Abstract 14725: Prognostic Value of Myocardial Infarction Detected by Late Gadolinium Enhanced MRI in Patients with High-normal Fasting Blood Glucose in Non-diabetic Range
Background: Although diabetes is a well-known risk factor of cardiovascular disease (CVD), the CVD risk of glycemia below the current diabetic threshold remains uncertain. We tested the hypothesis that characterization of myocardial infarction (MI) by late gadolinium enhanced (LGE) MRI can provide prognostic value for major adverse cardiac events (MACE) in patients with impaired fating glucose (IFG).
Methods: Medical records of consecutive 1007 patients who underwent LGE MRI from 2000 to 2008 were reviewed regardless of whether the patients had coronary artery disease. Based on fasting glucose level, study group is composed of 202 patients with IFG, defined as fasting glucose level of 100–125 mg/dL (68±10 years, 68% male). Control group is consisted of 182 diabetic patients requiring oral glucose lowering agents or insulin treatment (66±10 years, 75% male). The presence and extent of LGE (% volume of LGE compared with total LV myocardium) were determined. MACE were defined as cardiac death, acute MI, unstable angina, congestive heart failure, stroke, and significant ventricular arrhythmias.
Results: LGE MRI revealed MI in 44% (88/202) of the study patients with mean LGE extent of 14.3±11.6% (range 0.4 to 44.9%). At median follow-up of 37 months, 14% (28/202) experienced MACE (1 cardiac death, 3 acute MI, 15 unstable angina, 7 heart failure, 2 stroke). Cox regression analysis revealed that the presence of LGE was associated with a > 3-fold hazard increase for MACE (HR, 3.209; p=0.008). And LGE was the strongest multivariable predictor of MACE by stepwise selection in the study patients (adjusted HR, 2.588, p=0.044). IFG patients with LGE had significantly lower MACE-free survival rate compared to those without LGE (p=0.005, long rank test), but comparable with that of diabetes (p=0.182).
Conclusions: Characterization of MI by LGE-MRI is useful for risk stratification in patients with IFG. IFG patients with LGE had a cardiac event rate that was similar to that of diabetics.
- © 2010 by American Heart Association, Inc.