Background: Insulin resistance(IR) and hyperinsulinemia(HI) have been reported to be associated with prognosis in patients with heart disease and poor prognosis.
Methods: 172 patients with a first-time ST elevation AMI (STEMI) who underwent reperfusion within 12 hours were enrolled. Patients had no history of diabetes mellitus prior to the onset STEMI. We examined echocardiography 24 hours after PCI and 12 months later. We measured global longitudinal strain using 3D speckle tracking echocardiography (4D-LV Analysis, TOMTEC). We calculated 3D global longitudinal strain(3D-GLS) as the parameter of accurate systolic function. Infarct size(IS) was defined using Tc99m-sestamibi as the area of <50% uptake. We checked HOMA-R at 2 weeks 'The patients with overt DM were exclided). The absolute difference of the LV end-diastolic volume (ΔLVEDV) after 12 months was calculated as a parameter of LVR. We excluded the patients with CKD (eGFR <30).
Results: Infarct size (r2=0.30, p=0.03) had good relationship not only with HOMA-R(r2=0.50, p=0.018) but also HI. There was a significant relationship between HOMA-R and ΔLVEDV (r2=0.096, p=0.0007). Multivariate analysis showed that HOMA-R was the strongest predictor of ΔLVEDV, followed by 3D-GLS.This tendency was stronger in patients with smaller infarct size (IS <20%). Therefore hyperinsulinemia/IR may play an important role to progress LV remodeling.
Conclusion: IR/HI was the strongest predictor for the degree of LV remodeling in patients with a first STEM without overt DM based on the results of 3D speckle tracking and SPECT study.