[Pathogenesis of impaired glucose tolerance and its relationship to hemodynamics in patients with acute myocardial infarction].

To evaluate the relationship between hemodynamics and hormonal factors as a basis for impaired glucose tolerance associated with acute myocardial infarction, blood glucose (BS), insulin (IRI), glucagon (IRG) and catecholamine (CA) were measured in 47 patients during the 48 hours after attack. BS values were correlated closely to Killip's classification of severity according to clinical signs (r=0.632, p<0.01). A significant correlation was also observed between BS and hemodynamic parameters; i.e. there were positive linear relations between BS values and heart rate (r=0.376, p<0.01), central venous pressure (r=0.440, p<0.001) respectively, and inverse correlation between BS values and cardiac index (r=-0.366, p<0.01), stroke volume index (r=0.470, p<0.001), respectively. According to multiple correlation analysis performed to clarify these relations, increased BS level was especially related to a reduced stroke volume index. IRI and IRG levels were higher in patients with cardiogenic shock than patients without shock. Furthermore, both values were closely related to central venous pressure, suggesting that congestion of the liver might play an important role in the mechanism of hyperinsulinemia or hyperglucagonemia after acute myocardial infarction. As well as BS, CA values were higher in cases with more severe pump failure and also correlated to Killip's classification (r=0.509, p<0.01). In all cases, CA values were most closely related to heart rate. However, in cases without a history of diabetes mellitus the values were related to stroke volume index. Calculated actual values of BS, IRI, IRG and CA which can discriminate abnormal hemodynamics from normal (increased central venous pressure and/or reduced stroke volume index), were 210mg/dl, 32iu/ml, 372pg/ml and 0.77ng/ml, respectively. In patients whose hormonal