Cardiovascular Intervention and Therapeutics
Impact of glycemic variability on myocardial infarct size in patients
with ST‑segment elevation myocardial infarction: quantitative
assessment of left ventricular wall motion severity
· Kota Nishida
· Satoshi Soda
· Takumi Akiyama
· Takahiro Hakamata
· Koji Sudo
· Yukio Hosaka
· Kazuyoshi Takahashi
· Hirotaka Oda
Received: 29 January 2018 / Accepted: 24 May 2018
© Japanese Association of Cardiovascular Intervention and Therapeutics 2018
Glycemic variability (GV) is relevant to impaired myocardial salvage in acute ST-elevation myocardial infarction (STEMI).
Severity of hypokinesis at the infarct site as assessed from contrast left ventriculography can reportedly predict infarct size
in STEMI. We prospectively studied 58 consecutive patients (mean age, 63 ± 11 years) with anterior or inferior STEMI who
underwent successful reperfusion therapy. Mean amplitude of glucose excursion (MAGE) was obtained from continuous glu-
cose monitoring system. Patients were divided into the upper tertile of MAGE as Group H, and the other two-thirds as Group
L. Serial regional wall motion severity at the infarct site was computed postprocedure and at follow-up using a quantitative left
ventricular analysis system. Impaired myocardial salvage was deﬁned as severity recovery ratio < 20%. Signiﬁcantly shorter
onset-to-balloon time (196.9 vs. 279.0 min, p = 0.033) and relatively lower postprocedural wall motion severity (2.4 vs. 2.9,
p = 0.096) were observed in Group H, but absolute severity recovery was signiﬁcantly smaller in Group H (0.5 vs. 1.3, p = 0.017).
Multivariate analysis showed higher MAGE as predictive of impaired myocardial salvage (OR, 406.10; 95% CI, 4.41–37,366.60;
p = 0.009). Recovery of reginal wall motion severity at the infarct site was compromised in STEMI patients with higher MAGE.
Our results suggest that ﬁnal infarct size is potentially larger than expected in STEMI patients with higher GV.
Keywords Glucose ﬂuctuation · Myocardial infarction · Left ventricular wall motion
Glycemic variability (GV), another component of glycemic
disorder, has received growing interest as a novel aggravat-
ing factor for cardiovascular disease. GV has been noticed
to represent a negative prognostic factor for patients with
acute ST-elevation myocardial infarction (STEMI) . Pri-
mary percutaneous coronary intervention (PCI) is the most
commonly adopted treatment strategy for STEMI and has
contributed to improving survival . However, coronary
blood restoration can raise the issue termed reperfusion
injury, which leads to unfavorable myocardial salvage and
is potentially associated with adverse clinical outcomes .
To date, the mechanisms underlying reperfusion injury are
not fully understood. A preclinical study has demonstrated
that GV aggravates susceptibility to ischemia/reperfusion
injury . Furthermore, acute-phase GV in STEMI patients
is associated with impairment of myocardial salvage and sub-
sequent infarct size after successful reperfusion therapy .
In a previous report, we showed the relationship between
GV and electrocardiographic ST-segment resolution which
is well known as a surrogate marker of reperfusion injury .
Several techniques have been employed to quantify the
myocardium at risk or infarct size in STEMI, including radi-
onuclear myocardial perfusion imaging  and magnetic
resonance imaging . Contrast left ventriculography (LVG)
analysis for assessing regional wall motion abnormalities
has been traditionally used to determine the myocardium at
risk in daily practice. The wall motion severity at the site of
infarction derived from LVG analysis correlates well with
infarct size estimated from creatinine kinesis release  or
myocardial perfusion imaging .
* Keiichi Tsuchida
Department of Cardiology, Niigata City General Hospital,
Shumoku 463-7, Chuo-ku, Niigata 950-1197, Japan
Department of Endocrinology and Metabolism, Niigata City
General Hospital, Niigata, Japan