Could glucose level be a marker of myocardial energy deficit severity in progressing coronary insufficiency among patients with coronary heart disease?

Abstract

Aim. То study possible mechanisms of glycemia changes in patients with coronary heart disease (CHD) and progressing coronary insufficiency.Material and methods. In total, 108 men aged 48,7±6,5 years were examined: 19 with progressing angina without previous myocardial infarction (MI), 74 with acute MI (AMI), and 15 healthy men as controls. After diagnosis verification, glucose and insulin levels were measured by glucosuric and radio-immune methods, respectively. According to glycemia level, clinical course, outcomes, insulin resistance (IR) and insulin production were analysed.Results. Acute coronary syndrome development was associated with increased IR and compensatory increase in insuhn production, up to five-fold elevation of the latter. AMI development was characterized by hyperglycemia (HG) in 44,4 % of the patients, which correlated with myocardial damage severity and adverse prognosis.Conclusion. HG could be regarded as a metabolic marker of myocardial energy deficit severity and myocardial endocrine dysregulation, possibly due to increased IR in ischemia. Long-term non-corrected IR decreases compensatory potential of insulin production, increases intracellular insulin deficit and cardiomyocyte death. This process is reflected by transient HG in AMI patients. Therefore, in CHD patients, glycemia could be an informative diagnostic criterion of myocardial energy metabolism in progressing coronary insufficiency and MI development.

Keywords

• myocardial infarction
• hyperglycemia
• hypoglycemia
• energy metabolism
• insulin resistance
• hyperinsulinemia