European Heart Journal Advance Access originally published online on October 24, 2007
European Heart Journal 2007 28(22):2821; doi:10.1093/eurheartj/ehm458
Is stress hyperglycaemia a prognostic marker of left ventricular remodelling after first anterior myocardial infarction?
1st Cardiology Department
AHEPA University Hospital Aristotle University of Thessaloniki
Greece
1st Cardiology Department
AHEPA University Hospital Aristotle University of Thessaloniki
Greece
1st Cardiology Department
AHEPA University Hospital Aristotle University of Thessaloniki
Greece
Fax: +30 2310 223330; E-mail address: chpapado{at}auth.gr
Previous studies demonstrated that stress hyperglycaemia (SH) is associated with an adverse outcome in patients with acute myocardial infarction (AMI). Recently Bauters et al.1 suggested that SH is a major and independent predictor of left ventricular remodelling after anterior AMI in non-diabetic patients, postulating that this effect may partly account for the increased rate of mortality associated with SH. These investigators have shown that non-diabetic patients with SH demonstrated a higher degree of left ventricular remodelling at 1 year following the index infarction and interestingly SH remained a major predictor of remodelling after adjusting for the extent of infarct size. However, they did not take into account, as they correctly state in the limitation section of their manuscript, the markers of neurohormonal activation such as BNP plasma levels that may accurately predict remodelling following AMI.2
We have recently commented on a paper by the same (REVE) study group3 and documented our own experience concerning left ventricular remodelling in a similar—but rather smaller—cohort of patients facing first anterior AMI. Our findings were supportive of the frequency of the remodelling process observed earlier. Furthermore, we emphasized the significant association of pre-existing left ventricular hypertrophy and BNP plasma levels with subsequent remodelling.4
When we used the change in left ventricular end-diastolic volume index as the index marker of left ventricular remodelling in 40 (>53) patients with no history of diabetes mellitus, we found that SH (r = 0.471, P = 0.004), left ventricular mass index (r = 0.294, P = 0.03), left ventricular mass/volume ratio (measure of concentric hypertrophy, r = 0.571, P < 0.001) and BNP plasma levels measured at discharge of the index infarction (r = 0.436, P = 0.01) were all positively correlated with the remodelling process in a 6 month period. Median glycaemia at admission was 130 mg/dL and SH was defined as glycaemia on admission >130 mg/dL. Interestingly, we observed that patients with SH had significantly higher levels of BNP at discharge (1088 ± 302 vs. 395 ± 116 pg/mL, P = 0.05). Further, using multivariate linear regression analysis, we found that the most significant predictors of left ventricular remodelling were BNP levels (ß-coefficient = 0.392, P = 0.04) and mass/volume ratio (ß-coefficient = 0.460, P = 0.02). Thus, we concluded that SH when adjusted for BNP plasma levels was not associated with remodelling at 6 months.
Further studies are needed in order to establish the significance of SH to predict left ventricular remodelling in non-diabetics patients following AMI.
References
- Bauters C, Ennezat PV, Tricot O, Lauwerier, Lallement R, Saadouni H, Quandalle P, Jaboureck O, Lamblin N, Le Tourneau T, on behalf of The REVE Investigators. Stress hyperglycaemia is an independent predictor of left ventricular remodeling after first anterior myocardial infarction in non-diabetic patients. Eur Heart J (2007) 28:546–552.
[Abstract/Free Full Text] - Hirayama A, Kusuoka H, Yamamoto H, Sakata Y, Asakura M, Higuchi Y, Mizuno H, Kashiwase K, Ueda Y, Okuyama Y, Hori M, Kodama K. Usefulness of plasma brain natriuretic concentration for predicting subsequent left ventricular remodeling after coronary angioplasty in patients with acute myocardial infarction. Am J Cardiol (2006) 98:453–457.[CrossRef][Web of Science][Medline]
- Savoye C, Equine O, Tricot O, Nugue O, Segrestin B, Sautiere K, Elkohen M, Pretorian EM, Taghipour K, Philias A, Aumegeat V, Decoulx E, Ennezat PV, Bauters C. Myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] Study Group). Am J Cardiol (2006) 98:1144–1149.[CrossRef][Web of Science][Medline]
- Papadopoulos CE, Karvounis HI, Giannakoulas G, Karamitsos TD, Efthimiadis GK, Parharidis GE. Predictors of left ventricular remodeling after reperfused acute myocardial infarction. Am J Cardiol (2007) 99:1024–1025.[Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||