Backgrounds:
Insulin resistance (IR) has been reported to be associated with worse prognosis in patients with coronary artery disease. However, the role of IR in patients with acute myocardial infarction(AMI) remains unclear. Therefore, we explored the impact of IR on left ventricular remodeling (LVR) after ST elevation AMI (STEMI) without overt DM.
Methods:
One hundred seventy patients with a first-time ST elevation AMI (STEMI) who underwent reperfusion within 12 hours were enrolled in this study. Patients had no history of diabetes mellitus prior to their first STEMI. We examined echocardiography results 24 hours after PCI and 12 months later. We measured global longitudinal strain using 3D speckle tracking echocardiography (4D LV Analysis, TOMTEC, Germany). We calculated 3D global longitudinal strain(3D-GLS) as the parameter of accurate systolic function free from tethering effect. Infarct size was defined using Tc99m-sestamibi as the area of <50% uptake at 2 weeks. We checked HOMA-R at 2 weeks. The absolute difference of the LV end-diastolic volume (ΔLVEDV) after 12 months was calculated as a parameter of LVR. We excluded the patients with CKD (eGFR <30ml/min/1.73m2) and the high fasting glucose level (>140mg/dl).
Results:
Infarct size (r2=0.30, p=0.03) and HOMA-R (r2=0.50, p=0.018) had a good association with ΔLVEDV. There was a significant relationship between HOMA-R andΔLVEDV (r2=0.096, p=0.0007). Multiple regression analysis showed that HOMA-R was the strongest predictor of ΔLVEDV, followed by 3D-GLS (Table).
Conclusions:
Insulin resistance was the strongest predictor for the degree of LV remodeling in patients with a first STEM without overt DM.
Global longitudinal strain value for predicting left ventricular remodeling after primary percutaneous reperfusion therapy in acute myocardial infarction
