Improved Cardiac Function With Glucose-Insulin-Potassium After Aortocoronary Bypass Grafting

Gradinac, Siniša; Coleman, Gary M.; Taegtmeyer, Heinrich; Sweeney, Michael S.; Frazier, O. H.

doi:10.1016/s0003-4975(10)66844-0

Cited by 113 publications

(54 citation statements)

References 22 publications

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“…The discrepancy between improved hemodynamic performance and TnT release has led to speculation that rather than improving myocardial protection, GIK increases cardiac output simply by vasodilatation. 33 Consistent with this hypothesis, we have detected an increase in the need for vasoconstriction in patients treated with GIK. Although there is evidence to suggest that TnT release has modest prognostic value in cardiac surgery, 34 myocardial protection in cardiac surgery is highly efficacious, and the majority of patients undergoing surgery have only a modest TnT rise of insignificant value.…”

Section: Discussionsupporting

confidence: 80%

“…The use of GIK was associated with a significant reduction in the use of inotropes during the infusion period (nϭ35 patients [33.0%] in the control group versus 13 patients [11.9%] in the treatment group; odds ratio, 0.27; 95% confidence interval, 0.13 to 0.57; Pϭ0.0006). This difference continued from 6 to 12 hours ( Table 2).…”

Section: Inotrope and Vasoconstrictor Usementioning

confidence: 99%

See 1 more Smart Citation

Glucose-Insulin-Potassium Reduces the Incidence of Low Cardiac Output Episodes After Aortic Valve Replacement for Aortic Stenosis in Patients With Left Ventricular Hypertrophy

et al. 2011

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Background— Patients undergoing aortic valve replacement for critical aortic stenosis often have significant left ventricular hypertrophy. Left ventricular hypertrophy has been identified as an independent predictor of poor outcome after aortic valve replacement as a result of a combination of maladaptive myocardial changes and inadequate myocardial protection at the time of surgery. Glucose-insulin-potassium (GIK) is a potentially useful adjunct to myocardial protection. This study was designed to evaluate the effects of GIK infusion in patients undergoing aortic valve replacement surgery. Methods and Results— Patients undergoing aortic valve replacement for aortic stenosis with evidence of left ventricular hypertrophy were randomly assigned to GIK or placebo. The trial was double-blind and conducted at a single center. The primary outcome was the incidence of low cardiac output syndrome. Left ventricular biopsies were analyzed to assess changes in 5′ adenosine monophosphate–activated protein kinase (AMPK), Akt phosphorylation, and protein O-linked β- N -acetylglucosamination (O-GlcNAcylation). Over a 4-year period, 217 patients were randomized (107 control, 110 GIK). GIK treatment was associated with a significant reduction in the incidence of low cardiac output state (odds ratio, 0.22; 95% confidence interval, 0.10 to 0.47; P =0.0001) and a significant reduction in inotrope use 6 to 12 hours postoperatively (odds ratio, 0.30; 95% confidence interval, 0.15 to 0.60; P =0.0007). These changes were associated with a substantial increase in AMPK and Akt phosphorylation and a significant increase in the O-GlcNAcylation of selected protein bands. Conclusions— Perioperative treatment with GIK was associated with a significant reduction in the incidence of low cardiac output state and the need for inotropic support. This benefit was associated with increased signaling protein phosphorylation and O-GlcNAcylation. Multicenter studies and late follow-up will determine whether routine use of GIK improves patient prognosis. Clinical Trial Registration— URL: http://www.controlled-trials.com . Reference number: ISRCTN 05758301.

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Section: Discussionsupporting

confidence: 80%

Section: Inotrope and Vasoconstrictor Usementioning

confidence: 99%

Glucose-Insulin-Potassium Reduces the Incidence of Low Cardiac Output Episodes After Aortic Valve Replacement for Aortic Stenosis in Patients With Left Ventricular Hypertrophy

et al. 2011

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“…However, we and other have previously shown that both glucose-insulin-potassium (GIK) and glutamate can enhance the metabolic and functional recovery of the postischemic heart (40,49,(57)(58)(59)(60)(61)(62)(63). In contrast to inotropes the improvement in hemodynamic state is achieved without undue increase in myocardial oxygen demand.…”

Section: Metabolic Supportmentioning

confidence: 99%

A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG

Svedjeholm

Vidlund²,

Vanhanen

et al. 2010

Scandinavian Cardiovascular Journal

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Hemodynamic state was primarily assessed by mixed venous oxygen saturation (SvO 2 ).Follow-up averaged 9.7±1.4 years.Results LVEF was 0.30 ± 0.05 (range 0.20-0.37) and 3.5 ± 1.3 vessels were bypassed.Inotropes were used in 6.7% for weaning from CPB. Increase of s-creatinine by 50% compared to preoperative values was observed in 2.9 %. Logistic EuroSCORE was 8.3%whereas observed 30-day mortality was 1.0%. Crude 5-year survival was 89.4%. ConclusionsThe metabolic strategy allowed restrictive use of inotropes and was associated with encouraging long-term survival. Renal function was well preserved suggesting that SvO 2 served as an adequate marker of circulation. Randomized trials with metabolic support are warranted.

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“…146 The short-term infusion of GIK (up to 48 hours) has been used very effectively in patients with refractory left ventricular failure after hypothermic ischemic arrest of the heart for revascularization surgery. 147,148 In these patients, the adminis-tration of GIK (a solution of 50% D-glucose containing 80 U of regular insulin and 100 mEq KCl) lowered the plasma concentration of free fatty acids, decreased systemic vascular resistance, raised the cardiac index, and increased urine output. The need for inotropic drugs, the time on the intra-aortic balloon pump, and the stay in the intensive care unit were all significantly reduced.…”

Section: Glucose and Insulin As Substrates For Postischemic Heartmentioning

confidence: 99%

Glucose for the Heart

Depré¹,

Vanoverschelde²,

Taegtmeyer³

1999

Circulation

Self Cite

380

260

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Improved Cardiac Function With Glucose-Insulin-Potassium After Aortocoronary Bypass Grafting

Cited by 113 publications

References 22 publications

Glucose-Insulin-Potassium Reduces the Incidence of Low Cardiac Output Episodes After Aortic Valve Replacement for Aortic Stenosis in Patients With Left Ventricular Hypertrophy

Glucose-Insulin-Potassium Reduces the Incidence of Low Cardiac Output Episodes After Aortic Valve Replacement for Aortic Stenosis in Patients With Left Ventricular Hypertrophy

A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG

Glucose for the Heart

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