Effects of glucose-insulin-potassium infusion on chronic ischaemic left ventricular dysfunction

Abstract

Background: Glucose-insulin-potassium (GIK) infusion improves cardiac function and outcome during acute ischaemia. Objective: To determine whether GIK infusion benefits patients with chronic ischaemic left ventricular dysfunction, and if so whether this is related to the presence and nature of viable myocardium. Methods: 30 patients with chronic ischaemic left ventricular dysfunction had dobutamine echocardiography and were given a four hour infusion of GIK. Segmental responses were quantified by improvement in wall motion score index (WMSI) and peak systolic velocity using tissue Doppler. Global responses were assessed by left ventricular volume and ejection fraction, measured using a three dimensional reconstruction. Myocardial perfusion was determined in 15 patients using contrast echocardiography. Results: WMSI (mean (SD)) improved with dobutamine (from 1.8 (0.4) to 1.6 (0.4), p < 0.001) and with GIK (from 1.8 (0.4) to 1.7 (0.4), p < 0.001); there was a similar increment for both. Improvement in wall motion score with GIK was observed in 55% of the 62 segments classed as viable by dobutamine echocardiography, and in 5% of 162 classed as non-viable. There was an increment in peak systolic velocity after both dobutamine echocardiography (from 2.5 (1.8) to 3.2 (2.2) cm/s, p < 0.01) and GIK (from 3.0 (1.6) to 3.5 (1.7) cm/s, p < 0.001). The GIK effects were not mediated by changes in pulse, mean arterial pressure, lactate, or catecholamines, nor did they correlate with myocardial perfusion. End systolic volume improved after GIK (p = 0.03), but only in 25 patients who had viable myocardium on dobutamine echocardiography. Conclusions: In patients with viable myocardium and chronic left ventricular dysfunction, GIK improves wall motion score, myocardial velocity, and end systolic volume, independent of effects on haemodynamics or catecholamines. The response to GIK is observed in areas of normal and abnormal perfusion assessed by contrast echocardiography.

Glucose-Insulin-Potassium Revived

“…22,95 Although few in number, clinical reports using GIK therapy in several other non-ACS energy-poor conditions also suggest that it may be efficacious. [96][97][98] In patients with chronic ischemic cardiomyopathy with left ventricular dysfunction, GIK infused over 4 hours improved wall motion score, peak systolic velocity, and end-systolic volume independently of effects on hemodynamics or catecholamines. 98 In patients with mitral valve replacement, preoperative GIK increased cardiac glycogen levels and provided a lower incidence of postoperative acute HF with hypotension, less serious postoperative arrhythmias, and overall fewer serious complications.…”

“…[96][97][98] In patients with chronic ischemic cardiomyopathy with left ventricular dysfunction, GIK infused over 4 hours improved wall motion score, peak systolic velocity, and end-systolic volume independently of effects on hemodynamics or catecholamines. 98 In patients with mitral valve replacement, preoperative GIK increased cardiac glycogen levels and provided a lower incidence of postoperative acute HF with hypotension, less serious postoperative arrhythmias, and overall fewer serious complications. 99 During aortic valve replacement for aortic stenosis in patients with left ventricular hypertrophy, GIK protected from episodes of low cardiac output.…”

Effects of high-dose insulin infusion on left ventricular function in normal subjects

“…[6][7][8][9][10] Dobutamine enhances overall myocardial performance and contraction, and high-dose insulin (HDI) infusion improves left ventricular systolic function in patients with left ventricular impairment due to ischaemic coronary disease. [11][12][13][14][15] However, the effect of high-dose insulin infusion is less clear in normal subjects; one study with no effects on myocardial function in normal, healthy subjects has been published. 16 We compared wall motion improvement during low-dose dobutamine infusion with high-dose insulin infusion in ten normal subjects, and observed an increase in stroke volume during highdose insulin infusion which was not significantly different from the increase in stroke volume during low-dose dobutamine stimulation.…”

The impact of antidiabetic therapies on cardiovascular disease

“…Not only does insulin infusion improve outcome in acute ischemia, but it also improves wall motion score, myocardial velocity, and end systolic function in patients with viable myocardium and chronic left ventricular dysfunction [61]. The addition of insulin infusion to primary angioplasty in patients with an acute MI significantly reduced mortality in patients without signs of heart failure [62••].…”