Impact of stress hyperglycemia on myocardial salvage in patients with ST-Elevation myocardial infarction: Cardiac magnetic resonance study

Meshref, Taghreed S.; Aal, Refaat Fathi Abd El; Ashry, Mahmoud; Imam, Hisham; Elden, Ahmad B.

doi:10.1016/j.ihj.2020.08.011

“…Neuroendocrine disorders can also lead to insulin resistance in the body [10][11][12]. Hematoma compression can lead to hypothalamuspituitary-adrenal axis injury and reduce the biological uptake and utilization of glucose in peripheral tissues [13,14]. In contrast, hyperglycemic state can affect brain tissue energy metabolism, leading to acidosis due to lactic acid accumulation and can induce oxidative stress, which aggravates neuronal cell damage and is detrimental to the prognosis of patients with cerebral hemorrhage [15,16].…”

Section: Discussionmentioning

confidence: 99%

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage

Sun

¹

,

Sun

²

,

Su

³

2022

Computational and Mathematical Methods in Medicine

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Background. Cerebral hemorrhage, also known as hemorrhagic stroke, is a common clinical cerebrovascular disease, accounting for about 10%-30% of stroke, with high morbidity and mortality. Objective. To observe the effect of optimal management of hyperglycemia and intensive nursing on blood glucose control level and complications in patients with postoperative cerebral hemorrhage. Methods. One hundred and eight patients with postoperative cerebral hemorrhage comorbid with stress hyperglycemia admitted to our neurosurgery department from February 2019 to February 2022 were selected and divided into a general group of 54 cases and an optimized group of 54 cases by simple random method. The general group was managed with conventional care, while the optimized group developed optimized management of hyperglycemia for intensive care. The indexes related to blood glucose control, electrolytes, National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI) scores, and time to achieve blood glucose standard, insulin pumping time, patient satisfaction, and prognosis were compared between the two groups. Results. Before intervention, there was no statistical significance in the comparison of blood glucose control-related indicators and electrolytes between the two groups ( P > 0.05 ). After 7 d and 14 d of intervention, the fasting blood glucose and 2 h postprandial blood glucose in the two groups were lower than before, while K+ and Na+ were higher than before ( P < 0.05 ). The blood glucose indexes at the same time point in the optimized group were found to be lower than those in the general group by statistical analysis, but electrolytes were not statistically significant when compared with the general group ( P > 0.05 ). In the optimized group, the time to achieve blood glucose standard ( 6.59 ± 1.94 ) d and insulin pumping time ( 7.14 ± 1.89 ) d were shorter than those in the general group [( 7.48 ± 2.12 ) d and ( 8.58 ± 2.14 ) d], insulin dosage ( 748.85 ± 63.61 ) U was less than that in the general group ( 923.54 ± 84.14 ) U, and the incidence of hypoglycemia (3.70%) was lower than that in the general group (16.67%), and the satisfaction rate (92.59%) was higher than that of the general group (77.78%), which was statistically significant ( P < 0.05 ). Before intervention, there was no significant difference in NIHSS score and BI score between the two groups ( P > 0.05 ). After 7 d and 14 d of intervention, the NIHSS scores of the two groups were lower than before, while the BI scores were higher than before, and the NIHSS scores of the optimized group at the same time point were all lower than those of the general group, and the BI scores were higher than those of the general group ( P < 0.05 ). The incidence of pulmonary infection (11.11%) and rebleeding (7.41%) in the optimized group were lower than those in the general group (25.93% and 22.22%), while deep vein thrombosis, multiple organ dysfunction syndrome (MODS), and death within 28 d was not statistically significant when compared with the general group ( P > 0.05 ). Conclusion. Optimal management of hyperglycemia and intensive nursing can effectively control the blood sugar level of patients after cerebral hemorrhage, reducing insulin dosage, and the occurrence of hypoglycemia, pulmonary infection, and rebleeding.

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“…The proportion of patients with diabetes in the two groups was statistically different. Hyperglycemia is strongly associated with a poor prognosis after reperfusion treatment in STEMI patients [31,32] . This may be, in part, due to the general in ammation that characterizes diabetes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of myocardial salvage obtained by gated SPECT myocardial perfusion imaging using scoring evaluation method early after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction

Li

¹

,

Dou

²

,

Yao

³

et al. 2022

Preprint

1

0

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Purpose Myocardial salvage (MS) and myocardial salvage index(MSI) assessed by Gated SPECT myocardial perfusion imaging (GSMPI) have demonstrated prognostic significance in ST-segment-elevation myocardial infarction(STEMI). However, this method requires GSMPI after tracer injection before percutaneous coronary intervention(PCI), so make it limited in clinical practice. This study aims to obtain the MSI by simple GSMPI early after primary PCI (PPCI) in STEMI , evaluate the predictive significance of MSI in efficacy of PCI and major adverse cardiovascular events (MACEs). Apply the scoring evaluation method innovatively different from the previous method, and confirm the former’s advantage. Methods 62 patients with STEMI, who underwent GSMPI after PPCI. MS and MSI were obtained by scoring and the number evaluation method,respectively. Left ventricular ejection fraction (LVEF) before discharge and 6 months after PCI were estimated by cardiac ultrasound.Patients whose LVEF increased by at least 20% compared to baseline were defined as PCI-effective group. Compare the MS ,MSI and their prognostic significancein PCI efficacy between the two evaluation methods. Patients were divided into two groups according to the median MSI(0.27), over a median follow-up period of 270(128-366) days, estimate the prognostic significance of MSI on MACEs. Results The MS and MSI were relevant [ r(MS)=0.491, r(MSI)=0.779, P< .05], but significant different by the two methods (P < .01). MSI by the scoring method showed the stronger prognostic value in PCI efficacy with AUC of 0.793, sensitivity: 71.40%, specificity: 73.70% than the number method with AUC of 0.634, sensitivity: 43.80%, specificity: 94.40% (all P<.05). COX prevalence of MACEs was significantly higher in the <median MSI group than≥median MSI [HR 0.20; 95% ci, 0.04–1.10; P <0.05].ROC analysis showed that MSI predict MACEs with an area under the curve (AUC) of 0.870, sensitivity: 73.70%, specificity: 87.50%(P<0.01).There was a obvious linear correlation trend between MSI and LVEF before discharge by Jonckheere-Terpstra test( P< .05). Conclusion MSI obtained from an simple GSMPI after re-perfusion on scoring evaluation method is a reliable prognostic indicator which provides feasible way to predict the PPCI efficacy and MACEs in STEMI patients.

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“…Free radicals aggravate oxidation, produce a large number of lipid peroxides in the blood and adhere to the vessel wall, making the blood vessel cavity thinner, the pipe wall rough, the elasticity weaker and the blood vessel brittle, thus increasing the incidence of cardiovascular events. It is found that the level of blood glucose is positively correlated with the size of myocardial infarction area [8]. The higher the blood glucose level is, the higher the infarct size is.…”

Section: Damage To Heartmentioning

confidence: 93%

Perioperative Glycemic Control for Patients Undergoing Coronary Artery Bypass Grafting

Luo¹,

Wang²,

Xie³

et al. 2022

Coronary Artery Bypass Grafting

0

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Coronary artery bypass grafting (CABG), as a gold standard treatment for coronary artery disease, has been widely adopted all around the world. Meanwhile, it’s also well known that diabetes is an independent risk factor for postoperative mortality. However, hyperglycemia often occurs perioperatively, regardless of whether the patient has diabetes or not. Perioperative stress hyperglycemia is harmful to patients undergoing cardiac surgery and has a clear correlation with increased inflammatory response, and clinical adverse events, especially for patients with diabetes. Thus, proper perioperative blood glycemic control can reduce the short-term and long-term mortality and the incidence of complications in patients undergoing CABG.

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Impact of stress hyperglycemia on myocardial salvage in patients with ST-Elevation myocardial infarction: Cardiac magnetic resonance study

Cited by 4 publications

References 12 publications

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage

Prognostic significance of myocardial salvage obtained by gated SPECT myocardial perfusion imaging using scoring evaluation method early after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction

Perioperative Glycemic Control for Patients Undergoing Coronary Artery Bypass Grafting

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