Association of dysglycaemia with persistent infarct core iron in patients with acute ST-segment elevation myocardial
Ivan Lechner1, Martin Reindl1, Fritz Oberhollenzer1
1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Insights
Ongoing dysglycaemia, indicated by elevated HbA1c, is linked to persistent infarct core iron after myocardial infarction. This suggests dysglycaemia may hinder iron resolution, impacting heart tissue recovery.
Area of Science:
- Cardiology
- Metabolic Disorders
- Medical Imaging
Background:
- Dysglycaemia elevates risks for myocardial infarction and recurrent cardiovascular events.
- The impact of dysglycaemia on ischemia/reperfusion injury and myocardial tissue damage is not fully understood.
- Investigating dysglycaemia's role in infarct core iron persistence is crucial for understanding long-term outcomes.
Purpose of the Study:
- To investigate the association between ongoing dysglycaemia and the persistence of infarct core iron.
- To analyze longitudinal changes in infarct core iron over time in ST-segment elevation myocardial infarction (STEMI) patients.
- To explore the relationship between glycated hemoglobin (HbA1c) levels and infarct core iron resolution post-primary percutaneous coronary intervention (PCI).
Main Methods:
- Analysis of 348 STEMI patients undergoing primary PCI, enrolled in the MARINA-STEMI study.
- Collection of peripheral venous blood for glucose and HbA1c measurements at admission and 4 months post-STEMI.
- Cardiac magnetic resonance (CMR) imaging with T2* mapping for infarct core iron assessment at both time points, analyzed using multivariable regression.
Main Results:
- Intramyocardial hemorrhage was present in 42% of patients at baseline.
- Persistent infarct core iron was observed in 61% of these patients at 4 months, increasing with HbA1c levels.
- Ongoing dysglycaemia (HbA1c at 4 months) was independently associated with persistent infarct core iron (OR: 7.87; p < 0.001), even in non-diabetic patients.
Conclusions:
- Ongoing dysglycaemia, defined by HbA1c, is independently linked to persistent infarct core iron in STEMI patients treated with primary PCI.
- Dysglycaemia is associated with a reduced likelihood of infarct core iron resolution.
- Further research into the therapeutic implications of this association is warranted.
Background:
Dysglycaemia increases the risk of myocardial infarction and subsequent recurrent cardiovascular events. However, the role of dysglycaemia in ischemia/reperfusion injury with development of irreversible myocardial tissue alterations remains poorly understood. In this study we aimed to investigate the association of ongoing dysglycaemia with persistence of infarct core iron and their longitudinal changes over time in patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).
Methods:
We analyzed 348 STEMI patients treated with primary PCI between 2016 and 2021 that were included in the prospective MARINA-STEMI study (NCT04113356). Peripheral venous blood samples for glucose and glycated hemoglobin (HbA1c) measurements were drawn on admission and 4 months after STEMI. Cardiac magnetic resonance (CMR) imaging including T2 * mapping for infarct core iron assessment was performed at both time points. Associations of dysglycaemia with persistent infarct core iron and iron resolution at 4 months were calculated using multivariable regression analysis.
Results:
Intramyocardial hemorrhage was observed in 147 (42%) patients at baseline. Of these, 89 (61%) had persistent infarct core iron 4 months after infarction with increasing rates across HbA1c levels (<5.7%: 33%, ≥5.7: 79%). Persistent infarct core iron was independently associated with ongoing dysglycaemia defined by HbA1c at 4 months (OR: 7.87 [95% CI: 2.60-23.78]; p < 0.001), after adjustment for patient characteristics and CMR parameters. The independent association was present even after exclusion of patients with diabetes (pre- and newly diagnosed, n = 16).
Conclusions:
In STEMI patients treated with primary PCI, ongoing dysglycaemia defined by HbA1c is independently associated with persistent infarct core iron and a lower likelihood of iron resolution. These findings suggest a potential association between ongoing dysglycaemia and persistent infarct core iron, which warrants further investigation for therapeutic implications.
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