Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: Paradoxical contribution of plasma glucose level and glycohemoglobin

Sekiyama, Hiroshi; Nagoshi, Tomohisa; Komukai, Kimiaki; Matsushima, Masato; Katoh, Daisuke; Ogawa, Kazuo; Minai, Kosuke; Ogawa, Takayuki; Yoshimura, Michihiro

doi:10.1186/1475-2840-12-4

Cited by 26 publications

(42 citation statements)

References 27 publications

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“…The patients who underwent coronary bypass surgery were excluded from the analysis of “Duration of hospital stay”, since the surgery affects the hospitalization period independently of the disease severity. When all of the study subjects were divided into two groups based on the median value of ΔK (<0.3 and ≥0.3), a higher incidence of MI relative to unstable angina pectoris, in association with a longer hospitalization period and higher peak CK level, was observed in patients with a larger ΔK (Table 6), consistent with the findings from our previous study [13]. We further investigated the association of ΔK with the disease severity and clinical course in the subjects divided into two groups based on quartiles of ΔK (S5 Table).…”

Section: Resultssupporting

confidence: 89%

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

et al. 2017

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ObjectiveAlthough glucose-insulin-potassium (GIK) therapy ought to be beneficial for ischemic heart disease in general, variable outcomes in many clinical trials of GIK in acute coronary syndrome (ACS) had a controversial impact. This study was designed to examine whether “insulin resistance” is involved in ACS and to clarify other potential intrinsic compensatory mechanisms for GIK tolerance through highly statistical procedure.Methods and resultsWe compared the degree of insulin resistance during ACS attack and remission phase after treatment in individual patients (n = 104). During ACS, homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly increased (P<0.001), while serum potassium levels were transiently decreased (degree of which was indicated by ΔK) (P<0.001). This finding provides a renewed paradox, as ΔK, a surrogate marker of intrinsic GIK cascade activation, probably reflects the validated glucose metabolism during ischemic attack. Indeed, multiple regression analysis revealed that plasma glucose level during ACS was positively correlated with ΔK (P = 0.026), whereas HOMA-IR had no impact on ΔK. This positive correlation between ΔK and glucose was confirmed by covariance structure analysis with a strong impact (β: 0.398, P = 0.015). Intriguingly, a higher incidence of myocardial infarction relative to unstable angina pectoris, as well as a longer hospitalization period were observed in patients with larger ΔK, indicating that ΔK also reflects disease severity of ACS.ConclusionsInsulin resistance most likely increases during ACS; however, ΔK was positively correlated with plasma glucose level, which overwhelmed insulin resistance condition. The present study with covariance structure analysis suggests that there are potential endogenous glucose-coupled potassium lowering mechanisms, other than insulin, regulating glucose metabolism during ACS.

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Section: Resultssupporting

confidence: 89%

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

et al. 2017

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“…Concerning electrolytes and blood glucose level, the present finding revealed a decreased in serum potassium (K) level but within normal level with no significant difference was found between two groups regarding serum potassium (K) and sodium (Na). This may be justified to that decreasing K level lead to vasoconstriction and may always associated with the occurrence of acute coronary syndrome [33]. This result was in line with Madias (2000) [34] and Foo (2003) [35] who suggested that reducing serum potassium (K) was detected in patients with acute coronary syndrome.…”

Section: Discussionsupporting

confidence: 80%

Effect of Implementing Clinical Pathway Guidelines on Patients' Clinical Outcomes with Acute Coronary Syndrome

Ahmed¹

2017

AJNS

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Acute coronary syndrome refers to a range of potentially life-threatening conditions that affect the coronary artery blood supply to the heart. It is associated with increased patient mortality, length of hospital stay and health care costs. Clinical pathways are now one of the main tools that used to manage the quality in healthcare concerning the standardization of care processes. Hence, the aim of this study is to evaluate the effect of implementing a clinical pathway guideline on the clinical outcomes of patients with acute coronary syndrome. A quasi experimental research design was utilized in this study and it was conducted on 60 adult patients at the Cardiac Intensive Care Unit of Tanta University Hospital. The patients were divided into two groups (control and study group) 30 patients in each. The control group: non-clinical pathway group involved patients receiving the routine management regimen while the study group: clinical pathway group (CP group) involved patients who received management according to the clinical pathway guidelines. The findings of this study revealed that a significant changes among control and study group from admission to discharge regarding mean scores of body temperature, Pulse and respiration rate where P<0.05. There was significant increased mean score of central venous pressure among control group compared to study group on admission, after 2 hrs and on 2 nd day of admission with P=0.013, 0.007 and 0.001, respectively. The present study showed that low percentages (20.0 %) of control group had cardiogenic shock compared to none patient in the study group with a significant difference between two groups, where P=0.012. Insignificant difference was observed between control and study group regarding duration of stay in ICU and status of patients on discharge with P=0.075 and 0.206. Also it was noticed that the level of reduction of the mean of Hamilton Anxiety Score in the study group was higher than its level in the control group on discharge. It can be concluded that the established pathway achieved its goal of, improving physiological parameters and decreasing patient's complications, length of stay, and anxiety levels. Based on the findings of this study, the following recommendations are suggested; clinical pathway should be implemented routinely for patients with acute coronary syndrome. Integrating ACS clinical pathway into plan of care to replace the traditional nursing care plan.

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“…We previously reported increased levels of aldosterone production/secretion from failing human hearts. Moreover, our recent study demonstrated that there is a transient decrease in serum potassium level during ischemic attacks of acute coronary syndrome, which is at least partially mediated through the activation of the aldosterone cascade (Sekiyama et al 2013). Although these clinical findings provide evidence for local cardiac aldosterone synthesis/actions, this issue remains very controversial, and in fact, some reports have offered negative findings regarding the question of local aldosterone synthesis in the heart (Gomez-Sanchez et al 2004, Fiebeler et al 2005, Chai et al 2010.…”

Section: Discussionmentioning

confidence: 90%

Preconditioning actions of aldosterone through p38 signaling modulation in isolated rat hearts

Yoshino¹,

Nagoshi²,

Anzawa³

et al. 2014

Journal of Endocrinology

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Although persistent excessive actions of aldosterone have unfavorable effects on the cardiovascular system, primarily via mineralocorticoid receptor (MR)-dependent pathways, the pathophysiological significance of aldosterone cascade activation in heart diseases has not yet been fully clarified. We herein examined the effects of short-term aldosterone stimulation at a physiological dose on cardiac function during ischemia-reperfusion injury (IRI). In order to study the effects of aldosterone preconditioning, male Wistar rat Langendorff hearts were perfused with 10 K9 mol/l of aldosterone for 10 min before ischemia, and the response to IRI was assessed. Although aldosterone did not affect the baseline hemodynamic parameters, preconditioning actions of aldosterone significantly improved the recovery in left ventricular contractility and left ventricular end-diastolic pressure associated with a reduced activity of creatine phosphokinase released into the perfusate after ischemia-reperfusion. Notably, the MR inhibitor eplerenone did not abrogate these beneficial effects. Biochemical analyses revealed that p38MAPK phosphorylation was significantly increased during aldosterone preconditioning before ischemia, whereas its phosphorylation was substantially attenuated during sustained ischemiareperfusion, compared with the results for in the non-preconditioned control hearts. This dual regulation of p38MAPK was not affected by eplerenone. The phosphorylation levels of other MAPKs were not altered by aldosterone preconditioning. In conclusion, the temporal induction of the aldosterone cascade, at a physiological dose, has favorable effects on cardiac functional recovery and injury following ischemia-reperfusion in a MR-independent manner. Phasic dynamism of p38MAPK activation may play a key role in the physiological compensatory pathway of aldosterone under severe cardiac pathological conditions.

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Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: Paradoxical contribution of plasma glucose level and glycohemoglobin

Cited by 26 publications

References 27 publications

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

Effect of Implementing Clinical Pathway Guidelines on Patients' Clinical Outcomes with Acute Coronary Syndrome

Preconditioning actions of aldosterone through p38 signaling modulation in isolated rat hearts

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Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: Paradoxical contribution of plasma glucose level and glycohemoglobin

Cited by 26 publications

References 27 publications

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

Effect of Implementing Clinical Pathway Guidelines on Patients&apos; Clinical Outcomes with Acute Coronary Syndrome

Preconditioning actions of aldosterone through p38 signaling modulation in isolated rat hearts

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Effect of Implementing Clinical Pathway Guidelines on Patients' Clinical Outcomes with Acute Coronary Syndrome