Document Detail

Tight glycemic control reduces heart inflammation and remodeling during acute myocardial infarction in hyperglycemic patients.
MedLine Citation:
PMID:  19371826     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We analyzed the molecular mechanisms evoked by tight glycemic control during post-infarction remodeling in human hearts. BACKGROUND: The molecular mechanisms by which tight glycemic control improves heart remodeling during acute myocardial infarction (AMI) are still largely unknown. METHODS: Eighty-eight patients with first AMI undergoing coronary bypass surgery were studied: 38 normoglycemic patients served as the control group; hyperglycemic patients (glucose >or=140 mg/dl) were randomized to intensive glycemic control (IGC) (n = 25; glucose 80 to 140 mg/dl) or conventional glycemic control (CGC) (n = 25; glucose 180 to 200 mg/dl) for almost 3 days before surgery, with insulin infusion followed by subcutaneous insulin treatment. Echocardiographic parameters were investigated at admission and after treatment period. During surgery, oxidative stress (nitrotyrosine, superoxide anion [O(2)(-)] production, inducible nitric oxide synthase [iNOS]), inflammation (nuclear factor kappa B [NFkappaB], tumor necrosis factor [TNF]-alpha, and apoptosis (caspase-3) were analyzed in biopsy specimens taken from the peri-infarcted area. RESULTS: Compared with normoglycemic patients, hyperglycemic patients had higher myocardial performance index (MPI) (p < 0.05), reduced ejection fraction (p < 0.05), more nitrotyrosine, iNOS, and O(2)(-) production, more macrophages, T-lymphocytes, and HLA-DR (Dako, Milan, Italy) cells, and more NFkappaB-activity, TNF-alpha, and caspase-3 levels (p < 0.01) in peri-infarcted specimens. After the treatment period, plasma glucose reduction was greater in the IGC than in the CGC group (p < 0.001). Compared with IGC patients, CGC patients had higher MPI (p < 0.02), had lower ejection fraction (p < 0.05), and had more markers of oxidative stress, more inflammation and apoptosis (p < 0.01) in peri-infarcted specimens. CONCLUSIONS: Tight glycemic control, by reducing oxidative stress and inflammation, might reduce apoptosis in peri-infarcted areas and remodeling in AMI patients.
Raffaele Marfella; Clara Di Filippo; Michele Portoghese; Franca Ferraraccio; Maria Rosaria Rizzo; Mario Siniscalchi; Emilio Musacchio; Michele D'Amico; Francesco Rossi; Giuseppe Paolisso
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  53     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-17     Completed Date:  2009-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1425-36     Citation Subset:  AIM; IM    
Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy.
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MeSH Terms
Blood Glucose*
Coronary Artery Bypass
Hyperglycemia / blood*
Middle Aged
Myocardial Infarction / blood*,  physiopathology*,  surgery
Oxidative Stress
Ventricular Remodeling*
Reg. No./Substance:
0/Blood Glucose
Comment In:
J Am Coll Cardiol. 2009 Apr 21;53(16):1437-9   [PMID:  19371827 ]

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