Abstract 15338: Glycemic Variability Determined by a Continuous Glucose Monitoring System Predicts the Extent of the Peri-Infarct Zone and Left Ventricular Remodeling in Patients With a First-Time ST-Segment Elevation Myocardial Infarction.: Cardiac MRI study
Background: Glycemic Variability (GV) may play an important role in development of cardiovascular disease, however the clinical significance of GV is not fully understood in patients with ST-segment elevation AMI (STEMI). We explored the clinical utility of GV using cardiac MRI (CMR).
Methods: We explored the clinical utility of measuring GV using a Continuous Glucose Monitoring System (CGMS) in patients with a first STEMI reperfused within 12 hours after the onset. Consecutive 58 patient (50 males; age=64±12 years; LAD=29, RCA=23, LCX=6; peak-CPK=2,962±2,545U/l) were included. STEMI was defined when their peak-CPK level were more than twice the upper limit of normal to evaluate infarct size using CMR. All patients were fitted with a CGMS immediately after admission and GV was assessed by measuring the Mean Amplitude of Glycemic Excursion (MAGE) during 24 hours with first 3 regular meals. CMR including late gadolinium enhancement (LGE) was performed at 9±3 days and 6 months using a 1.5T Avanto (SIEMENS) repeatedly. In addition to measuring infarct size by LGE, the Peri-Infarct Zone (PIZ), which is a predictor of remodeling and mortality, was measured using Q-Mass MR ver 7.5 (Medis) (Figure below). LV remodeling was considered present when LV end diastolic volume (EDV) increased 20% from baseline.
Results: The results are shown in the Table. By univariate analysis, MAGE and HbA1c level were associated with the extent of PIZ. Therefore, MAGE showed a significant relationship with PIZ in addition to the other glycemic parameters. CMR at 6 months were performed in 29 patients repeatedly. Seven patients experienced LV remodeling and higher PIZ predicted LV remodeling at 6 months (P<0.01, Figure below). Our results thus suggest that a higher MAGE is associated with a greater risk of LV remodeling.
Conclusions: GV was an important predictor of the extent of PIZ, which in turn predicted LV remodeling at 6 months. Assessment of GV using CGMS may thus be useful in the management of STEMI.
- © 2013 by American Heart Association, Inc.