| Abstract | Introduction: Microvascular dysfunction and glucometabolic dysregulation are associated with poor prognosis after acute myocardial infarction. It has been reported that adiponectin modulates vascular homeostasis and protects against cardiometabolic disorders. Hypoadiponectinemia is associated with left ventricular remodeling and poor clinical outcome. This study aimed to investigate the association of adiponectin and HbA1C with major adverse cardiac events in non-diabetic patients who survived ST-elevation myocardial infarction. -----
Methods: The study enrolled prospectively 73 non-diabetic patients who experienced STEMI infarction. We measured the level of adiponectin and HbA1C in all patients. The subjects were divided into two groups: 37 patients with elevated HbA1C and 36 patients with normal levels of HbA1C. Cardiac structure and function were assessed using two-dimensional transthoracic echocardiography.
In a one-year follow-up, the study subjects were observed for major adverse cardiac events (MACE). -----
Results: Adiponectin correlated inversely with HbA1C in all study subjects (p < 0.001). Mean adiponectin levels were significantly lower in Group 1 than in Group 2 (p = 0.004). Serum values of HDL were also significantly lower in patients with elevated HbA1C than in Group 2 (p = 0.004). In our study patients we found a negative correlation between adiponectin and body mass index (p < 0.01). Left ventricular remodeling was diagnosed in 36 (49.3%) patients with higher frequency in Group 1 than in Group 2, specifically concentric left ventricular remodeling (21.6% vs. 11.1%) and concentric left ventricular hypertrophy (10.8 vs. 5.6%). The correlation between adiponectin and LVEdD (p = 0.422) and between HbA1C and LVEdD (p = 0.375) was not statistically significant. During follow up, the frequency of MACE in patients with elevated HbA1C was significantly higher (p = 0.048).
----- Conclusion: Adiponectin correlated inversely with HbA1C and BMI and was associated with major adverse cardiac events after STEMI. The frequency of left ventricular remodeling especially concentric remodeling was higher in patients with HbA1C >6%. However, the correlation of adiponectin and HbA1C with LVEdD was not statistically significant. The patients with a HbA1C level between 5.7 and 6.5% were at a particularly high risk and might be considered for prevention interventions. |
| Abstract (croatian) | Uvod: Poremećaji mikrovaskularne funkcije i glukometaboličke regulacije povezani su s lošom prognozom nakon akutnog infarkta miokarda. Uočeno je da adiponektin modulira vaskularnu homeostazu i štiti od srčanih metaboličkih poremećaja. Hipoadiponektinemija je povezana s remodeliranjem lijeve klijetke i lošim kliničkim ishodom. Cilj ovog istraživanja bio je proučiti povezanost razine adiponektina i HbA1C s velikim neželjenim kardijalnim događajima (MACE) u bolesnika bez šećerne bolesti nakon infarkta miokarda s elevacijom ST-spojnice (STEMI). -----
Metode: U istraživanje su bila uključena 73 pacijenta bez šećerne bolesti nakon infarkta miokarda s elevacijom ST-spojnice. Svim bolesnicima mjerene su razine adiponektina i HbA1C. Ispitanici su bili podijeljeni u dvije skupine: 37 bolesnika s povišenom razinom HbA1C i 36 bolesnika s normalnim vrijednostima HbA1C. Srčana struktura i funkcija bile su procijenjene korištenjem dvodimenzionalne transtorakalne ekokardiografije. Tijekom godine dana praćenja bolesnika nakon akutnog infarkta miokarda ustanovljeni su veliki neželjeni kardijalni događaji. -----
Rezultati: Uočena je obrnuta povezanost razine adiponektina s HbA1C kod svih ispitanika (p < 0,001). Prosječne vrijednosti adiponektina bile su značajno niže u skupini 1 u odnosu na skupinu 2 (p = 0,004). Vrijednosti HDL-a u serumu također su bile značajno niže kod ispitanika s povišenim HbA1C (p = 0,004) u odnosu na skupinu 2. Uočena je negativna povezanost između razine adiponektina i indeksa tjelesne mase (p < 0,01). Remodeliranje lijeve klijetke dijagnosticirano je kod 36 (49,3%) bolesnika s višim frekvencijama u skupini 1 nego u skupini 2; konkretno, koncentrično remodeliranje lijeve klijetke (21,6% vs. 11,1%) i koncentrična hipertrofija lijeve klijetke (10,8 vs. 5,6%). Povezanost razine adiponektina i LVEdD (p = 0,422) te HbA1C i LVEdD (p = 0,375) nije bila statistički značajna. Tijekom godinu dana praćenja, učestalost velikih neželjenih kardijalnih događaja bila je značajno veća u bolesnika s povišenom razinom HbA1C (p= 0,048). -----
Zaključak: Ovo je istraživanje pokazalo da je razina adiponektina u obrnutoj korelaciji s HbA1C i indeksom tjelesne mase, te povezana s velikim neželjenim kardijalnim događajima nakon infarkta miokarda s elevacijom ST-spojnice. Učestalost remodeliranja lijeve klijetke, osobito koncentričnog remodeliranja, bila je viša kod bolesnika s razinom HbA1C >6%. Međutim, povezanost razine adiponektina i HbA1C s LVEdD nije bila statističi značajna. Bolesnici s razinom HbA1C između 5,7 i 6,5% bili su izrazito rizična skupina te je za takve pacijente potrebno uzeti u obzir preventivne mjere. |
