The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction

Abstract

Background Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling. Methods We recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively. Results In the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p = 0.007). Conclusions In the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.

Association of stress hyperglycemia ratio and poor long-term prognosis in patients with myocardial infarction with non-obstructive coronary arteries

“…We also found a significant correlation between SHR and NT-proBNP, cTnT, and LVEF, which may contribute to an increased risk of MACE to some extent. Several clinical studies have confirmed such results among MI patients, which reported that SHR had a significant correlation with myocardial injury as shown by high peak cTnT and peak CK-MB values and their association with the severity of CAD (assessed by the Gensini score and Syntax score) [10,35,38]. On the other hand, we found that inflammatory marker such as CRP was higher among the high SHR group, which may also be associated with some unfavorable outcomes.…”

“…The prospective, nationwide, multi-center China AMI registry results demonstrated a significant positive correlation between SHR and long-term death in patients with AMI [ 34 ]. Numerous clinical studies have also indicated a link between SHR and unfavorable outcomes in AMI patients [ 21 , 22 , 35 , 36 ]. Pasquale et al also found that SHR significantly increases the risk of rehospitalization among 2,874 patients with ischemia with non-obstructive coronary arteries [ 37 ].…”

3-year mortality after acute myocardial infarction in patients with different diabetic status

“…[33] In Lamblin's study [33], DM was an independent predictor of cardiovascular death or rehospitalization for HF during 1-year follow up. Since stress hyperglycemia presents as an independent predictor for adverse left ventricular remodelling, Shuai et al [34] suggest this non-invasive parameter may be used to estimate its risk.…”

The Glycemic Ratio Is Strongly and Independently Associated With Mortality in the Critically Ill

“…Malglycemia (the collective of absolute hypoglycemia, relative hypoglycemia, and hyperglycemia) is driven by both increases and decreases from preadmission glycemia across the admission. 13,14,22,[24][25][26][27][28][29][30][31] Compared with a single point at admission, a metric assessing malglycemia across the entire admission may provide superior insight into the nature of malglycemia. In recognition of the bidirectional nature of malglycemia over the course of an entire admission, we use the term Glycemic Ratio (GR).…”

“…Anemia may affect HbA1c and it is unknown whether this significantly affects the prognostic ability of SHR. 35 The association of elevated SHR with mortality has been previously investigated in both the critical care setting 23 and other clinical settings, 22,[24][25][26][27][28][29][30][31] and consistently displays superior prognostic insight compared with BG. However, this does not address the association of glucose control across the entirety of the ICU admission with mortality.…”