The paradox of obesity and postinfarction remodeling in patients with the Q-wave myocardial infarction

• Lebedev P.A.
• Andrey F. Verbovoy
• Mateesku K.A.
• Aleksandrov M.Yu.
• Paranina E.V.

Abstract

The aim is to determine the effect of obesity, overweight, adipokines on the severity of postinfarction remodeling in men with the Q-wave myocardial infarction (MI).

Material and methods. We examined 49 men who received emergency treatment with acute MI with ST elevation (mean age 57.06±1.21 years). We investigated troponins I and T, creatine phosphokinase-MB (CK-MB), lipid spectrum, inflammatory activity, insulin resistance (IR), were studied by ECG, echocardiography, coronarography with Gensini stenosis index, bioimpedanceometry, body mass index (BMI), body obesity index (BAI), visceral obesity index (VAI). The follow-up was conducted during hospitalization (1^st visit), 1 month after discharge (2^nd visit), 1 year (3^rd visit). All patients were divided into 3 groups according to the myocardial performance index (MPI).

Results. Diastolic dysfunction of the left ventricle was observed in 49% of patients, in combination with systolic - in 35%. In patients with medium (2^nd group) and severe (3^rd group) myocardial dysfunction, there was a significant increase in troponin I and CK-MB, C-reactive protein (CRP) of blood, myocardial necrosis by ECG, as well as low BMI (27.32±0.91 kg/m²), the percentage of adipose mass in the body structure (29.75±1.51%) compared with group 1 with normal myocardial function (BMI 30.73±1.02 kg/m², content of adipose tissue 23.3±1.83%, p<0,05). Visceral obesity in terms of the VAI parameter is associated with a less myocardial damage of ECG and the MPI parameter (r=-0.42, p<0.001). BAI was inversely associated with interleukin-6 (r=-0.45, p<0.001) and CRP (r=-0.31, p<0.05). Resistin was inversely correlated with the systolic function of the left ventricular, measured by the rate of displacement of the mitral ring (r =-0.45, p<0.01).

Conclusions. Overweight and obesity have protective effects in men with MI. Our study, being a pilot, draws attention to the anti-inflammatory phenomenon, as a possible explanation for less myocardial damage in obese patients with infarction.

Keywords: adipokines, myocardial infarction, postmyocardial remodeling, myocardial productivity index, diastolic dysfunction, systolic dysfunction, visceral obesity, paradox of obesity

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