Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Left Ventricular Remodeling in
Masaomi Gohbara1, Noriaki Iwahashi, Shunsuke Kataoka
1Division of Cardiology, Yokohama City University Medical Center.
Insights
High glycemic variability (GV) after ST-segment elevation myocardial infarction (STEMI) predicts left ventricular remodeling (LVR). Early GV assessment using mean amplitude of glycemic excursions (MAGE) identifies at-risk patients for long-term cardiac changes.
Area of Science:
- Cardiology
- Endocrinology
- Medical Technology
Background:
- Impaired glucose metabolism is significant in acute myocardial infarction.
- The role of glycemic variability (GV) post-ST-segment elevation myocardial infarction (STEMI) requires further clarification.
Purpose of the Study:
- To investigate the clinical impact of early GV on left ventricular remodeling (LVR) in STEMI patients.
- To determine if GV predicts long-term cardiac changes after myocardial infarction.
Main Methods:
- Prospective study of 69 STEMI patients within 12 hours of onset.
- Continuous glucose monitoring system (CGMS) used to assess GV (MAGE).
- Cardiac magnetic resonance imaging (CMR) assessed LVR at baseline and 7 months.
Main Results:
- Higher MAGE (upper tertile) was associated with significantly more frequent LVR (56% vs. 11%, P<0.001).
- Higher MAGE was an independent predictor of chronic LVR (OR 13.999, P=0.001).
Conclusions:
- Mean amplitude of glycemic excursions (MAGE) early after STEMI identifies patients who develop LVR.
- GV assessment may aid in predicting long-term cardiac remodeling post-STEMI.
Background:
Impaired glucose metabolism plays an important role in patients with acute myocardial infarction, but the clinical significance of glycemic variability (GV) early after the onset of ST-segment elevation myocardial infarction (STEMI) remains to be fully elucidated.
Methods And Results:
We prospectively investigated the clinical impact of GV, as determined by a continuous glucose monitoring system (CGMS), on left ventricular remodeling (LVR) assessed by cardiac magnetic resonance imaging (CMR) in 69 patients (63±13 years, 59 men) with a first reperfused STEMI within 12 h of onset. All patients were equipped with a CGMS when in a stable phase after admission and underwent repeat CMR at baseline and 7 months follow-up. Patients were divided into 2 groups according to the mean amplitude of glycemic excursions (MAGE). Patients in the upper tertile of MAGE were categorized as group High (H) and the other two-thirds as group Low (L). LVR was defined as an absolute increase in left ventricular end-diastolic volume index of ≥20%. LVR more frequently occurred in group H than in group L (56% vs. 11%, P<0.001). Multivariate analysis showed the higher MAGE group was an independent predictor of LVR in the chronic phase (odds ratio, 13.999; 95% confidence interval, 3.059 to 64.056; P=0.001).
Conclusions:
MAGE early after the onset of STEMI identified patients with LVR in the chronic phase.
