervention (PCI), modern antithrombotic therapy, and secondary prevention in recent years, the incidence of post-infarction cardiac remodelling and subsequent heart failure remains relatively high [1, 2]
After adjusting for other confounding variables (Age, sex, type 2 diabetes mellitus (T2DM), total ischaemic time, number of diseased vessels, and variables with p < 0.05 in univariable linear analysis) through multivariable linear regression analysis, stress hyperglycaemia ratio (SHR) remained associated with δLVEF, δLVEDD, and δLVESD, as indicated in Tables 3, 4, and 5, respectively
Our present research suggested that peak cardiac troponin I (cTnI) and peak creatine kinase muscle/brain subtype (CK-MB) were both significantly lower in the low SHR group than in the high SHR group
Summary
Despite rapid development in reperfusion therapy, primary percutaneous coronary intervention (PCI), modern antithrombotic therapy, and secondary prevention in recent years, the incidence of post-infarction cardiac remodelling and subsequent heart failure remains relatively high [1, 2]. ST-segment elevation myocardial infarction (STEMI), could trigger inflammatory and fibrotic responses in both infarcted and non-infarcted areas, contributing to the occurrence of cardiac remodelling and dysfunctional ventricles [3, 4]. Mounting evidence has revealed that stress hyperglycaemia is strongly associated with prognosis and post-infarction cardiac remodelling even after successful reperfusion therapy [5,6,7]. The stress hyperglycaemia ratio (SHR), a novel index of stress hyperglycaemia, was proposed by Roberts et al. In the study from Roberts et al, SHR was defined as ABG divided by estimated average glucose (eAG) derived from glycated haemoglobin (HbA1c) [11]. Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling
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