Association of dysglycaemia with persistent infarct core iron in patients with acute ST-segment elevation myocardial infarction.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Ivan Lechner, Martin Reindl, Fritz Oberhollenzer, Christina Tiller, Magdalena Holzknecht, Priscilla Fink, Thomas Kremser, Paolo Bonatti, Felix Troger, Benjamin Henninger, Agnes Mayr, Axel Bauer, Bernhard Metzler, Sebastian J Reinstadler
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引用次数: 0

Abstract

Background: Dysglycaemia increases the risk of myocardial infarction and subsequent recurrent cardiovascular events. However, the role of dysglycaemia in ischemia/reperfusion injury with development of irreversible myocardial tissue alterations remains poorly understood. In this study we aimed to investigate the association of ongoing dysglycaemia with persistence of infarct core iron and their longitudinal changes over time in patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).

Methods: We analyzed 348 STEMI patients treated with primary PCI between 2016 and 2021 that were included in the prospective MARINA-STEMI study (NCT04113356). Peripheral venous blood samples for glucose and glycated hemoglobin (HbA1c) measurements were drawn on admission and 4 months after STEMI. Cardiac magnetic resonance (CMR) imaging including T2 * mapping for infarct core iron assessment was performed at both time points. Associations of dysglycaemia with persistent infarct core iron and iron resolution at 4 months were calculated using multivariable regression analysis.

Results: Intramyocardial hemorrhage was observed in 147 (42%) patients at baseline. Of these, 89 (61%) had persistent infarct core iron 4 months after infarction with increasing rates across HbA1c levels (<5.7%: 33%, ≥5.7: 79%). Persistent infarct core iron was independently associated with ongoing dysglycaemia defined by HbA1c at 4 months (OR: 7.87 [95% CI: 2.60-23.78]; p < 0.001), after adjustment for patient characteristics and CMR parameters. The independent association was present even after exclusion of patients with diabetes (pre- and newly diagnosed, n = 16).

Conclusions: In STEMI patients treated with primary PCI, ongoing dysglycaemia defined by HbA1c is independently associated with persistent infarct core iron and a lower likelihood of iron resolution. These findings suggest a potential association between ongoing dysglycaemia and persistent infarct core iron, which warrants further investigation for therapeutic implications.

急性 ST 段抬高型心肌梗死患者血糖异常与梗死核心铁持续存在的关系
背景:血糖异常会增加心肌梗死和随后的心血管事件复发的风险。然而,人们对血糖异常在心肌缺血/再灌注损伤和心肌组织不可逆改变中的作用仍知之甚少。在这项研究中,我们旨在调查因急性 ST 段抬高型心肌梗死(STEMI)而接受初级经皮冠状动脉介入治疗(PCI)的患者中,持续的血糖异常与梗死核心铁持续存在的关系及其随时间的纵向变化:我们分析了2016年至2021年间接受初级PCI治疗的348例STEMI患者,这些患者被纳入前瞻性MARINA-STEMI研究(NCT04113356)。在入院时和 STEMI 后 4 个月抽取外周静脉血样本进行血糖和糖化血红蛋白 (HbA1c) 测量。在两个时间点均进行了心脏磁共振(CMR)成像,包括用于评估梗死核心铁质的 T2* 映像。使用多变量回归分析计算了血糖异常与持续性梗死核心铁和4个月时铁溶解的关系:结果:基线时观察到心肌内出血的患者有 147 人(42%)。其中,89 人(61%)在梗死 4 个月后心肌梗死核心铁质持续存在,且随着 HbA1c 水平的升高而增加:在接受初级 PCI 治疗的 STEMI 患者中,以 HbA1c 定义的持续性血糖异常与持续性梗死核心铁质和较低的铁质溶解可能性独立相关。这些研究结果表明,持续性血糖异常与持续性梗死核心铁质之间存在潜在联系,值得进一步研究其治疗意义。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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