Plasma Glucose at Hospital Admission and Previous Metabolic Control Determine Myocardial Infarct Size and Survival in Patients With and Without Type 2 Diabetes: The Langendreer Myocardial Infarction and Blood Glucose in Diabetic Patients Assessment (LAMBDA)

Obesity is associated with metabolic syndrome and increased incidence of and mortality from myocardial infarction. The aim of the present study was to develop an animal model with metabolic syndrome and examine how that influences size of myocardial infarcts induced by occlusion and reperfusion of the left anterior descending coronary artery. Sprague–Dawley rats (n=105) were fed either LF (low-fat) or MHF (moderately high-fat) diets for 13 weeks before coronary occlusion for 45 min, followed by reperfusion for 60 min. Compared with LF-fed and lean MHF-fed rats, obese MHF-fed rats developed metabolic disturbances similar to those seen in the metabolic syndrome, including being overweight by 24% (compared with lean MHF-fed rats), having 74% more visceral fat (compared with LF-fed rats), 15% higher blood pressure (compared with LF-fed rats), 116% higher plasma insulin (compared with lean MHF-fed rats), 10% higher fasting plasma glucose (compared with LF-fed rats), 35% higher non-fasting plasma glucose (compared with lean MHF-fed rats), 36% higher plasma leptin (compared with lean MHF-fed rats) and a tendency to lower plasma adiponectin and higher plasma non-esterified fatty acids. Infarct size was similar in the three groups of rats (36±14, 42±18 and 41±14% in obese MHF-fed, lean MHF-fed and LF-fed rats respectively). In conclusion, rats fed a MHF diet developed metabolic syndrome, but this did not influence myocardial infarct size.

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Chronic Metformin Treatment is Associated with Reduced Myocardial Infarct Size in Diabetic Patients with ST-segment Elevation Myocardial Infarction

Cardiovascular Drugs and Therapy ◽

10.1007/s10557-013-6504-7 ◽

2013 ◽

Vol 28 (2) ◽

pp. 163-171 ◽

Cited By ~ 33

Author(s):

Chris P. H. Lexis ◽

Wouter G. Wieringa ◽

Bart Hiemstra ◽

Vincent M. van Deursen ◽

Erik Lipsic ◽

...

Keyword(s):

Myocardial Infarction ◽

Infarct Size ◽

Myocardial Infarct ◽

Diabetic Patients ◽

Myocardial Infarct Size ◽

Metformin Treatment ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Comparison of two sulfonylureas with high and low myocardial KATP channel affinity on myocardial infarct size and metabolism in a rat model of type 2 diabetes

Diabetologia ◽

10.1007/s00125-010-1970-y ◽

2010 ◽

Vol 54 (2) ◽

pp. 451-458 ◽

Cited By ~ 20

Author(s):

S. B. Kristiansen ◽

B. Løfgren ◽

J. M. Nielsen ◽

N. B. Støttrup ◽

E. S. Buhl ◽

...

Keyword(s):

Type 2 Diabetes ◽

Infarct Size ◽

Rat Model ◽

Katp Channel ◽

Myocardial Infarct ◽

Myocardial Infarct Size

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IGF-1 is not related to long-term outcome in hyperglycemic acute coronary syndrome patients

Diabetes and Vascular Disease Research ◽

10.1177/14791641211047436 ◽

2021 ◽

Vol 18 (6) ◽

pp. 147916412110474

Author(s):

Cindya P Iswandi ◽

Victor J van den Berg ◽

Suat Simsek ◽

Daan van Velzen ◽

Edwin Ten Boekel ◽

...

Keyword(s):

Type 2 Diabetes ◽

Acute Coronary Syndrome ◽

Infarct Size ◽

Myocardial Infarct ◽

Myocardial Infarct Size ◽

Coronary Syndrome ◽

The Relationship

Purpose Insulin-like growth factor-1 (IGF-1) has been associated with both protective and detrimental effects on the development of ischemic heart disease. The relationship between IGF-1 levels and major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients remains unclear. This study aimed to investigate the relationship between IGF-1 admission levels in hyperglycemic ACS patients and: (1) MACE over a 5 years follow-up, (2) type 2 diabetes at discharge, and (3) post-ACS myocardial infarct size and dysfunction. Methods This was a post hoc analysis of the BIOMArCS-2 randomized controlled trial. From July 2008 to February 2012, 276 ACS patients with admission plasma glucose level between 140 and 288 mg/dL were included. Records of the composite of all-cause mortality and recurrent non-fatal myocardial infarction were obtained during 5 years follow-up. Venous blood samples were collected on admission. IGF-1 was measured batchwise after study completion. Oral glucose tolerance test was performed to diagnose type 2 diabetes, whereas infarct size and left ventricular function were assessed by myocardial perfusion scintigraphy (MPS) imaging, 6 weeks post-ACS. Results Cumulative incidence of MACE was 24% at 5 years follow-up. IGF-1 was not independently associated with MACE (HR:1.00 (95%CI:0.99–1.00), p = 0.29). Seventy-eight patients (28%) had type 2 diabetes at discharge, and the highest quartile of IGF-1 levels was associated with the lowest incidence of diabetes (HR:0.40 (95%CI:0.17–0.95), p = 0.037). IGF-1 levels were not associated with post-ACS myocardial infarct size and dysfunction. Conclusions IGF-1 carries potential for predicting type 2 diabetes, rather than long-term cardiovascular outcomes and post-ACS myocardial infarct size and dysfunction, in hyperglycemic ACS patients.

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Vitamin E reduces myocardial infarct size in type 2 diabetes

The FASEB Journal ◽

10.1096/fasebj.20.5.a1153-c ◽

2006 ◽

Vol 20 (5) ◽

Author(s):

Grace Frances Davis‐Gorman ◽

Raoul Gonzales ◽

Zoe Cohen ◽

Paul F. McDonagh

Keyword(s):

Type 2 Diabetes ◽

Vitamin E ◽

Infarct Size ◽

Myocardial Infarct ◽

Myocardial Infarct Size

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Effects of glucagon-like peptide 1 analogs in combination with insulin on myocardial infarct size in rats with type 2 diabetes mellitus

World Journal of Diabetes ◽

10.4239/wjd.v9.i9.149 ◽

2018 ◽

Vol 9 (9) ◽

pp. 149-156 ◽

Cited By ~ 3

Author(s):

Vladislav A Zykov ◽

Taisiia P Tuchina ◽

Denis A Lebedev ◽

Irina B Krylova ◽

Alina Y Babenko ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Infarct Size ◽

Myocardial Infarct ◽

Myocardial Infarct Size ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

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Acute hyperglycemia abolishes ischemic preconditioning in vivo

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.275.2.h721 ◽

1998 ◽

Vol 275 (2) ◽

pp. H721-H725 ◽

Cited By ~ 51

Author(s):

Judy R. Kersten ◽

Todd J. Schmeling ◽

Karl G. Orth ◽

Paul S. Pagel ◽

David C. Warltier

Keyword(s):

Myocardial Infarction ◽

Infarct Size ◽

Ischemic Preconditioning ◽

Plasma Glucose ◽

Myocardial Infarct ◽

Coronary Artery Occlusion ◽

Myocardial Infarct Size ◽

Area At Risk ◽

Acute Hyperglycemia

Ischemic preconditioning provides a powerful means to reduce myocardial infarct size in vivo and has been proposed to limit the extent of myocardial infarction in patients. In contrast, hyperglycemia correlates with increases in mortality after acute myocardial infarction. Thus we hypothesized that acute hyperglycemia alters the protection afforded by ischemic preconditioning, and this hypothesis was tested in acutely instrumented dogs subjected to a prolonged (60 min) coronary artery occlusion and 3 h of reperfusion. Ischemic preconditioning was elicited by four 5-min occlusion-reperfusion periods in the presence or absence of an intravenous infusion of 15% dextrose in water to produce acute hyperglycemia (plasma glucose concentration of 300 mg/dl). The dose-dependent effects of hyperglycemia on myocardial infarct size independent of preconditioning stimuli were further evaluated in dogs subjected to increases in plasma glucose concentrations to either 300 or 600 mg/dl. Infarct size (triphenyltetrazolium staining) was 24 ± 2% of the area at risk in control dogs and was significantly ( P < 0.05) decreased by ischemic preconditioning (8 ± 1%). Modest degrees of hyperglycemia (300 mg/dl) had no effect on infarct size (34 ± 4%) but abolished the protective effect of ischemic preconditioning (30 ± 5%). In contrast, profound hyperglycemia (600 mg/dl) increased infarct size (44 ± 6%). Hemodynamics and coronary collateral blood flow (radioactive microspheres) were similar between groups. Thus acute hyperglycemia adversely modulates myocardial injury in response to ischemia in vivo.

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Risk stratification score for acute myocardial infarction and sudden cardiac death in type 2 diabetes mellitus

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.459 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

S Lee ◽

J Zhou ◽

CL Guo ◽

WKK Wu ◽

WT Wong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cardiac Death ◽

Adverse Outcomes ◽

Risk Scores ◽

Diabetic Patients ◽

Type 2 Diabetic

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are major cardiovascular adverse outcomes in patients with type 2 diabetic mellitus. Although there are many risk scores on composite outcomes of major cardiovascular adverse outcomes or cardiovascular mortality for diabetic patients, these existing scores did not account for the difference in pathogenesis and prognosis between acute coronary syndrome and lethal ventricular arrhythmias. Furthermore, recent studies reported that HbA1c and lipid levels, which were often accounted for in these risk scores, have J/U-shaped relationships with adverse outcomes. Purpose The present study aims to evaluate the application of incorporating non-linear J/U-shaped relationships between mean HbA1c and cholesterol levels into risk scores for predicting for AMI and non-AMI related SCD respectively, amongst type 2 diabetes mellitus patients. Methods This was a territory-wide cohort study of patients with type 2 diabetes mellitus above the age 40 and free from prior AMI and SCD, with or without prescriptions of anti-diabetic agents between January 1st, 2009 to December 31st, 2009 at government-funded hospitals and clinics in Hong Kong. Risk scores were developed for predicting incident AMI and non-AMI related SCD. The performance of conditional inference survival forest (CISF) model compared to that of random survival forests (RSF) model and multivariate Cox model. Results This study included 261308 patients (age = 66.0 ± 11.8 years old, male = 47.6%, follow-up duration = 3552 ± 1201 days, diabetes duration = 4.77 ± 2.29 years). Mean HbA1c and high-density lipoprotein-cholesterol (HDL-C) were significant predictors of AMI under multivariate Cox regression and were linearly associated with AMI. Mean HbA1c and total cholesterol were significant multivariate predictors with a J-shaped relationship with non-AMI related SCD. The AMI and SCD risk scores had an area-under-the-curve (AUC) of 0.666 (95% confidence interval (CI)= [0.662, 0.669]) and 0.677 (95% CI= [0.673, 0.682]), respectively. CISF significantly improves prediction performance of both outcomes compared to RSF and multivariate Cox models. Conclusions A holistic combination of demographic, clinical, and laboratory indices can be used for the risk stratification of type 2 diabetic patients against AMI and SCD.

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