Effects of Stress Hyperglycemia on Acute Myocardial Infarction

Role of inflammatory immune process in functional cardiac outcome

  1. Raffaele Marfella, MD, PHD12,
  2. Mario Siniscalchi, MD, PHD1,
  3. Katherine Esposito, MD12,
  4. Ausilia Sellitto, MD1,
  5. Umberto de Fanis, MD1,
  6. Ciro Romano, MD, PHD1,
  7. Michele Portoghese, MD3,
  8. Silvio Siciliano, MD4,
  9. Francesco Nappo, MD, PHD1,
  10. Ferdinando Carlo Sasso, MD, PHD1,
  11. Nicola Mininni, MD4,
  12. Federico Cacciapuoti, MD1,
  13. Giacomo Lucivero, MD, PHD1,
  14. Riccardo Giunta, MD1,
  15. Mario Verza, MD1 and
  16. Dario Giugliano, MD, PHD12
  1. 1Department of Geriatric and Metabolic Diseases, Second University of Naples, Naples, Italy
  2. 2Cardiovascular Research Center, Second University of Naples, Naples, Italy
  3. 3Cardiac Surgery of “Monteverigine” Mercogliano Avellino, Italy
  4. 4Cardiology Department of Hospital V. Monaldi Naples, Naples, Italy
  1. Address correspondence and reprint requests to Raffaele Marfella, MD, Via Emilio Scaglione, 141, 80145 Napoli, Italy. E-mail: raffaele.marfella{at}unina2.it

Abstract

OBJECTIVE—Stress hyperglycemia has been associated with increased mortality in patients with myocardial infarction (MI). We examined the association between plasma glucose levels, circulating inflammatory markers, T-cell activation, and functional cardiac outcome in patients with first MI.

RESEARCH DESIGN AND METHODS—Echocardiographic parameters, circulating levels of interleukin-18 (IL-18), C-reactive protein (CPR), and the percent of CD16-CD56, CD4/CD8, CD152, and HLA-DR expression were investigated in 108 patients with acute MI on admission to the emergency ward.

RESULTS—Our review found that 31 new hyperglycemic patients (glycemia ≥7 mmol/l) had higher infarct segment length (P < 0.05) and myocardial performance index (P < 0.02) and reduced transmitral Doppler flow (P < 0.05), pulmonary flow analysis (P < 0.02), and ejection fraction (P < 0.05) compared with 36 hyperglycemic diabetic patients and 41 normoglycemic patients. Plasma IL-18 and CRP were higher in the hyperglycemic than in the normoglycemic patients (P < 0.005), with the highest values in patients with new hyperglycemia (P < 0.05). Hyperglycemic patients had a higher percent of CD16+/CD56+ cells and CD4/CD8 ratio (P < 0.01), whereas they had lower CD152 expression (which has a negative regulatory function in T-cell activation) compared with normoglycemic patients (P < 0.001).

CONCLUSIONS—During MI, hyperglycemia is associated with increased levels of inflammatory markers, enhanced expression of cytotoxic T-cells, and reduced expression of T-cells, which are implicated in limiting the immune process. An increased inflammatory immune process seems a likely mechanism linking acute hyperglycemia to poor cardiac outcome in MI patients.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted July 30, 2003.
    • Received May 20, 2003.
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  1. doi: 10.2337/diacare.26.11.3129 Diabetes Care November 2003 vol. 26 no. 11 3129-3135
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