1. Author: Moldovan Carmen Co-authors: Opincariu Diana Balan Daniel University of Medicine and Pharmacy Tg. Mures Cardiology Clinic, Mures Emergency Clinical CountyHospital, Prof. Benedek Imre, MD, Head of Clinic Coordinators: Prof. Dr. Benedek Theodora Prof. Dr. Benedek Imre

2. Key stages in the development of Acute Coronary Syndrome 1.Ischemic cascade 2.Plaque formation and rupture 3.Coronary occlusion and MI 4.Ventricular remodeling

3. REMODELING PREVENTION  Pharmacological intervention: -ACE-inhibitors -Beta-blockers -Diuretics -Ca-blockers and other  PTCA

4. AIM We aimed at assessing the correlation between the amplitude of the left ventricular remodeling and persistence of elevated circulating levels of an inflammation marker - highly sensitive CRP - at 7 +/- 2 days after an AMI in patients with type 2 DM.

5. MATERIALS AND METHODS 45 patients Inclusion criteria:  Acute myocardial infarction  DM type II  Optimal medical treatment  Primary PCI Exclusion criteria:  History of cardiac surgery  Previous myocardial infarction  Age under 18 The LV function and remodeling were assessed at baseline and at 6 months after the infarction.

6. MATERIALS AND METHODS Patients underwent through several steps:  Clinical examination  Laboratory examination  ECG  Echocardiography  Coronarography

7. The study population was divided into 2 groups: Group 1: Group 1: 22patients with low-to-intermediate risk (hsCRP<3mg/l) Group 2: Group 2: 23 patients with high-risk (hsCRP>3mg/l)

8. Characteristics of the study population at baseline FEATUREGROUP 1GROUP 2P value Age60.59 +/- 8.761.30 +/- 10.700.8 Gender, male16 (68.18%)13 (56.5%)0.3 Presence of hypertension 16 (68.18%)19 (82.6%)0.76 Dyslipidemia14 (63.3%)15 (65.2%)1 Obesity5 (22.7%)6 (26.1%)0.9 Smoker*10 (45.4%)6 (26.1%)0.22 *past or present

9. Characteristics of the study population at baseline FEATUREGROUP 1GROUP2P value Ejection fraction 95% confidence interval 48.88+/-4.64 44.19 – 48.36 46.26 +/- 4.84 38.62 – 43.08 0.07 LVED volume 95% confidence interval 127.1 +/- 16.5 119.8 - 134.4 134.4 +/- 16.1 127.45 – 141.33 0.14 hs-CRP 95% confidence interval 1.71+/-0.78 mg/l 1.36 – 2.06 12.3+/-11.1 mg/l 7.5 – 17.1 0.0001 Number of diseased coronary arteries 95% confidence interval 1.86 +/- 0.88 1.46 – 2.25 2.94 +/- 0.64 2.07 – 2.6 0.04 The echocardiographic and angiographic assessments at baseline revealed no statistically significant differences between the groups in regards to the ejection fraction, the LVED volume and the location of the infarction.

10. Results FEATUREGROUP 1GROUP 2P value Ejection fraction at 6 months (%) 95% confidence interval 46.27 +/- 4.7 44.19 – 48.36 40.85 +/- 5.16 38.62 – 43.08 0.0006 LVED volume at 6 months 95% confidence interval 142.5 +/- 16.54 135.16 – 149.84 157.82 +/- 15.3 151.2 – 164.46 <0.002 Decrease in EF at 6 months (%) 95% confidence interval 5.25 +/- 4.68 3.18 – 7.33 11.3 +/- 10.17 6.9 – 15.7 0.01 Remodeling index 95% confidence interval 12.49 +/- 6.76 9.49 – 15.49 17.85 +/- 5.6 15.43 – 20.27 0.005 Positive remodeling (PR) was defined as an increase in the LV end-diastolic global volume >15% compared with baseline.

11. RESULTS

13. Major Cardiovascular Events in the study population ( MACE ) MACEGROUP 1GROUP 2P value Death1 (4.54%)0 (0%)0.4 Reinfarction1 (4.54%)2 (8.69%)1 Revascularization1 (4.54%)1 (4.34%)1 Rehospitalisation2 (9.09%)5 (21.74%)0.4 Total MACE5 (22.7%)8 (34.78%)0.5

14. Conclusions The persistence of a marked inflammation at seven days post-infarction is associated with a more severe impairment of ventricular function in patients with type 2 DM and acute myocardial infarction. The diabetic patients with persistently high levels of hs-CRP at seven days post-infarction have a poorer outcome, as reflected by lower ejection fractions, marked enlargement of the ventricular cavities and the development of ventricular remodeling at six months following the infarction.

15. THANK YOU FOR YOUR ATTENTION! Special recognition to members of Cardiology Clinic, of the MURES COUNTY EMERGENCY CLINICAL HOSPITAL - Prof. Dr. Benedek Imre Prof. Dr. Benedek Theodora