Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage.
Vyacheslav Ryabov, Evgeny Vyshlov, Stanislav Dil, Yana Alexeeva, Vladimir Usov, Olga Mochula, Konstantin Zavadovsky, Kristina Nasekina, Leonid Maslov
{"title":"Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage.","authors":"Vyacheslav Ryabov, Evgeny Vyshlov, Stanislav Dil, Yana Alexeeva, Vladimir Usov, Olga Mochula, Konstantin Zavadovsky, Kristina Nasekina, Leonid Maslov","doi":"10.1007/s12055-025-02082-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>In ST-elevation myocardial infarction (STEMI), timely reperfusion via percutaneous coronary intervention (PCI) reduces mortality but is limited by microvascular injury (MVI), including microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), which drive adverse cardiac remodeling. This study evaluates the incidence of MVO and IMH, their combined effects, and associations with hyperglycemia, inflammation, and left ventricular (LV) dysfunction after successful non-surgical revascularization of STEMI.</p><p><strong>Methods and results: </strong>A single-center cohort of 60 STEMI patients (2019-2020) underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) 48 ± 6 h post-infarction to assess MVI. Patients were classified into four groups: no MVI, isolated MVO, isolated IMH, and combined MVO + IMH. For some analyses, patients were also dichotomized into MVI-present versus MVI-absent groups to facilitate comparison of functional and biochemical outcomes. LV function was evaluated via echocardiography (days 7 and 90). Biomarkers were analyzed at admission and day 7. MVI occurred in 68.3% of patients: isolated MVO (16.7%), isolated IMH (15%), and combined MVO + IMH (36.7%). Combined MVO + IMH correlated with larger infarct size, prolonged ischemia, and higher admission glucose. C-reactive protein (CRP) levels on day 7 were elevated in isolated MVO (59.8 [9.1-75.9] mg/L) and MVO + IMH (32.8 [4-55.6] mg/L) versus no-MVI (4.6 [2.9-12.7] mg/L). LV ejection fraction (LVEF) was significantly lower in MVO + IMH groups (p < 0.05). Admission glucose inversely correlated with day 7 LVEF (r = -0.43, p < 0.0001).</p><p><strong>Conclusion: </strong>Combined MVO and IMH was associated with a more unfavorable remodeling pattern and subtle LV dysfunction, which may be exaggerated by hyperglycemia and inflammation. Elevated CRP links MVO to systemic inflammation, while IMH reflects mechanical capillary damage. These findings emphasize the need for early glycemic control, anti-inflammatory strategies, and imaging-guided risk stratification to mitigate microvascular injury and improve outcomes in STEMI.</p><p><strong>Graphical abstract: </strong>AMI-Acute Myocardial Infarction; IMH-Intramyocardial Hemorrhage: MVO-Microvascular Obstruction.Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02082-8.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"595-607"},"PeriodicalIF":0.6000,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065921/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-02082-8","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/17 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: In ST-elevation myocardial infarction (STEMI), timely reperfusion via percutaneous coronary intervention (PCI) reduces mortality but is limited by microvascular injury (MVI), including microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), which drive adverse cardiac remodeling. This study evaluates the incidence of MVO and IMH, their combined effects, and associations with hyperglycemia, inflammation, and left ventricular (LV) dysfunction after successful non-surgical revascularization of STEMI.
Methods and results: A single-center cohort of 60 STEMI patients (2019-2020) underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) 48 ± 6 h post-infarction to assess MVI. Patients were classified into four groups: no MVI, isolated MVO, isolated IMH, and combined MVO + IMH. For some analyses, patients were also dichotomized into MVI-present versus MVI-absent groups to facilitate comparison of functional and biochemical outcomes. LV function was evaluated via echocardiography (days 7 and 90). Biomarkers were analyzed at admission and day 7. MVI occurred in 68.3% of patients: isolated MVO (16.7%), isolated IMH (15%), and combined MVO + IMH (36.7%). Combined MVO + IMH correlated with larger infarct size, prolonged ischemia, and higher admission glucose. C-reactive protein (CRP) levels on day 7 were elevated in isolated MVO (59.8 [9.1-75.9] mg/L) and MVO + IMH (32.8 [4-55.6] mg/L) versus no-MVI (4.6 [2.9-12.7] mg/L). LV ejection fraction (LVEF) was significantly lower in MVO + IMH groups (p < 0.05). Admission glucose inversely correlated with day 7 LVEF (r = -0.43, p < 0.0001).
Conclusion: Combined MVO and IMH was associated with a more unfavorable remodeling pattern and subtle LV dysfunction, which may be exaggerated by hyperglycemia and inflammation. Elevated CRP links MVO to systemic inflammation, while IMH reflects mechanical capillary damage. These findings emphasize the need for early glycemic control, anti-inflammatory strategies, and imaging-guided risk stratification to mitigate microvascular injury and improve outcomes in STEMI.
Graphical abstract: AMI-Acute Myocardial Infarction; IMH-Intramyocardial Hemorrhage: MVO-Microvascular Obstruction.Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02082-8.
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
