Effects of Stress Hyperglycemia on Acute Myocardial Infarction

Effects of Stress Hyperglycemia on Acute Myocardial Infarction Role of inflammatory immune process in functional cardiac outcome Raffaele Marfella , MD, PHD 1 2 , Mario Siniscalchi , MD, PHD 1 , Katherine Esposito , MD 1 2 , Ausilia Sellitto , MD 1 , Umberto de Fanis , MD 1 , Ciro Romano , MD, PHD 1 , Michele Portoghese , MD 3 , Silvio Siciliano , MD 4 , Francesco Nappo , MD, PHD 1 , Ferdinando Carlo Sasso , MD, PHD 1 , Nicola Mininni , MD 4 , Federico Cacciapuoti , MD 1 , Giacomo Lucivero , MD, PHD 1 , Riccardo Giunta , MD 1 , Mario Verza , MD 1 and Dario Giugliano , MD, PHD 1 2 1 Department of Geriatric and Metabolic Diseases, Second University of Naples, Naples, Italy 2 Cardiovascular Research Center, Second University of Naples, Naples, Italy 3 Cardiac Surgery of “Monteverigine” Mercogliano Avellino, Italy 4 Cardiology Department of Hospital V. Monaldi Naples, Naples, Italy 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 l