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Zhang R, Shi S, Chen W, Wang Y, Lin X, Zhao Y, Liao L, Guo Q, Zhang X, Li W, Zhang K, Liao Y, Fang Y. Independent effects of the triglyceride-glucose index on all-cause mortality in critically ill patients with coronary heart disease: analysis of the MIMIC-III database. Cardiovasc Diabetol 2023; 22:10. [PMID: 36639637 PMCID: PMC9838037 DOI: 10.1186/s12933-023-01737-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index is a reliable alternative biomarker of insulin resistance (IR). However, whether the TyG index has prognostic value in critically ill patients with coronary heart disease (CHD) remains unclear. METHODS Participants from the Medical Information Mart for Intensive Care III (MIMIC-III) were grouped into quartiles according to the TyG index. The primary outcome was in-hospital all-cause mortality. Cox proportional hazards models were constructed to examine the association between TyG index and all-cause mortality in critically ill patients with CHD. A restricted cubic splines model was used to examine the associations between the TyG index and outcomes. RESULTS A total of 1,618 patients (65.14% men) were included. The hospital mortality and intensive care unit (ICU) mortality rate were 9.64% and 7.60%, respectively. Multivariable Cox proportional hazards analyses indicated that the TyG index was independently associated with an elevated risk of hospital mortality (HR, 1.71 [95% CI 1.25-2.33] P = 0.001) and ICU mortality (HR, 1.50 [95% CI 1.07-2.10] P = 0.019). The restricted cubic splines regression model revealed that the risk of hospital mortality and ICU mortality increased linearly with increasing TyG index (P for non-linearity = 0.467 and P for non-linearity = 0.764). CONCLUSIONS The TyG index was a strong independent predictor of greater mortality in critically ill patients with CHD. Larger prospective studies are required to confirm these findings.
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Affiliation(s)
- Rongting Zhang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Shanshan Shi
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Weihua Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Yani Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Xueqin Lin
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Yukun Zhao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Lihua Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Qian Guo
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Xiaoying Zhang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China ,grid.256112.30000 0004 1797 9307The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000 China
| | - Weiguo Li
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000 China
| | - Kaijun Zhang
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Ying Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Yong Fang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
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Swieszkowski SP, Costa D, Aladio JM, Matsudo M, Pérez de la Hoz A, Castro M, González D, Brignoli A, Pons S, Scazziota A, Pérez de la Hoz R. Neurohumoral response and stress hyperglycemia in myocardial infarction. J Diabetes Complications 2022; 36:108339. [PMID: 36345108 DOI: 10.1016/j.jdiacomp.2022.108339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hyperglycemia is associated with an increased risk for death in acute coronary syndromes. This could be related to underlying glucose metabolism abnormalities or be caused by a counter-regulatory stress response. However, there is a paucity of data on the relationship between stress hormones, hyperglycemia, and clinical outcomes in myocardial infarction. METHODS Single-center, prospective, observational study. Patients admitted to the coronary care unit with a diagnosis of myocardial infarction were included. On admission, blood samples were obtained to measure serum glucose, cortisol, and catecholamines. A second sample was obtained at 8 AM after 48 h from admission. RESULTS There was a mild and positive correlation between serum cortisol and glucose (Spearman's rho = 0.24, p = 0.005), and no significant correlation was found between glucose and catecholamines. A similar correlation between cortisol and glucose among diabetics and non-diabetics was observed. Significantly higher serum cortisol and glucose levels were present in patients who developed heart failure or died during hospitalization. The association between glycemia and mortality lost significance in multivariate analysis, with a significant interaction term with cortisol (p = 0.003). CONCLUSION Cortisol is a key responsible for stress hyperglycemia, and its deleterious effects on the cardiovascular system could be the cause for worst outcomes associated with hyperglycemia in ACS. Further research is warranted to ascertain this relationship and to investigate potential therapeutic targets.
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Affiliation(s)
| | - Diego Costa
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - José Martín Aladio
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Maia Matsudo
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Alejo Pérez de la Hoz
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Marcela Castro
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Diego González
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Alejandra Brignoli
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Silvina Pons
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Alejandra Scazziota
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Ricardo Pérez de la Hoz
- Hospital de Clínicas "José de San Martín", Facultad de Medicina, Universidad de Buenos Aires, Argentina
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Cheng SY, Wang H, Lin SH, Wen JH, Ma LL, Dai XC. Association of admission hyperglycemia and all-cause mortality in acute myocardial infarction with percutaneous coronary intervention: A dose–response meta-analysis. Front Cardiovasc Med 2022; 9:932716. [PMID: 36172574 PMCID: PMC9510712 DOI: 10.3389/fcvm.2022.932716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study is to evaluate the associations between admission hyperglycemia and the risk of all-cause mortality in patients with acute myocardial infarction (AMI) with or without diabetes, to find optimal admission glucose intervention cut-offs, and to clarify the shape of the dose–response relations. Methods Medline/PubMed and EMBASE were searched from inception to 1 April 2022. Cohort studies reporting estimates of all-cause mortality risk in patients with admission hyperglycemia with AMI were included. The outcomes of interest include mortality and major adverse cardiac events (MACEs). A random effect dose–response meta-analysis was conducted to access linear trend estimations. A one-stage linear mixed effect meta-analysis was used for estimating dose–response curves. Relative risks and 95% confidence intervals were pooled using a random-effects model. Results Of 1,222 studies screened, 47 full texts were fully reviewed for eligibility. The final analyses consisted of 23 cohort studies with 47,177 participants. In short-term follow-up, admission hyperglycemia was associated with an increased risk of all-cause mortality (relative risk: 3.12, 95% confidence interval 2.42–4.02) and MACEs (2.34, 1.77–3.09). In long-term follow-up, admission hyperglycemia was associated with an increased risk of all-cause mortality (1.97, 1.61–2.41) and MACEs (1.95, 1.21–3.14). A linear dose–response association was found between admission hyperglycemia and the risk of all-cause mortality in patients with or without diabetes. Conclusion Admission hyperglycemia was significantly associated with higher all-cause mortality risk and rates of MACEs. However, the association between admission hyperglycemia and long-term mortality risk needs to be determined with caution. Compared with current guidelines recommendations, a lower intervention cut-off and more stringent targets for admission hyperglycemia may be appropriate. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022317280], identifier [CRD42022317280].
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Affiliation(s)
- Shao-Yong Cheng
- Department of Cardiology, Beijing Royal Integrative Medicine Hospital, Beijing, China
| | - Hao Wang
- Department of Cardiology, Beijing Royal Integrative Medicine Hospital, Beijing, China
| | - Shi-Hua Lin
- Department of Internal Medicine, Zhejiang Hospital, Hangzhou, China
| | - Jin-Hui Wen
- Department of Endocrinology and Metabolism, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Ling-Ling Ma
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China
- *Correspondence: Ling-Ling Ma,
| | - Xiao-Ce Dai
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China
- Xiao-Ce Dai,
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Kethireddy R, Gandhi D, Kichloo A, Patel L. Challenges in hyperglycemia management in critically ill patients with COVID-19. World J Crit Care Med 2022; 11:219-227. [PMID: 36051939 PMCID: PMC9305683 DOI: 10.5492/wjccm.v11.i4.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/10/2021] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay. Data from the corona virus disease 2019 (COVID-19) pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality. The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance, critical illness hyperglycemia (stress- induced hyperglycemia) secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action, acute cytokine storm and pancreatic cell dysfunction. Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state. Management of hyperglycemia in COVID-19 is often complicated by use of steroids, prolonged total parenteral or enteral nutrition, frequent acute hyperglycemic events, and restrictions with fluid management due to acute respiratory distress syndrome. While managing hyperglycemia special attention should be paid to mode of insulin delivery, frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment. In this article we describe the pathophysiology of hyperglycemia, challenges encountered in managing hyperglycemia, and review some potential solutions to address them.
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Affiliation(s)
- Rajesh Kethireddy
- Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
| | - Darshan Gandhi
- Department of Diagnostic Radiology, University of Tennessee Health Science Center, Memphis, TN 38103, United States
| | - Asim Kichloo
- Internal Medicine, Central Michigan University School of Medicine, Mt Pleasant, MI 48859, United States
| | - Love Patel
- Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
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Ritsinger V, Hagström E, Lagerqvist B, Norhammar A. Admission Glucose Levels and Associated Risk for Heart Failure After Myocardial Infarction in Patients Without Diabetes. J Am Heart Assoc 2021; 10:e022667. [PMID: 34719236 PMCID: PMC8751923 DOI: 10.1161/jaha.121.022667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Dysglycemia at acute myocardial infarction (AMI) is common and is associated with mortality. Information on other outcomes is less well explored in patients without diabetes in a long‐term perspective. We aimed to explore the relationship between admission glucose level and long‐term outcomes in patients with AMI without diabetes in a nationwide setting. Methods and Results Patients without diabetes (n=45 468) with AMI registered in SWEDEHEART (Swedish Web–System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) and admission glucose ≤11 mmol/L (≤198 mg/dL) were followed for outcomes (AMI, heart failure, stroke, renal failure, and death) between 2012 and 2017 (mean follow‐up time 3.3±1.7 years). The association between categorized glucose levels and outcomes was assessed in adjusted Cox proportional hazards regression analyses (glucose levels 4.0–6.0 mmol/L [72–109 mg/dL] as reference). Further nonfatal complications and their associated mortality were explored (patients without events served as a reference). A glucose level of 7.8–11.0 mmol/L (140–198 mg/dL) was associated with hospitalization for heart failure (hazard ratio [HR] 1.40 [95% CI, 1.30–1.51], P<0.001), renal failure (1.17; 1.04–1.33, P=0.009), and death (1.31; 1.20–1.43, P<0.001), but not with recurrent myocardial infarction (0.99; 0.92–1.07, P=0.849) or stroke (1.03; 0.88–1.19, P=0.742). Renal failure had the strongest association with future mortality (age‐adjusted HR 4.93 [95% CI, 4.34–5.60], P<0.001), followed by heart failure (3.71; 3.41–4.04, P<0.001), stroke (3.39; 2.94–3.91, P<0.001), and myocardial infarction (2.08; 1.88–2.30, P<0.001). Conclusions Elevated glucose levels at AMI admission identifies patients without diabetes at increased risk of long‐term complications: in particular, hospitalization for heart and renal failure. These results emphasize that glucose levels at admission could be useful in risk assessment after myocardial infarction.
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Affiliation(s)
- Viveca Ritsinger
- Department of Medicine K2 Karolinska InstitutetCardiology Unit Stockholm Sweden.,Department of Research and Development Region KronobergVäxjö Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Anna Norhammar
- Department of Medicine K2 Karolinska InstitutetCardiology Unit Stockholm Sweden.,Capio S:t Görans Hospital Stockholm Sweden
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Koraćević G, Zdravković M. WHAT IS STRESS HYPERGLYCEMIA? A SUGGESTION FOR AN IMPROVEMENT OF ITS DEFINITION. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:548-551. [PMID: 35747859 PMCID: PMC9206148 DOI: 10.4183/aeb.2021.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
CONTEXT Stress hyperglycemia has been studied in numerous critical illnesses for several decades. Despite the extensive accumulation of knowledge about this topic, the definition of stress hyperglycemia is not updated since 2007. SUBJECTS AND METHODS We performed a narrative review about stress hyperglycemia in acute myocardial infarction (AMI), aiming to improve its current definition and to give evidence supporting this. RESULTS The definition of stress hyperglycemia in 2021 we recommend is: "SH is a high ABGly in an AMI patient irrespective of DM status. It can be calculated as e.g., "stress hyperglycemia ratio" or "admission glucose delta"/"glycemic gap". This definition may serve to start a consensus document of the experts in the field. The evidence accumulates supporting the possibility to recognize stress hyperglycemia also in AMI patients with diabetes mellitus (DM) by calculating glycemia during the previous 2-3 months using glycated hemoglobin. Moreover, it is now obvious that 2007 definition of stress hyperglycemia did not take into account the necessity to separate cut-offs for the subgroups with vs. without DM. CONCLUSIONS We demonstrated the insufficiency of the current 2007 definition of stress hyperglycemia, provided evidence-based recommendation for the improvement and suggested the need for a consensus of the experts on this topic. In order to optimize the treatment of stress hyperglycemia in numerous critical illnesses, we ought to have its universal definition (as we already have the universal definition of AMI).
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Affiliation(s)
- G. Koraćević
- Clinical Centre Nis - Department for Cardiovascular Diseases, Niš, Serbia
- University of Nis Faculty of Medicine, Niš, Serbia
| | - M. Zdravković
- University of Nis Faculty of Medicine, Niš, Serbia
- Correspondence to: Miloš Zdravković MD, University of Nis Faculty of Medicine, Niš, Serbia, E-mail:
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Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction. ACTA ACUST UNITED AC 2021; 60:34-41. [PMID: 34407328 DOI: 10.2478/rjim-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 01/08/2023]
Abstract
Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome.Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality.Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 - 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 - 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 - 0.995, p=0.031).Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.
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Cui C, Zhou M, Cheng L, Ye T, Zhang Y, Zhu F, Li S, Jiang X, Chen Q, Qi L, Chen X, Yang S, Cai L. Admission hyperglycemia as an independent predictor of long-term prognosis in acute myocardial infarction patients without diabetes: A retrospective study. J Diabetes Investig 2021; 12:1244-1251. [PMID: 33249775 PMCID: PMC8264390 DOI: 10.1111/jdi.13468] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/23/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION The predictive value of admission hyperglycemia in the long-term prognosis of acute myocardial infarction patients is still controversial. We aimed to investigate this value based on the diabetes status. MATERIALS AND METHODS We carried out a multicenter, retrospective study of 1,288 acute myocardial infarction patients enrolled in 11 hospitals between March 2014 and June 2019 in Chengdu, China. The patients were classified into those with diabetes and those without diabetes, each was further divided into: hyperglycemia and non-hyperglycemia subgroups, according to the optimal cut-off value of the blood glucose to predict all-cause mortality during follow up. The end-points were all-cause death and major adverse cardiovascular and cerebrovascular events, including all-cause death, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke. RESULTS In the follow-up period of 15 months, we observed 210 (16.3%), 6 (0.5%), 57 (4.4%) and 34 (2.6%) cases of death, non-fatal myocardial infarction, revascularization and non-fatal stroke, respectively. The optimal cut-off values of admission blood glucose for patients with diabetes and patients without diabetes to predict all-cause mortality during follow up were 14.80 and 6.77 mmol/L, respectively. We divided patients with diabetes (n = 331) into hyperglycemia (n = 92) and non-hyperglycemia (n = 239), and patients without diabetes (n = 897) into hyperglycemia (n = 425) and non-hyperglycemia (n = 472). The cumulative rates of all-cause death and major adverse cardiovascular and cerebrovascular events among the patients in each hyperglycemia group was higher than that in the corresponding non-hyperglycemia group (P < 0.001). In patients without diabetes, admission hyperglycemia was an independent predictor of all-cause mortality and major adverse cardiovascular and cerebrovascular events. CONCLUSION Admission hyperglycemia was an independent predictor for long-term prognosis in acute myocardial infarction patients without diabetes.
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Affiliation(s)
- Cai‐yan Cui
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Ming‐gang Zhou
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Lian‐chao Cheng
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Tao Ye
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Yu‐mei Zhang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Feng Zhu
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Si‐yi Li
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Xing‐lin Jiang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Qiang Chen
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Ling‐yao Qi
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Xu Chen
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Si‐qi Yang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Lin Cai
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
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Kewcharoen J, Ali M, Trongtorsak A, Mekraksakit P, Vutthikraivit W, Kanjanauthai S. Admission hyperglycemia is associated with reperfusion failure in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:348-359. [PMID: 34322304 PMCID: PMC8303032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Admission hyperglycemia (AH) is a common finding in patients with acute coronary syndrome and has been reported to be associated with increased morbidity and mortality. Prior studies suggest that AH could be associated with reperfusion failure. We conducted a systematic review and meta-analysis to explore an association between AH and risk of reperfusion failure in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). METHODS Two investigators searched the databases of MEDLINE and EMBASE from inception to February 2021. Study eligibility was independently determined by two investigators and needed to demonstrate association of AH and rate of reperfusion failure, or sufficient raw data to calculate the effect size. Participants were classified into two groups corresponding to their level of admission hyperglycemia. Group 1 was defined as an AH of ≥120-150 mg/dl, and group 2 as ≥150-200 mg/dl. Data from each study were combined using the random-effects model, the generic inverse-variance method of Der Simonian and Laird. The heterogeneity of effect size was quantified using the I2 statistic. A sensitivity analysis was performed by omitting one study at a time. Publication bias was assessed using a funnel plot and the Egger's test. All data analyses were performed using STATA SE version 14.2. RESULTS A total of ten studies from 2008 to 2019 met eligibility criteria and were included in the final analysis. We found that AH is associated with increased risk of reperfusion failure in both group 1 (pooled OR=1.78, 95% CI: 1.35-2.33, I2=63.2%, P<0.001) and group 2 (pooled OR=1.44, 95% CI: 1.14-1.82, I2=57.1%, P<0.001). Sensitivity analysis showed that none of the results were significantly altered after removing one study at a time. In subgroup analysis of non-diabetic patients, we found that AH is also associated with increased risk of reperfusion failure in both group 1 (pooled OR=1.81, 95% CI: 1.29-2.54, P<0.001) and group 2 (pooled OR=1.61, 95% CI: 1.17-2.21, P<0.001). We did not perform a funnel plot or Egger's test as the number of available outcomes was insufficient to reject the assumption of funnel plot asymmetry. CONCLUSIONS Our systematic review and meta-analysis demonstrated that AH is associated with increased risk of reperfusion failure in STEMI patients undergoing pPCI, in the non-diabetic population.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency ProgramHonolulu, HI, USA
| | - Mohammed Ali
- University of Hawaii Internal Medicine Residency ProgramHonolulu, HI, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn UniversityBangkok, Thailand
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbock, TX, USA
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbock, TX, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern CaliforniaLos Angeles, CA, USA
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Mamadjanov T, Volaklis K, Heier M, Freuer D, Amann U, Peters A, Kuch B, Thilo C, Linseisen J, Meisinger C. Admission glucose level and short-term mortality in older patients with acute myocardial infarction: results from the KORA Myocardial Infarction Registry. BMJ Open 2021; 11:e046641. [PMID: 34083341 PMCID: PMC8183232 DOI: 10.1136/bmjopen-2020-046641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES To investigate the association between admission blood glucose levels and 28-day mortality as well as in-hospital complications in older patients with incident acute myocardial infarction (AMI) undergoing modern treatment. METHODS From a German population-based regional MI registry, 5530 patients (2016 women), aged 65-84 years, hospitalised with an incident AMI between 1 January 2009 and 31 December 2016 were included in the study. Multivariable logistic regression models were used to assess the associations between admission blood glucose and 28-day mortality as well as in-hospital complications after AMI. Analyses stratified according to age, diabetes and type of infarction (ST-elevation MI (STEMI)/non-STEMI) were conducted. RESULTS The adjusted ORs for the association between admission blood glucose and 28-day mortality in young-old (65-74 years) and old (75-84 years) patients with AMI were 1.40 (95% CI: 1.21 to 1.62) and 1.21 (95% CI: 0.98 to 1.50) per 1 SD increase in admission blood glucose, respectively. Furthermore, higher admission blood glucose was related to case fatality irrespective of the diabetes status and type of infarction only in the under-75 group. For the patients aged 75-84 years, it was only true for those without diabetes and STEMI. Admission blood glucose was also associated with major cardiac complications in both age groups. CONCLUSION Admission blood glucose was significantly associated with 28-day case fatality in patients with AMI aged 65-74 years but not 75-84 years; furthermore, in both age groups there was an increased risk of major complications. It seems that admission glucose may play a rather minor role in terms of case fatality in higher aged patients with AMI.
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Affiliation(s)
- Temur Mamadjanov
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munchen, Germany
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Konstantinos Volaklis
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Ute Amann
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - B Kuch
- Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Christian Thilo
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
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Mazori AY, Bass IR, Chan L, Mathews KS, Altman DR, Saha A, Soh H, Wen HH, Bose S, Leven E, Wang JG, Mosoyan G, Pattharanitima P, Greco G, Gallagher EJ. Hyperglycemia is Associated With Increased Mortality in Critically Ill Patients With COVID-19. Endocr Pract 2021; 27:95-100. [PMID: 33551315 PMCID: PMC7796656 DOI: 10.1016/j.eprac.2020.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Abstract
Objective To explore the relationship between hyperglycemia in the presence and absence of diabetes mellitus (DM) and adverse outcomes in critically ill patients with coronavirus disease 2019 (COVID-19). Methods The study included 133 patients with COVID-19 admitted to an intensive care unit (ICU) at an urban academic quaternary-care center between March 10 and April 8, 2020. Patients were categorized based on the presence or absence of DM and early-onset hyperglycemia (EHG), defined as a blood glucose >180 mg/dL during the first 2 days after ICU admission. The primary outcome was 14-day all-cause in-hospital mortality; also examined were 60-day all-cause in-hospital mortality and the levels of C-reactive protein, interleukin 6, procalcitonin, and lactate. Results Compared to non-DM patients without EHG, non-DM patients with EHG exhibited higher adjusted hazard ratios (HRs) for mortality at 14 days (HR 7.51, CI 1.70-33.24) and 60 days (HR 6.97, CI 1.86-26.13). Non-DM patients with EHG also featured higher levels of median C-reactive protein (306.3 mg/L, P = .036), procalcitonin (1.26 ng/mL, P = .028), and lactate (2.2 mmol/L, P = .023). Conclusion Among critically ill COVID-19 patients, those without DM with EHG were at greatest risk of 14-day and 60-day in-hospital mortality. Our study was limited by its retrospective design and relatively small cohort. However, our results suggest the combination of elevated glucose and lactate may identify a specific cohort of individuals at high risk for mortality from COVID-19. Glucose testing and control are important in individuals with COVID-19, even those without preexisting diabetes.
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Affiliation(s)
- Alon Y Mazori
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ilana Ramer Bass
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deena R Altman
- Division of Infectious Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aparna Saha
- Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Howard Soh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Huei Hsun Wen
- Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonali Bose
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emily Leven
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jing Gennie Wang
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gohar Mosoyan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giampaolo Greco
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emily J Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York.
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12
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Liu F, Huang R, Li Y, Zhao S, Gong Y, Xu Z. In-Hospital Peak Glycemia in Predicting No-Reflow Phenomenon in Diabetic Patients with STEMI Treated with Primary Percutaneous Coronary Intervention. J Diabetes Res 2021; 2021:6683937. [PMID: 33506051 PMCID: PMC7811415 DOI: 10.1155/2021/6683937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 01/04/2023] Open
Abstract
Although percutaneous coronary intervention (PCI) significantly improves the prognosis for myocardial infarction, the no-reflow phenomenon is still the major adverse complication of PCI leading to increased mortality, especially for the patients with ST-segment elevation myocardial infarction (STEMI) combined with diabetes. To reduce the occurrence of no-reflow, prognostic factors must be identified for no-reflow phenomenon before PCI. A total of 262 participants with acute STEMI and diabetes were recruited into our cardiovascular center and underwent primary PCI for the analyses of prognostic factors of no-reflow. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI): the normal flow and no-reflow groups, and related factors were analyzed with different statistical methods. In the present investigation, the in-hospital peak glycemia was significantly higher in the no-reflow group than the normal flow group, while more narrowed vessels, higher level of initial TIMI flow, were observed in the patients of the no-reflow group. A multivariate logistic regression analysis further demonstrated that peak glycemia was an independent predictor for no-reflow in the diabetic patients with STEMI. Our data indicated the importance of the proper control of glucose before PCI for the diabetic patients with STEMI before PCI to reduce the occurrence of the no-reflow after operation.
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Affiliation(s)
- Fang Liu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Rui Huang
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Ya Li
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Surui Zhao
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Yue Gong
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
| | - Zesheng Xu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou, 061000 Hebei, China
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Goldstein DS. The extended autonomic system, dyshomeostasis, and COVID-19. Clin Auton Res 2020; 30:299-315. [PMID: 32700055 PMCID: PMC7374073 DOI: 10.1007/s10286-020-00714-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
The pandemic viral illness COVID-19 is especially life-threatening in the elderly and in those with any of a variety of chronic medical conditions. This essay explores the possibility that the heightened risk may involve activation of the “extended autonomic system” (EAS). Traditionally, the autonomic nervous system has been viewed as consisting of the sympathetic nervous system, the parasympathetic nervous system, and the enteric nervous system. Over the past century, however, neuroendocrine and neuroimmune systems have come to the fore, justifying expansion of the meaning of “autonomic.” Additional facets include the sympathetic adrenergic system, for which adrenaline is the key effector; the hypothalamic-pituitary-adrenocortical axis; arginine vasopressin (synonymous with anti-diuretic hormone); the renin-angiotensin-aldosterone system, with angiotensin II and aldosterone the main effectors; and cholinergic anti-inflammatory and sympathetic inflammasomal pathways. A hierarchical brain network—the “central autonomic network”—regulates these systems; embedded within it are components of the Chrousos/Gold “stress system.” Acute, coordinated alterations in homeostatic settings (allostasis) can be crucial for surviving stressors such as traumatic hemorrhage, asphyxiation, and sepsis, which throughout human evolution have threatened homeostasis; however, intense or long-term EAS activation may cause harm. While required for appropriate responses in emergencies, EAS activation in the setting of chronically decreased homeostatic efficiencies (dyshomeostasis) may reduce thresholds for induction of destabilizing, lethal vicious cycles. Testable hypotheses derived from these concepts are that biomarkers of EAS activation correlate with clinical and pathophysiologic data and predict outcome in COVID-19 and that treatments targeting specific abnormalities identified in individual patients may be beneficial.
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Affiliation(s)
- David S Goldstein
- Autonomic Medicine Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA.
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14
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Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction. Front Med 2020; 15:70-78. [PMID: 32519296 DOI: 10.1007/s11684-020-0749-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/18/2019] [Indexed: 01/11/2023]
Abstract
Recent studies have shown that acute blood glucose elevation in patients with ST-segment elevation myocardial infarction (STEMI) suggests a poor prognosis. To investigate the effect of fasting blood glucose (FBG) on the risk of heart failure (HF) and left ventricular systolic dysfunction (LVSD) in non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute STEMI, we retrospectively recruited consecutive non-diabetic patients who underwent primary PCI for STEMI in our hospital from February 2003 to March 2015. The patients were divided into two groups according to the FBG level. A total of 623 patients were recruited with an age of 61.3 ± 12.9 years, of whom 514 (82.5%) were male. The HF risk (odds ratio 3.401, 95% confidence interval (CI) 2.144-5.395, P < 0.001) was significantly increased in patients with elevated FBG than those with normal FBG. Elevated FBG was also independently related to LVSD (β 1.513, 95%CI 1.282-1.785, P < 0.001) in a multiple logistics regression analysis. In conclusion, elevated FBG was independently associated with 30-day HF and LVSD risk in non-diabetic patients undergoing primary PCI for STEMI.
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15
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Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction. Cardiovasc Endocrinol Metab 2020; 9:24-29. [PMID: 32104788 DOI: 10.1097/xce.0000000000000187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Abstract
Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients with NSTEMI undergoing PCI. Materials and methods We retrospectively enrolled 281(149, 53% men) NSTEMI patients undergoing PCI. For each patient, plasma glucose levels were secreened at hospital admission. Acute hyperglycemia was defined as glucose levels > 198 mg/dl. CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48-72 hours. Results Overall, 44 (15.7%) patients had acute hyperglycemia. Patients with acute hyperglycemia had higher incidence of CIN than those without acute hyperglycemia (29.5 vs 5.1%, P < 0.001). Also, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation and dialysis were observed significantly higher in patients with hyperglycemia. Patients were then reallocated to two groups according to the presence or absence of CIN. Overall, 25 cases (8.9%) of CIN were diagnosed. Diabetes mellitus, weight, age, glucose level and estimated glomerular filtration rate (eGFR) were detected as independent risk factors of CIN. Additionally, admission glucose levels were significantly correlated with creatinine levels after PCI, eGFR and contrast volume/eGFR ratio. Conclusion In NSTEMI patients undergoing primary PCI, acute hyperglycemia may be associated with an increased risk for CIN and in-hospital mortality and morbidity.
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Zhou J, Sheng Z, Liu C, Zhou P, Li J, Chen R, Song L, Zhao H, Yan H. Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study. J Diabetes Res 2020; 2020:1763567. [PMID: 32685552 PMCID: PMC7327614 DOI: 10.1155/2020/1763567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. METHODS AND RESULTS We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (n = 182) non-DM patients and 34.3% (n = 95) DM patients. We measured acute blood glucose (ABG) and hemoglobin A1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, p = 0.012) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, p = 0.006) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, p = 0.130). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (p for trend = 0.002), lipid-rich plaque (p for trend = 0.001), and TCFA (p for trend = 0.003). A/C > 1.22 but not ABG > 140 mg/dl predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. CONCLUSIONS In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928.
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Affiliation(s)
- Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
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Does stress hyperglycemia affect mortality? Acute myocardial infarction - case control study. ACTA ACUST UNITED AC 2019; 4:e201-e207. [PMID: 31538125 PMCID: PMC6749178 DOI: 10.5114/amsad.2019.87303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022]
Abstract
Introduction We aimed to investigate the effect of stress (acute) hyperglycemia in patients with acute coronary syndrome who had not been previously diagnosed with diabetes mellitus (DM) on the prognosis of the disease in terms of mortality. Material and methods Patients who were admitted to the Adana Numune Training and Research Hospital Emergency Service Clinic between August 2010 and August 2013 and whose plasma blood glucose level was over 140 mg/dl at the time of admission but were not previously diagnosed with DM, who were over the age of 18 and considered to have acute myocardial infarction were included. Results A total of 259 patients whose data were fully attainable were included in the study. 80.3% (n = 208) of the patients were male and 19.7% (n = 41) were female. Non-ST elevation myocardial infarction was found in 71.6%, ST elevation myocardial infarction was found in 28.4% of the patients with stress hyperglycemia. It was determined that 10.1% of patients with stress-related hyperglycemia and 1.3% of patients without stress-related hyperglycemia had died. Conclusions The plasma blood glucose level at presentation of patients diagnosed with acute myocardial infarction at the emergency room is associated with early in-hospital mortality.
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Elevated Glycemic Gap Predicts Acute Respiratory Failure and In-hospital Mortality in Acute Heart Failure Patients with Diabetes. Sci Rep 2019; 9:6279. [PMID: 31000758 PMCID: PMC6472356 DOI: 10.1038/s41598-019-42666-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/05/2019] [Indexed: 02/08/2023] Open
Abstract
Diabetes is a common comorbidity in patients hospitalized for acute heart failure (AHF), but the relationship between admission glucose level, glycemic gap, and in-hospital mortality in patients with both conditions has not been investigated thoroughly. Clinical data for admission glucose, glycemic gap and in-hospital death in 425 diabetic patients hospitalized because of AHF were collected retrospectively. Glycemic gap was calculated as the A1c-derived average glucose subtracted from the admission plasma glucose level. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff value for glycemic gap to predict all-cause mortality. Patients with glycemic gap levels >43 mg/dL had higher rates of all-cause death (adjusted hazard ratio, 7.225, 95% confidence interval, 1.355-38.520) than those with glycemic gap levels ≤43 mg/dL. The B-type natriuretic peptide levels incorporated with glycemic gap could increase the predictive capacity for in-hospital mortality and increase the area under the ROC from 0.764 to 0.805 (net reclassification improvement = 9.9%, p < 0.05). In conclusion, glycemic gap may be considered a useful parameter for predicting the disease severity and prognosis of patients with diabetes hospitalized for AHF.
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Alavi-Moghaddam M, parsa-Mahjoob M, Ghodssi-ghassemabadi R, Bitazar B. Association of Admission Blood Glucose Level with Major Adverse Cardiac Events in Acute Coronary Syndrome; a Cohort Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e26. [PMID: 31432036 PMCID: PMC6637796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Appropriate management of abnormal admission blood glucose level (ABGL) in acute coronary syndrome (ACS) patients still remains a common issue. This study aims to assess the influence of ABGL on development of 30-day major adverse cardiac events (MACEs) in patients with suspected ACS. METHODS This is a prospective cohort study based on analysis of data collected from patients suspected to acute coronary syndrome admitted to emergency department. ABGL of patients was measured and its association with development of MACEs (MI, CVA, mortality) within 30 days of follow-up was studied. RESULTS 814 participants with the mean age of 61.8 ± 13.4 years were studied (58.1% male). MACE endpoints were developed in 166 (39.0%) hyperglycemic, 30 (46.9%) hypoglycemic, and 53 (16.4%) normoglycemic patients (p<0.001). Mean admission blood glucose level of patients who developed MACE within 30 days was significantly higher than others (210.6 ± 123.4 vs 157.4 ± 86.6mg/dL; p<0.001; OR: 1.006 (1.005 to 1.008)). There was a significant correlation between male gender (p=0.027), abnormal admission blood glucose level (p<0.001), diabetes (p = 0.001), hyoerlipidemia (p=0.059), prior CABG (p=0.008), first and second blood troponin levels (p<0.001), first and second abnormal ECGs (p<0.001), and also ECG changes (p<0.001) with developing MACE. Abnormal ABGL, first and second blood troponin levels, and the history of diabetes were among independent risk factors of developing MACE within 30 days. CONCLUSION It seems that abnormal admission blood glucose level in suspected ACS patients was an independent predictor of major adverse cardiac events within 30 days.
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Affiliation(s)
- Mostafa Alavi-Moghaddam
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohamad parsa-Mahjoob
- Cardiovascular Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Bita Bitazar
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Corresponding author: Bita Bitazar; Emergency Medicine Department, Imam Hossein Hospital, Madani Avenue, Imam Hossein Square, Tehran, Iran. , Tel: +9821-77558001
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Cheung NW, Wong KYC, Kovoor P, McLean M. Stress hyperglycemia: A prospective study examining the relationship between glucose, cortisol and diabetes in myocardial infarction. J Diabetes Complications 2019; 33:329-334. [PMID: 30691725 DOI: 10.1016/j.jdiacomp.2018.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Abstract
AIM We aimed to explore the relationship between stress, hyperglycemia and diabetes in myocardial infarction (MI), using serum cortisol as a surrogate marker for the severity of stress. METHODS Subjects with acute MI were prospectively recruited upon hospital admission. Serum glucose and cortisol were measured in addition to standard testing. Subjects were defined as having stress hyperglycemia (SH) if they had an admission glucose ≥7.8 mmol/L without a history of glucose intolerance. Subjects were followed up with glucose tolerance testing post-discharge. RESULTS Of the 200 subjects in the study, 58 had known diabetes/impaired glucose tolerance (IGT), and 45 had SH. There was a positive association between admission glucose and cortisol for the entire cohort (rs = 0.26, p < 0.01). This relationship was present in the subgroup who had SH and then normal glucose post-discharge (rs = 0.53, p = 0.03), but not in SH subjects who had diabetes/IGT on post-discharge testing. It was also evident amongst all subjects with normal glucose (rs = 0.46, p < 0.01), but not those with diabetes/IGT in general. On multivariate analysis, admission glucose was a positive predictor and cortisol a negative predictor of abnormal glucose tolerance. CONCLUSIONS Our data suggests that SH with MI reflects either underlying glucose intolerance or more severe stress in people without glucose intolerance.
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Affiliation(s)
- N Wah Cheung
- Dept of Diabetes & Endocrinology, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia; University of Sydney, Camperdown, NSW 2006, Australia.
| | - K Y Carmen Wong
- Dept of Diabetes & Endocrinology, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia; University of Sydney, Camperdown, NSW 2006, Australia
| | - Pramesh Kovoor
- Dept of Cardiology, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia; University of Sydney, Camperdown, NSW 2006, Australia.
| | - Mark McLean
- Dept of Diabetes & Endocrinology, Blacktown Hospital, Blacktown 2148, Australia; Western Sydney University, Penrith, NSW 2751, Australia.
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Negreiros PH, Bau A, Nadruz W, Coelho Filho OR, Matos-Souza JR, Coelho OR, Sposito AC, Carvalho LSF. Intensive treatment of hyperglycemia in the acute phase of myocardial infarction: the tenuous balance between effectiveness and safety - a systematic review and meta-analysis of randomized clinical trials. ACTA ACUST UNITED AC 2019; 65:24-32. [PMID: 30758416 DOI: 10.1590/1806-9282.65.1.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION In acute myocardial infarction (AMI), each 18 mg/dl (1 mmol/L) increment is associated with a 3% increase in mortality rates. All strategies applied for reducing blood glucose to this date, however, have not presented encouraging results. METHODOLOGY We searched the Medline (PubMed) and Cochrane Library databases for randomized clinical trials (RCTs) from 1995 to 2017 that used the intensive strategy or GIK therapy for blood glucose control during the acute stage of the AMI. We included eight studies. In order to identify the effects of GIK or insulin therapy, we calculated a overall risk ratio (RR) with meta-analysis of fixed and random effects models. A two-tail p-value of < 0.05 was considered statistically significant. RESULTS A total of 28,151 patients were included: 1,379 intensively treated with insulin, 13,031 in GIK group, and 13,741 in the control group. The total mortality was 10.5% (n=2,961) and the RR of 1.03 [95%CI 0.96-1.10]; I2 = 31%; p = 0.41 for the combined intensive insulin plus GIK groups in comparison with the control group. In meta-regression analyses, intense reductions in blood glucose (> 36 mg/dL) in relation to the estimated average blood glucose (estimated by HbA1c) were associated with higher mortality, whereas lower reductions in blood glucose (< 36 mg/dL) were not associated with mortality. The lowering of blood glucose in the acute phase of MI compared with the average blood glucose was more effective around 18 mg/dL. CONCLUSION This meta-analysis suggests that there may be a tenuous line between the effectiveness and safety of reducing blood glucose in the acute phase of MI. The targets must not exceed a reduction greater than 36 mg/dL in relation to estimated average blood glucose.
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Affiliation(s)
- Paulo H Negreiros
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Adriana Bau
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Wilson Nadruz
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Otavio R Coelho Filho
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - José Roberto Matos-Souza
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Otavio R Coelho
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Andrei C Sposito
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Luiz Sergio F Carvalho
- Cardiology Department, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, SP, Brasil
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22
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Kyaw NTT, Satyanarayana S, Oo HN, Kumar AMV, Harries AD, Aung ST, Kyaw KWY, Phyo KH, Aung TK, Magee MJ. Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011-2017). Open Forum Infect Dis 2018; 6:ofy355. [PMID: 30697575 PMCID: PMC6343962 DOI: 10.1093/ofid/ofy355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/09/2018] [Accepted: 12/26/2018] [Indexed: 12/17/2022] Open
Abstract
Background There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease. Methods We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality. Results Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68-310) cell/mm3, the median RBG level (IQR) was 88 (75-106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%-6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1-1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8-1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110-140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2-1.4; restricted spline: aHR, 1.1; 95% CI, 1.0-1.1) compared with those with RBG <110 mg/dL. Conclusions Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.
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Affiliation(s)
- Nang Thu Thu Kyaw
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
- Correspondence: Nang Thu Thu Kyaw, The Union Myanmar Office, 36, 27th Street, Between 72nd and 73rd Street, Mandalay, Myanmar ()
| | - Srinath Satyanarayana
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India
| | - Htun Nyunt Oo
- National HIV/AIDS Program, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Ajay M V Kumar
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anthony D Harries
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Si Thu Aung
- National Tuberculosis Program, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khine Wut Yee Kyaw
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Khaing Hnin Phyo
- Integrated HIV Care Program, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Thet Ko Aung
- Integrated HIV Care Program, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Matthew J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
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23
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Perez de la Hoz RA, Swieszkowski SP, Cintora FM, Aladio JM, Papini CM, Matsudo M, Scazziota AS. Neuroendocrine System Regulatory Mechanisms: Acute Coronary Syndrome and Stress Hyperglycaemia. Eur Cardiol 2018; 13:29-34. [PMID: 30310467 DOI: 10.15420/ecr.2017:19:3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Neurohormonal systems are activated in the early phase of acute coronary syndromes to preserve circulatory homeostasis, but prolonged action of these stress hormones might be deleterious. Cortisol reaches its peak at 8 hours after the onset of symptoms, and individuals who have continued elevated levels present a worse prognosis. Catecholamines reach 100-1,000-fold their normal plasma concentration within 30 minutes of ischaemia, therefore inducing the propagation of myocardial damage. Stress hyperglycaemia induces inflammation and endothelial dysfunction, and also has procoagulant and prothrombotic effects. Patients with hyperglycaemia and no diabetes elevated in-hospital and 12-month mortality rates. Hyperglycaemia in patients without diabetes has been shown to be an appropriate independent mortality prognostic factor in this type of patient.
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Affiliation(s)
| | | | | | | | | | - Maia Matsudo
- School of Medicine, Buenos Aires University Buenos Aires, Argentina
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24
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Itzhaki Ben Zadok O, Kornowski R, Goldenberg I, Klempfner R, Toledano Y, Biton Y, Fisman EZ, Tenenbaum A, Golovchiner G, Kadmon E, Omelchenko A, Gal TB, Barsheshet A. Admission blood glucose and 10-year mortality among patients with or without pre-existing diabetes mellitus hospitalized with heart failure. Cardiovasc Diabetol 2017; 16:102. [PMID: 28806975 PMCID: PMC5557317 DOI: 10.1186/s12933-017-0582-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/29/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High admission blood glucose (ABG) level has been associated with a poor short-term outcome among non-diabetic patients with heart failure (HF). We aimed to investigate the association between ABG levels and long-term (10 years) mortality in patients with or without pre-existing diabetes mellitus (DM) admitted with HF. METHODS We analyzed data on 1811 patients with DM and 2182 patients without pre-existing DM who were hospitalized with HF during a prospective national survey. The relationship between ABG and 10-year mortality was assessed using the Cox proportional hazard model adjusting for multiple variables. ABG was analyzed both as a categorical (<110, 110-140, 140-200, and >200 mg/dL) and as a continuous variable. RESULTS At 10 years of follow-up the cumulative probability of mortality was 85 and 78% among patients with DM and patients with no pre-existing DM (p < 0.001), respectively. Among patients with no pre-existing DM, glucose levels of 110-140, 140-200 and ≥200 mg/dL were associated with 9% (p = 0.140), 16% (p = 0.031) and 53% (p < 0.001) increased mortality risk compared to ABG < 110 mg/dL. Each 18-mg/dL (1-mmol/L) increase in glucose level was associated with a 5% increased risk of mortality (p < 0.001) among patients with no-pre-existing DM. In contrast, among patients with DM, only those with glucose levels >200 mg/dL had an increased mortality risk (>200 mg/dL versus <110 mg/dL; HR = 1.20, p = 0.032). CONCLUSION Among hospitalized HF patients with no pre-existing DM there is a linear relationship between ABG level and long-term mortality, whereas among patients with DM only ABG level >200 mg/dL is associated with increased mortality risk.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- "Leviev" Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- "Leviev" Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Toledano
- Division of Maternal-Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitschak Biton
- "Leviev" Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrique Z Fisman
- "Leviev" Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Tenenbaum
- "Leviev" Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gregory Golovchiner
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Kadmon
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Omelchenko
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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25
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Masnaghetti SE, Sarzi Braga S, Vaninetti R, Baiardi P, Pedretti RF. Altered fasting glycemia in cardiac patients during in-hospital rehabilitation. J Cardiovasc Med (Hagerstown) 2017; 18:625-630. [DOI: 10.2459/jcm.0000000000000478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Jang HJ, Oh PC, Moon J, Suh J, Park HW, Park SD, Lee K, Kim JS, Lee HJ, Choi RK, Choi YJ, Kang WC, Kwon SW, Kim TH. Prognostic Impact of Combined Dysglycemia and Hypoxic Liver Injury on Admission in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (from the INTERSTELLAR Cohort). Am J Cardiol 2017; 119:1179-1185. [PMID: 28214004 DOI: 10.1016/j.amjcard.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
Abstract
Dysglycemia on admission is known to predict the prognosis of ST-segment elevation myocardial infarction (STEMI). Recently, hypoxic liver injury (HLI) has been proposed as a novel prognosticator for STEMI. We evaluated the prognostic impact of combined dysglycemia and HLI at the time of presentation in patients with STEMI who underwent primary percutaneous coronary intervention. From 2007 to 2014, 1,525 consecutive patients (79% men, mean age 61 years) who underwent primary percutaneous coronary intervention for STEMI in the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort were analyzed retrospectively. Dysglycemia was defined as either hypoglycemia (serum glucose <90 mg/dl) or hyperglycemia (serum glucose >250 mg/dl). HLI was defined as more than twofold increase of any serum aminotransferases above the upper normal limit. Patients were divided into 4 groups according to their dysglycemia and HLI status on admission: group 1, normoglycemia without HLI; group 2, dysglycemia without HLI; group 3, normoglycemia with HLI; and group 4, dysglycemia with HLI. Primary end point was inhospital death and secondary end point was all-cause mortality at 12 months after the index procedure. Of the 1,525 patients, there were 87 inhospital deaths (5.7%) and 113 all-cause deaths (7.4%) at 12 months after the index procedure. Both dysglycemia and HLI on admission were independent predictors of inhospital death. Inhospital mortality rate was the highest in group 4 (32.1%), followed by groups 2 and 3. Kaplan-Meier survival analysis at 12 months showed similar trends among the 4 groups. In conclusion, combined dysglycemia and HLI on admission predicts early prognosis for STEMI.
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Affiliation(s)
- Ho-Jun Jang
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jon Suh
- Division of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyun Woo Park
- Division of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Je Sang Kim
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young-Jin Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea.
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27
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Kim EJ, Jeong MH, Kim JH, Ahn TH, Seung KB, Oh DJ, Kim HS, Gwon HC, Seong IW, Hwang KK, Chae SC, Kim KB, Kim YJ, Cha KS, Oh SK, Chae JK. Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients. Int J Cardiol 2017; 236:9-15. [PMID: 28126258 DOI: 10.1016/j.ijcard.2017.01.095] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/12/2016] [Accepted: 01/13/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate. METHODS A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status. RESULTS In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA1C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p<0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p<0.001). Comorbidity including cardiogenic shock (p<0.001), cerebral hemorrhage (p=0.012), decreased Hb≥5g/dL (p=0.013), atrioventricular block (p<0.001) and ventricular tachycardia (p=0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients. CONCLUSIONS These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.
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Affiliation(s)
- Eun Jung Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Ju Han Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Tae Hoon Ahn
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Ki Bae Seung
- The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Dong Joo Oh
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Cheol Gwon
- Sungkyunkwan Universtiy Samsung Medical Center, Seoul, Republic of Korea
| | - In Whan Seong
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyung Kuk Hwang
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Shung Chull Chae
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kwon-Bae Kim
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Young Jo Kim
- Yeungnam University Hospital, Daegu, Republic of Korea
| | - Kwang Soo Cha
- Pusan National University Hospital, Busan, Republic of Korea
| | - Seok Kyu Oh
- Wonkwang University Hospital, Iksan, Republic of Korea
| | - Jei Keon Chae
- Chonbuk National University Hospital, Jeonju, Republic of Korea
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Smit JWA, Romijn JA. Acute Insulin Resistance in Myocardial Ischemia: Causes and Consequences. Semin Cardiothorac Vasc Anesth 2016; 10:215-9. [PMID: 16959753 DOI: 10.1177/1089253206291153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Diabetes mellitus is associated with increased risk for cardiovascular mortality because of multiple pathophysiologic mechanisms. Acute stress-induced hyper-glycemia during acute myocardial infarction has gained much attention, as blood glucose levels seem to be an independent risk factor for acute myocardial infarction–related death. Clinical studies that identify stress-induced hyperglycemia as a risk factor are reviewed and its causes are discussed. They can be summarized as the consequence of acute insulin resistance, which in its turn is caused by stress hormones and by proinflammatory cytokines. Hyperglycemia causes the release of proinflammatory cytokines, the induction of reactive radicals, alterations in cardiovascular substrate metabolism, and propagation of coagulation and apoptosis. These all have harmful effects during and after acute myocardial infarction. Recommendations are for strict glycemic control in hyperglycemic patients with acute myocar-dial infarction, although the target glucose level is still a subject of debate.
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Affiliation(s)
- Johannes W A Smit
- Department of Endocrinology and Metabolic Diseasis, Leiden University Medical Center, RC Leiden, The Netherlands.
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29
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An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction. Sci Rep 2016; 6:27770. [PMID: 27291987 PMCID: PMC4904212 DOI: 10.1038/srep27770] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/24/2016] [Indexed: 02/07/2023] Open
Abstract
Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients' medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.
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30
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Khan I, Siddiqui AH, Singhal S, Aslam M, Perwez A, Faraz A. Glycaemic status in patients of acute myocardial infarction: A detailed analysis. Diabetes Metab Syndr 2016; 10:S140-S143. [PMID: 26701341 DOI: 10.1016/j.dsx.2015.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
AIMS Diabetes mellitus (DM) is considered to be one of the important risk factors for cardiac diseases. Frank diabetes is usually preceded by long term abnormality in glucose homeostasis which is called pre-diabetes. The hypothesis that diabetic patients have greater risk and worse prognosis of Acute Myocardial Infarction (AMI) than pre-diabetics is controversial. Considering that India has been declared as a diabetic capital of the world, the study aimed to assess the load of pre diabetics, diabetics and non-diabetics landing in myocardial infarction. MATERIALS AND METHODS The study consisted of through physiological and biochemical evaluation of 200 patients of newly diagnosed AMI and evaluating the load of non-diabetics, pre-diabetics and diabetics among them. RESULT It was found that the total non-diabetic population (normoglycaemic and pre-diabetic) formed the bulk of AMI patient (69%) in our study. The degree of biochemical alterations seen among the three groups suggests that abnormal glucose homeostasis is not the sole determinant of the severity of AMI. The study data also suggests that glycaemic status, which poses a risk for AMI, differs in male and female individuals. Males even with normal glucose level are at increased risk to develop MI. CONCLUSION The study concludes that both males and females with their blood glucose in pre-diabetic range are seen to be vulnerable to develop AMI. Thus all individuals irrespective of their glycaemic status around the age of forty should be screened and individuals with fasting sugar in pre-diabetic range should take extra precaution in terms of healthy diet, life style and regular check up.
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Affiliation(s)
- Imran Khan
- Department of Physiology, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University, Aligarh 202002, India.
| | - Anwar H Siddiqui
- Department of Physiology, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University, Aligarh 202002, India
| | - Sangeeta Singhal
- Department of Physiology, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University, Aligarh 202002, India
| | - Mohd Aslam
- Department of Physiology, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University, Aligarh 202002, India
| | - Anjum Perwez
- Department of Medicine, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University, Aligarh 202002, India
| | - Ahmad Faraz
- Department of Physiology, Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University, Aligarh 202002, India
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Benamer S, Eljazwi I, Mohamed R, Masoud H, Tuwati M, Elbarsha AM. Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes. Oman Med J 2015; 30:326-30. [PMID: 26421112 DOI: 10.5001/omj.2015.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Hyperglycemia on admission and during hospital stay is a well-established predictor of short-term and long-term mortality in patients with acute myocardial infarction. Our study investigated the impact of blood glucose levels on admission and in-hospital hyperglycemia on the morbidity and mortality of Libyan patients admitted with acute coronary syndromes (acute myocardial infarction and unstable angina). METHODS In this retrospective study, the records of patients admitted with acute coronary syndrome to The 7th Of October Hospital, Benghazi, Libya, between January 2011 and December 2011 were reviewed. The level of blood glucose on admission, and the average blood glucose during the hospital stay were recorded to determine their effects on in-hospital complications (e.g. cardiogenic shock, acute heart failure, arrhythmias, and/or heart block) and mortality. RESULTS During the study period, 121 patients with diabetes were admitted with acute coronary syndrome. The mortality rate in patients with diabetes and acute coronary syndrome was 12.4%. Patients with a mean glucose level greater than 200mg/dL had a higher in-hospital mortality and a higher rate of complications than those with a mean glucose level ≤200mg/dL (27.5% vs. 2.6%, p<0.001 and 19.7% vs. 45.5%, p=0.004, respectively). There was no difference in in-hospital mortality between patients with a glucose level at admission ≤140mg/dL and those admitted with a glucose level >140mg/dL (6.9% vs. 14.3%; p=0.295), but the rate of complications was higher in the latter group (13.8% vs. 34.1%; p=0.036). Patients with admission glucose levels >140mg/dL also had a higher rate of complications at presentation (26.4% vs. 6.9%; p=0.027). CONCLUSION In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with higher rate of complications particularly at the time of presentation.
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Affiliation(s)
- Sufyan Benamer
- Department of Medicine, University of Benghazi, Benghazi, Libya
| | - Imhemed Eljazwi
- Department of Medicine, University of Benghazi, Benghazi, Libya
| | - Rima Mohamed
- Department of Medicine, The 7th Of October Hospital, Benghazi, Libya
| | - Heba Masoud
- Department of Medicine, The 7th Of October Hospital, Benghazi, Libya
| | - Mussa Tuwati
- Department of Medicine, University of Benghazi, Benghazi, Libya
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Thiele RH, Hucklenbruch C, Ma JZ, Colquhoun D, Zuo Z, Nemergut EC, Raphael J. Admission hyperglycemia is associated with poor outcome after emergent coronary bypass grafting surgery. J Crit Care 2015; 30:1210-6. [PMID: 26428075 DOI: 10.1016/j.jcrc.2015.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Hyperglycemia during or after cardiac surgery is a common finding that is associated with poor outcome. Very few data, however, are available regarding a correlation between admission blood glucose and outcomes after coronary artery bypass grafting (CABG). Thus, the goal of the current study was to examine the relationship between admission blood glucose and outcome after emergency CABG surgery. MATERIALS AND METHODS A retrospective analysis to evaluate whether admission hyperglycemia associated with increased morbidity or mortality was performed in patients after emergency CABG surgery. The records of all the patients undergoing emergency CABG surgery between January 1999 and December 2010 at the University of Virginia Health System were reviewed. Postoperative in-hospital mortality and complications were considered as study end points. RESULTS A total of 240 patients met the final inclusion criteria. Overall mortality was 14.1%. The median admission blood glucose in patients who died 7.4 (interquartile range, 5.9-10.1) mmol/L was significantly higher compared with survivors 6.1 (interquartile range, 5.4-7.2; P<.01). Furthermore, 59% of the patients who died had admission blood glucose levels higher than 6.6 mmol/L, whereas only 35% of the patients who survived had similar blood glucose levels (P=.01). On multivariable analysis, admission blood glucose was identified as an independent risk factor for death after emergency CABG (P=.01; odds ratio, 1.16; 95% confidence interval, 1.04-1.29). Admission blood glucose was further identified as independently associated with increased risk for a composite outcome of death, postoperative renal failure or stroke (P=.01; odds ratio, 1.14; 95% confidence interval, 1.03-1.27). CONCLUSIONS Our study shows for the first time that admission blood glucose is correlated with increased morbidity and mortality among patients undergoing emergency CABG surgery.
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Affiliation(s)
- Robert H Thiele
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA
| | - Christoph Hucklenbruch
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA; Department of Anesthesiology, University of Muenster, Muenster, Germany
| | - Jennie Z Ma
- Department of Biostatistics and Epidemiology, University of Virginia Health System, Charlottesville, VA
| | - Douglas Colquhoun
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA
| | - Edward C Nemergut
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA
| | - Jacob Raphael
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
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Chen PC, Liao WI, Wang YC, Chang WC, Hsu CW, Chen YH, Tsai SH. An Elevated Glycemic Gap is Associated With Adverse Outcomes in Diabetic Patients With Community-Acquired Pneumonia. Medicine (Baltimore) 2015; 94:e1456. [PMID: 26313809 PMCID: PMC4602897 DOI: 10.1097/md.0000000000001456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Several studies argue against the association between admission hyperglycemia and adverse outcomes in infected diabetic patients. When investigating the association, it is necessary to consider preexisting hyperglycemia. The objective of this study was to assess whether stress-induced hyperglycemia, determined by the glycemic gap between admission glucose levels and A1c-derived average glucose levels adversely affects outcomes in diabetic patients admitted to hospital with community-acquired pneumonia (CAP).We retrospectively analyzed the glycemic gap and adverse outcomes of diabetic patients hospitalized because of CAP from June 1, 2007 to August 31, 2012 in single medical center in Taiwan.A total of 203 patients admitted with principal diagnosis of CAP and available data of glycemic gap.Patients with glycemic gaps ≥40 mg/dL had greater AUROC values for the development of adverse outcomes compared with acute hyperglycemia and long-term glycemic controls. Patients with an elevated glycemic gap had an odds ratio of 3.84 for the incidence of combined adverse outcomes. Incorporation of the glycemic gap into pneumonia severity index, CURB-65 or SMART-COP scores, increased the discriminative performance of predicting the development of adverse outcomes.Glycemic gaps were associated with adverse outcomes of diabetic CAP patients. The discriminative performance of the calculated glycemic gaps was comparable with those of current clinical scoring systems and may further increase the AUROC of each system.
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Affiliation(s)
- Po-Chuan Chen
- From the Department of Emergency Medicine (PCC, WIL, YHC, SHT); Department of Family Medicine (YCW); Department of Radiology, Tri-Service General Hospital, National Defense Medical Center (WCC); and Department of Emergency and Critical Care Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan (CWH)
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Angeli F, Reboldi G, Poltronieri C, Lazzari L, Sordi M, Garofoli M, Bartolini C, Verdecchia P. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications. Ther Adv Cardiovasc Dis 2015; 9:412-24. [PMID: 26194489 DOI: 10.1177/1753944715594528] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, Hospital S.M. della Misericordia, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - Ludovico Lazzari
- Department of Cardiology, University Hospital of Terni, Terni, Italy
| | - Martina Sordi
- Department of Cardiology, University Hospital of Terni, Terni, Italy
| | - Marta Garofoli
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | | | - Paolo Verdecchia
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
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Riyaz M, Imran I, Jaiswal RK, Ali A. A STUDY TO ESTABLISH ASSOCIAT ION OF HYPERGLYCEMIA AND INPATIENT MORTALITY IN PATIENTS WITH UNDIAGNOSED DIABETES MELLITUS. ACTA ACUST UNITED AC 2015. [DOI: 10.18410/jebmh/2015/483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ota S, Tanimoto T, Orii M, Hirata K, Shiono Y, Shimamura K, Matsuo Y, Yamano T, Ino Y, Kitabata H, Yamaguchi T, Kubo T, Tanaka A, Imanishi T, Akasaka T. Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction. J Cardiol 2014; 65:272-7. [PMID: 25533423 DOI: 10.1016/j.jjcc.2014.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Blood glucose level at admission in ST-segment elevation myocardial infarction (STEMI) is a predictor of heart failure and mortality. A previous study showed the association between hyperglycemia and microvascular dysfunction using myocardial contrast echocardiography. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) can demonstrate microvascular obstruction (MVO) as the area with hypointense core within LGE. This study was performed to investigate the association between hyperglycemia at admission and MVO using CMR in patients with STEMI. METHODS Ninety-three patients with first STEMI who were treated by percutaneous coronary intervention (PCI) were included. CMR was performed within 7 days after PCI. Venous blood was collected routinely immediately after admission for plasma glucose determination before intravenous injection of some medications. Samples were analyzed in the hospital's central laboratory. We performed LGE-CMR to assess the presence of MVO. RESULTS MVO was found in 34 (37%) of all 93 patients; their glucose level at admission was significantly higher than that of patients who did not exhibit MVO [204 (153-267)mg/dl vs. 157 (127-200)mg/dl, p=0.002]. There were no differences in glycosylated hemoglobin and incidence of diabetes mellitus between the two groups. A multivariable logistic regression analysis showed that glucose level at admission was an independent predictor of MVO (odds ratio, 1.014; 95% confidence interval, 1.004 to 1.023; p=0.006). The glucose level at admission 190mg/dl was the best threshold value for identifying MVO. The occurrence of MVO was significantly higher in the patients with glucose level at admission ≧190mg/dl compared with the patients with glucose level <190mg/dl [18 (53%) vs. 16 (27%), p=0.023]. CONCLUSIONS Hyperglycemia at admission in STEMI patients who were treated by PCI was associated with the presence of MVO assessed by LGE-CMR.
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Affiliation(s)
- Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tomoyuki Yamaguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Lindberg S, Jensen JS, Pedersen SH, Galatius S, Frystyk J, Flyvbjerg A, Bjerre M, Mogelvang R. Low adiponectin levels and increased risk of type 2 diabetes in patients with myocardial infarction. Diabetes Care 2014; 37:3003-8. [PMID: 25078899 DOI: 10.2337/dc14-0932] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with acute myocardial infarction (MI) have increased risk of developing type 2 diabetes mellitus (T2DM). Adiponectin is an insulin-sensitizing hormone produced in adipose tissue, directly suppressing hepatic gluconeogenesis, stimulating fatty acid oxidation and glucose uptake in skeletal muscle and insulin secretion. In healthy humans, low plasma adiponectin levels associate with increased risk of T2DM; however, the relationship between adiponectin and T2DM in patients with MI has never been investigated. RESEARCH DESIGN AND METHODS We prospectively included 666 patients with ST-segment elevation MI, without diabetes, treated with percutaneous coronary intervention, from September 2006 to December 2008 at a tertiary cardiac center. Blood samples were drawn before intervention, and total plasma adiponectin was measured in all samples. During follow-up (median 5.7 years [interquartile range 5.3-6.1]) 6% (n = 38) developed T2DM. Risk of T2DM was analyzed using a competing risk analysis. RESULTS Low adiponectin levels were associated with increased risk of T2DM (P < 0.001). Even after adjustment for confounding risk factors (age, sex, hypertension, hypercholesterolemia, current smoking, previous MI, BMI, blood glucose, total cholesterol, HDL, LDL, triglyceride, estimated glomerular filtration rate, C-reactive protein, peak troponin I, and proatrial natriuretic peptide), low adiponectin levels remained an independent predictor of T2DM (hazard ratio [HR] 5.8 [2.3-15.0]; P < 0.001). Importantly, plasma adiponectin added to the predictive value of blood glucose, with the combination of high blood glucose and low plasma adiponectin, vastly increasing the risk of developing T2DM (HR 9.6 [3.7-25.3]; P < 0.001). CONCLUSIONS Low plasma adiponectin levels are independently associated with increased risk of T2DM in patients with MI and added significantly to the predictive value of blood glucose.
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Affiliation(s)
- Søren Lindberg
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Jan S Jensen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sune H Pedersen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Jan Frystyk
- The Medical Research Laboratory, Department of Clinical Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Allan Flyvbjerg
- The Medical Research Laboratory, Department of Clinical Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Bjerre
- The Medical Research Laboratory, Department of Clinical Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
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Gardner LS, Nguyen-Pham S, Greenslade JH, Parsonage W, D'Emden M, Than M, Aldous S, Brown A, Cullen L. Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. Emerg Med J 2014; 32:608-12. [PMID: 25344576 DOI: 10.1136/emermed-2014-204046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/05/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aims to evaluate admission blood glucose level (BGL) in patients presenting to the emergency department (ED) as a risk factor for a major adverse cardiac event (MACE) on presentation and up to 30 days post discharge. Admission BGL is a prognostic indicator in patients with confirmed acute coronary syndrome (ACS). It is unclear if admission BGL improves the diagnosis and stratification of patients presenting to the ED with suspected ACS. METHODS This study is an analysis of data collected from a prospective observational study. The study population consisted of ED patients from Brisbane, Australia and Christchurch, New Zealand. Patients were enrolled between November 2007 and February 2011. Admission BGL was taken as part of routine admission blood with fasting status unknown. The primary end point for this study was a MACE at presentation and up to 30 days post discharge. Logistic regression analyses examined the relationship between admission hyperglycaemia and MACE. A hyperglycaemic threshold of 7 mmol/L was chosen based on WHO standards. RESULTS A total of 1708 patients were eligible. A MACE was identified in 336 patients (19.7%) within 30 days. Of these 98 had confirmed unstable angina and 232 had non-ST elevation myocardial infarction. Hyperglycaemia was identified in 476 (27.9%) patients with 147 (30.9%) having a MACE. Admission BGL >7 mmol/L was demonstrated as an independent predictor of a MACE (OR1.51 CI 1.06 to 2.14). Gender, age, hypertension, dyslipidaemia, family history, ischaemic ECG and positive troponin remained important factors. CONCLUSIONS Admission BGL is an independent risk factor for a MACE in patients with suspected ACS. Hyperglycaemia should be considered a risk factor for MACEs and consideration be given to its inclusion in existing diagnostic tools.
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Affiliation(s)
- Logan S Gardner
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia
| | - Sallyanne Nguyen-Pham
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia
| | - Jaimi H Greenslade
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - William Parsonage
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia
| | - Michael D'Emden
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia
| | - Martin Than
- Christchurch Hospital, Christchurch, New Zealand
| | - Sally Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - Anthony Brown
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia
| | - Louise Cullen
- Royal Brisbane and Women's Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia School of Public Health, Queensland University of Technology, Brisbane, Australia
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Konishi M, Akiyama E, Matsuzawa Y, Suzuki H, Maejima N, Iwahashi N, Tsukahara K, Hibi K, Kosuge M, Ebina T, Umemura S, Kimura K. Glucagon-like peptide-1 levels on admission for acute myocardial infarction with or without acute hyperglycemia. Int J Cardiol 2014; 176:1214-6. [PMID: 25125017 DOI: 10.1016/j.ijcard.2014.07.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 07/27/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States
| | - Hiroyuki Suzuki
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Tsukahara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
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Lee SA, Cho SJ, Jeong MH, Kim YJ, Kim CJ, Cho MC, Kim HS, Ahn Y, Koh G, Lee JM, Oh SK, Yun KH, Kim HY, Cho CG, Lee DH. Hypoglycemia at admission in patients with acute myocardial infarction predicts a higher 30-day mortality in patients with poorly controlled type 2 diabetes than in well-controlled patients. Diabetes Care 2014; 37:2366-73. [PMID: 24914243 DOI: 10.2337/dc13-2856] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to evaluate the association between hypoglycemia at admission and 30-day mortality in patients with acute myocardial infarction (AMI) and to determine whether these associations differed according to diabetes-control status in AMI patients with diabetes. RESEARCH DESIGN AND METHODS We analyzed the prognostic significance of hypoglycemia and hyperglycemia in 34,943 AMI patients with or without type 2 diabetes from two AMI registries: the Korea Acute Myocardial Infarction Registry (KAMIR) and the Korea Working Group on Myocardial Infarction (KorMI). RESULTS The patients were divided into five groups according to serum-glucose levels at admission: <3.9 mmol/L (<70 mg/dL); 3.9-7.72 mmol/L (70-139 mg/dL); 7.78-11.06 mmol/L (140-199 mg/dL); 11.11-14.39 mmol/L (200-259 mg/dL); and ≥14.44 mmol/L (≥260 mg/dL). The 30-day mortality rates in the lowest and highest glucose groups were higher than those in other groups; the lowest glucose group had the highest mortality for patients with type 2 diabetes, after adjusting for multiple factors. We also extracted and compared four subgroups from the patients with type 2 diabetes, based on hemoglobin A1c and serum-glucose levels at admission: group A, <6.5% (48 mmol/mol) and <3.9 mmol/L; group B, <6.5% (48 mmol/mol) and ≥11.11 mmol/L; group C, ≥8% (64 mmol/mol) and <3.9 mmol/L; and group D, ≥8% (64 mmol/mol) and ≥11.11 mmol/L. Group C had the highest 30-day mortality rate among the groups. CONCLUSIONS These data suggest that hypoglycemia at admission affects clinical outcomes differently in AMI patients with type 2 diabetes depending on the diabetes-control status.
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Affiliation(s)
- Sang Ah Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National School of Medicine, Jeju, Republic of Korea
| | - Suk Ju Cho
- Department of Anesthesiology, Jeju National University Hospital, Jeju National School of Medicine, Jeju, Republic of Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youngkeun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Gwanpyo Koh
- Department of Internal Medicine, Jeju National University Hospital, Jeju National School of Medicine, Jeju, Republic of Korea
| | - Jeong Mi Lee
- Department of Public Health, Wonkwang University, Iksan, Republic of Korea
| | - Seok Kyu Oh
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Kyeong Ho Yun
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Ha Young Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Chung Gu Cho
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Dae Ho Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
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Mapanga RF, Joseph D, Symington B, Garson KL, Kimar C, Kelly-Laubscher R, Essop M. Detrimental effects of acute hyperglycaemia on the rat heart. Acta Physiol (Oxf) 2014; 210:546-64. [PMID: 24286628 DOI: 10.1111/apha.12184] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/27/2013] [Accepted: 10/19/2013] [Indexed: 01/08/2023]
Abstract
AIM Hyperglycaemia is an important risk factor for acute myocardial infarction. It can lead to increased induction of non-oxidative glucose pathways (NOGPs) - polyol and hexosamine biosynthetic pathways, advanced glycation end products and protein kinase C - that may contribute to cardiovascular diseases onset. However, the precise underlying mechanisms remain poorly understood. Here we hypothesized that acute hyperglycaemia increases myocardial oxidative stress and NOGP activation resulting in cardiac dysfunction during ischaemia-reperfusion and that inhibition of, and/or shunting flux away from NOGPs [by benfotiamine (BFT) treatment], leads to cardioprotection. METHODS We employed several experimental systems: (i) Isolated rat hearts were perfused ex vivo with Krebs-Henseleit buffer containing 33 mm glucose vs. controls (11 mm glucose) ± global ischaemia and reperfusion ± BFT (first 20 min of reperfusion); (ii) Infarct size determination as per the ischaemic protocol, but with regional ischaemia and reperfusion ± BFT treatment; in separate experiments, NOGP inhibitors were also employed for (i) and (ii); and (iii) In vivo coronary ligations performed on streptozotocin-treated rats ± BFT treatment (early reperfusion). RESULTS Acute hyperglycaemia generated myocardial oxidative stress, NOGP activation and apoptosis, but caused no impairment of cardiac function during pre-ischaemia, thereby priming hearts for later damage. Following ischaemia-reperfusion (under hyperglycaemic conditions), such effects were exacerbated together with cardiac contractile dysfunction. Moreover, inhibition of respective NOGPs and shunting away by BFT treatment (in part) improved cardiac function during ischaemia-reperfusion. CONCLUSION Coordinate NOGP activation in response to acute hyperglycaemia results in contractile dysfunction during ischaemia-reperfusion, allowing for the development of novel cardioprotective agents.
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Affiliation(s)
- R. F. Mapanga
- Cardio-Metabolic Research Group (CMRG); Department of Physiological Sciences; Stellenbosch University; Stellenbosch South Africa
| | - D. Joseph
- Cardio-Metabolic Research Group (CMRG); Department of Physiological Sciences; Stellenbosch University; Stellenbosch South Africa
| | - B. Symington
- Cardio-Metabolic Research Group (CMRG); Department of Physiological Sciences; Stellenbosch University; Stellenbosch South Africa
| | - K.-L. Garson
- Cardio-Metabolic Research Group (CMRG); Department of Physiological Sciences; Stellenbosch University; Stellenbosch South Africa
| | - C. Kimar
- Cardio-Metabolic Research Group (CMRG); Department of Physiological Sciences; Stellenbosch University; Stellenbosch South Africa
| | - R. Kelly-Laubscher
- Department of Human Biology; Faculty of Health Sciences; University of Cape Town; Observatory South Africa
| | - M.Faadiel Essop
- Cardio-Metabolic Research Group (CMRG); Department of Physiological Sciences; Stellenbosch University; Stellenbosch South Africa
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Shore S, Borgerding JA, Gylys-Colwell I, McDermott K, Ho PM, Tillquist MN, Lowy E, McGuire DK, Stolker JM, Arnold SV, Kosiborod M, Maddox TM. Association between hyperglycemia at admission during hospitalization for acute myocardial infarction and subsequent diabetes: insights from the veterans administration cardiac care follow-up clinical study. Diabetes Care 2014; 37:409-18. [PMID: 24089537 DOI: 10.2337/dc13-1125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Among patients with acute myocardial infarction (AMI) without known diabetes, hyperglycemia at admission is common and associated with worse outcomes. It may represent developing diabetes, but this association is unclear. Therefore, we examined the association between hyperglycemia (≥140 mg/dL) at admission and evidence of diabetes among patients with AMI without known diabetes within 6 months of their hospitalization. RESEARCH DESIGN AND METHODS We studied a national cohort of consecutive patients with AMI without known diabetes presenting at 127 Veterans Affairs hospitals between October 2005 and March 2011. Evidence of diabetes either at discharge or in the following 6 months was ascertained using diagnostic codes, medication prescriptions, and/or elevated hemoglobin A1c. Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling. RESULTS Among 10,499 patients with AMI without known diabetes, 98% were men and 1,761 (16.8%) had hyperglycemia at admission. Within 6 months following their index hospitalization, 208 patients (11.8%) with hyperglycemia at admission had evidence of diabetes compared with 443 patients (5.1%) without hyperglycemia at admission (P < 0.001). After multivariable adjustment, hyperglycemia at admission was significantly associated with subsequent diabetes odds ratio 2.56 (95% CI 2.15-3.06). Among those with new evidence of diabetes, 41% patients (267 of 651) had a hemoglobin A1c ≥6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes. CONCLUSIONS Hyperglycemia at admission occurred in one of six patients with AMI without known diabetes and was significantly associated with new evidence of diabetes in the 6 months following hospitalization. In addition, two of five patients with evidence of diabetes were potentially unrecognized. Accordingly, diabetes-screening programs for hyperglycemic patients with AMI may be an important component of optimal care.
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43
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Luo G, Liu H, Luo S, Li F, Su M, Lu H. Fasting hyperglycemia increases in-hospital mortality risk in nondiabetic female patients with acute myocardial infarction: a retrospective study. Int J Endocrinol 2014; 2014:745093. [PMID: 25132854 PMCID: PMC4123565 DOI: 10.1155/2014/745093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 02/06/2023] Open
Abstract
Previous studies had shown that elevated admission plasma glucose (APG) could increase mortality rate and serious complications of acute myocardial infarction (AMI), but whether fasting plasma glucose (FPG) had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic (n = 87) and nondiabetic group (n = 166). Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyceride, higher rates of painless AMI (P < 0.01), non-ST-segment elevation myocardial infarction (NSTEMI), and reinfraction (P < 0.05). They also had lower high density lipoprotein cholesterol and rate of malignant arrhythmia, but in-hospital mortality rate did not differ significantly (P > 0.05). While nondiabetic patients were subgrouped in terms of APG and FPG (cut points were 11.1 mmol/L and 7.0 mmol/L, resp.), the mortality rate had significant difference (P < 0.01), whereas glucose level lost significance in diabetic group. Multivariate logistic regression analysis showed that FPG (OR: 2.014; 95% confidence interval: 1.296-3.131; p < 0.01) but not APG was independent predictor of in-hospital mortality for nondiabetic patients. These results indicate that FPG can be an independent predictor for mortality in nondiabetic female patients with AMI.
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Affiliation(s)
- Guojing Luo
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hong Liu
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Shunkui Luo
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Fang Li
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Minhong Su
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hongyun Lu
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
- *Hongyun Lu:
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Usami M, Sakata Y, Nakatani D, Suna S, Matsumoto S, Hara M, Kitamura T, Ueda Y, Iwakura K, Sato H, Hamasaki T, Nanto S, Hori M, Komuro I. Clinical impact of acute hyperglycemia on development of diabetes mellitus in non-diabetic patients with acute myocardial infarction. J Cardiol 2013; 63:274-80. [PMID: 24145196 DOI: 10.1016/j.jjcc.2013.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 08/11/2013] [Accepted: 08/20/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute hyperglycemia (AH) after the onset of acute myocardial infarction (AMI) is a manifestation of transient abnormal glucose metabolism that may reflect AMI severity, and thus be a predictor of poor prognosis. However, it remains unknown whether AH may predict development of de novo diabetes mellitus (dn-DM) in non-diabetic AMI patients. METHODS AND RESULTS Among AMI patients registered in the Osaka Acute Coronary Insufficiency Study between 1998 and 2007, we investigated hospital records of 1493 patients who had an admission glycated hemoglobin A1c (HbA1c) level of ≤6.0% and were subjected to glycometabolic profiling after survival discharge. dn-DM was defined as initiation of diabetic medication or documentation of an HbA1c level of ≥6.5% during the 5-year follow-up period. AH, defined as an admission serum glucose level of ≥200mg/dl, was observed in 133 (8.9%) patients. dn-DM development was more frequent in post-AMI patients with AH than those without [24.8% vs 12.0%, adjusted hazard ratio (HR) 1.776, p=0.021], particularly among patients with an HbA1c of <5.6% on admission. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a reduced incidence of dn-DM in patients with AH (adjusted HR 0.397, p=0.031). CONCLUSION Admission AH was a predictor of dn-DM in non-diabetic post-AMI patients. Renin-angiotensin system inhibitors were associated with reduced incidence of dn-DM in post-AMI patients with AH.
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Affiliation(s)
- Masaya Usami
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan; Department of Evidence-based Cardiovascular Medicine and Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Sen Matsumoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Hara
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasunori Ueda
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Katsuomi Iwakura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Hiroshi Sato
- School of Human Welfare Studies Health Care Center and Clinic, Kwansei Gakuin University, Nishinomiya, Japan
| | - Toshimitsu Hamasaki
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masatsugu Hori
- Osaka Prefectural Hospital Organization Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Shi Z, Tang S, Chen Y, Yang J, Jiang B, Liu X, Zhou X, Pan X, Yang J, Wu J, Hu H, Ji B, Lin X, Chen S, Zhang J. Prevalence of stress hyperglycemia among hepatopancreatobiliary postoperative patients. Int J Clin Exp Med 2013; 6:799-803. [PMID: 24179574 PMCID: PMC3798216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of stress hyperglycemia and its association with mortality among hepatopancreatobiliary postoperative patients admitted. METHODS Retrospectively analysis was made on 706 cases of the hepatopancreatobiliary postoperative patients from three Grade A hospitals in Hunan province from November 2011 to June 2012, including the incidence and risk factors of patients with stress hyperglycemia. RESULTS The incidence of stress hyperglycemia of pancreatic postoperative patients was 34.28%. The incidence of pancreatic surgery, simple cholecystectomy and biliary tract and liver surgery in patients with stress hyperglycemia was 63.08%, 20.83% and 32.21%, respectively. Stress hyperglycemia was associated with the first postoperative glucose values, duration of surgery, whether the anemia and the presence or absence of hypoproteinemia (P<0.05), but was no related with sex, weight and previous history (P>0.05). CONCLUSION Stress hyperglycemia is common among emergency admissions and these patients have significantly higher mortality rate compared to other patients (P=0.001). Postoperative first blood glucose levels, duration of surgery, whether the anemia and the presence or absence of hypoproteinemia were stress hyperglycemia risk factors for patients.
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Affiliation(s)
- Zeya Shi
- School of Nursing Central South UniversityChangsha 410013, China
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Siyuan Tang
- School of Nursing Central South UniversityChangsha 410013, China
| | - Yuxiang Chen
- Biomedical Engineering Institute Central South UniversityChangsha 410008, China
| | - Jinxu Yang
- Luohe Medical CollegeLuohe, Henan 462002, China
| | - Bo Jiang
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Xiaoming Liu
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Xu Zhou
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Xiaoji Pan
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Juan Yang
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Jinshu Wu
- People’s Hospital of Hunan ProvinceChangsha 410005, China
| | - Hongjuan Hu
- School of Nursing Central South UniversityChangsha 410013, China
| | - Binbin Ji
- School of Nursing Central South UniversityChangsha 410013, China
| | - Xiaolin Lin
- School of Nursing Central South UniversityChangsha 410013, China
| | - Sanmei Chen
- School of Nursing Central South UniversityChangsha 410013, China
| | - Juan Zhang
- People’s Hospital of Hunan ProvinceChangsha 410005, China
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Tang S, Buriro R, Liu Z, Zhang M, Ali I, Adam A, Hartung J, Bao E. Localization and expression of Hsp27 and αB-crystallin in rat primary myocardial cells during heat stress in vitro. PLoS One 2013; 8:e69066. [PMID: 23894407 PMCID: PMC3716771 DOI: 10.1371/journal.pone.0069066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
Abstract
Neonatal rat primary myocardial cells were subjected to heat stress in vitro, as a model for investigating the distribution and expression of Hsp27 and αB-crystallin. After exposure to heat stress at 42°C for different durations, the activities of enzymes expressed during cell damage increased in the supernatant of the heat-stressed myocardial cells from 10 min, and the pathological lesions were characterized by karyopyknosis and acute degeneration. Thus, cell damage was induced at the onset of heat stress. Immunofluorescence analysis showed stronger positive signals for both Hsp27 and αB-crystallin from 10 min to 240 min of exposure compared to the control cells. According to the Western blotting results, during the 480 min of heat stress, no significant variation was found in Hsp27 and αB-crystallin expression; however, significant differences were found in the induction of their corresponding mRNAs. The expression of these small heat shock proteins (sHsps) was probably delayed or overtaxed due to the rapid consumption of sHsps in myocardial cells at the onset of heat stress. Our findings indicate that Hsp27 and αB-crystallin do play a role in the response of cardiac cells to heat stress, but the details of their function remain to be investigated.
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Affiliation(s)
- Shu Tang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Rehana Buriro
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Zhijun Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Miao Zhang
- College of Animal Science and Technology, Jinling Institute of Technology, Nanjing, China
| | - Islam Ali
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Abdelnasir Adam
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Jörg Hartung
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Endong Bao
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
- * E-mail:
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Horáková L, Strosova MK, Spickett CM, Blaskovic D. Impairment of calcium ATPases by high glucose and potential pharmacological protection. Free Radic Res 2013; 47 Suppl 1:81-92. [PMID: 23710650 DOI: 10.3109/10715762.2013.807923] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The review deals with impairment of Ca(2+)-ATPases by high glucose or its derivatives in vitro, as well as in human diabetes and experimental animal models. Acute increases in glucose level strongly correlate with oxidative stress. Dysfunction of Ca(2+)-ATPases in diabetic and in some cases even in nondiabetic conditions may result in nitration of and in irreversible modification of cysteine-674. Nonenyzmatic protein glycation might lead to alteration of Ca(2+)-ATPase structure and function contributing to Ca(2+) imbalance and thus may be involved in development of chronic complications of diabetes. The susceptibility to glycation is probably due to the relatively high percentage of lysine and arginine residues at the ATP binding and phosphorylation domains. Reversible glycation may develop into irreversible modifications (advanced glycation end products, AGEs). Sites of SERCA AGEs are depicted in this review. Finally, several mechanisms of prevention of Ca(2+)-pump glycation, and their advantages and disadvantages are discussed.
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Affiliation(s)
- L Horáková
- Institute of Experimental Pharmacology and Toxicology, SAS, Bratislava, Slovakia.
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Lazzeri C, Valente S, Chiostri M, Attanà P, Picariello C, Gensini GF. The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia. Acta Diabetol 2013; 50:293-300. [PMID: 21984048 DOI: 10.1007/s00592-011-0325-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/31/2011] [Indexed: 01/27/2023]
Abstract
In the setting of acute myocardial infarction, hyperglycemia and acute insulin resistance may represent a stress response to myocardial injury mainly related to acute catecholamine release. By measuring glucose values and insulin resistance (Homeostatic Model Assessment index-HOMA), we evaluated in 356 non-diabetic patients with ST-elevation myocardial infarction (STEMI) undergone mechanical revascularization: (a) the acute glycometabolic response by evaluating insulin resistance, glucose levels, and their combination and (b) whether insulin resistance and increased glucose values (and their combination) are able to affect in-Intensive Cardiac Care Unit (ICCU) mortality and complications. In the overall population, 226 (63.5%) patients showed glucose values ≤140 mg/dl (group B), while 130 patients had glucose values >140 mg/dl (group A) (36.5%). Within group B, insulin resistance (as inferred by positive HOMA index) was present in 125 patients (55.3%), whereas 101 patients (44.7%) exhibited normal values of HOMA index. Within group A, 109 patients (83.8%) were insulin resistant, while 21 patients (16.2%) had normal values of HOMA index. At multivariable analysis, glucose values were independently associated with in-ICCU mortality (OR: 7.387; 95% CI 2.701-20.201; P < 0.001) and complications (OR: 1.786; 95% CI 1.089-2.928; P = 0.022). In the early phase of STEMI, the acute glycometabolic response to stress is heterogeneous (ranging from no insulin resistance to glucose levels >140 mg/dl and, finally, to the combination of increased glucose values and insulin resistance). Increased glucose values are stronger prognostic factors since they are independently associated with in-ICCU mortality and complications.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit, Department of Heart and Vessel, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
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Liao WI, Sheu WHH, Chang WC, Hsu CW, Chen YL, Tsai SH. An elevated gap between admission and A1C-derived average glucose levels is associated with adverse outcomes in diabetic patients with pyogenic liver abscess. PLoS One 2013; 8:e64476. [PMID: 23724053 PMCID: PMC3665809 DOI: 10.1371/journal.pone.0064476] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/14/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To assess whether chronic glycemic control and stress-induced hyperglycemia, determined by the gap between admission glucose levels and A1C-derived average glucose (ADAG) levels adversely affects outcomes in diabetic patients with pyogenic liver abscess (PLA). METHODS Clinical, laboratory, and multi-detector computed tomography (MDCT) findings of 329 PLA patients (2004-2010) were retrospectively reviewed. HbA1C levels were used to determine long-term glycemic control status, which were then converted to estimated average glucose values. For the gap between admission glucose levels and ADAG levels, we used receiver operating characteristic (ROC) curve to determine the optimal cut-off values predicting adverse outcomes. Univariate and multivariate logistic regressions were used to identify predictors of adverse outcomes. RESULTS Diabetic PLA patients with poorer glycemic control had significantly higher Klebsiella pneumoniae (KP) infection rates, lower albumin levels, and longer hospital stays than those with suboptimal and good glycemic control. The ROC curve showed that a glycemic gap of 72 mg/dL was the optimal cut-off value for predicting adverse outcomes and showed a 22.3% relative increase in adverse outcomes compared with a glycemic gap<72 mg/dL. Multivariate analysis revealed that an elevated glycemic gap≥72 mg/dL was important predictor of adverse outcomes. CONCLUSIONS A glycemic gap≥72 mg/dL, rather than admission hyperglycemia or chronic glycemic control, was significantly correlated with adverse outcomes in diabetic PLA patients. Poorer chronic glycemic control in diabetic PLA patients is associated with high incidence of KP infection, hypoalbuminemia and longer hospital stay.
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Affiliation(s)
- Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency and Critical Care Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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50
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Matsushita M, Shirakabe A, Hata N, Shinada T, Kobayashi N, Tomita K, Tsurumi M, Shimura T, Okazaki H, Yamamoto Y, Yokoyama S, Asai K, Mizuno K. Association between the visiting time and the clinical findings on admission in patients with acute heart failure. J Cardiol 2013; 61:210-5. [DOI: 10.1016/j.jjcc.2012.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 09/25/2012] [Accepted: 10/22/2012] [Indexed: 01/09/2023]
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