Document Detail


Effects of glucose-insulin-potassium infusion on chronic ischaemic left ventricular dysfunction.
MedLine Citation:
PMID:  12482794     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
V K Khoury; B Haluska; J Prins; T H Marwick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  89     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2002-12-16     Completed Date:  2003-01-31     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  61-5     Citation Subset:  AIM; IM    
Affiliation:
University of Queensland, Brisbane, Queensland, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiotonic Agents / administration & dosage*,  diagnostic use
Chronic Disease
Diabetic Angiopathies / drug therapy*,  physiopathology
Dopamine / diagnostic use
Drug Combinations
Echocardiography / methods
Female
Glucose / administration & dosage*
Humans
Hypoglycemic Agents / administration & dosage*
Infusions, Intravenous
Insulin / administration & dosage*
Male
Myocardial Ischemia / complications,  drug therapy*,  physiopathology
Potassium / administration & dosage*
Stroke Volume / drug effects
Ventricular Dysfunction, Left / complications,  drug therapy*,  physiopathology
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Drug Combinations; 0/Hypoglycemic Agents; 0/Insulin; 0/glucose-insulin-potassium cardioplegic solution; 50-99-7/Glucose; 7440-09-7/Potassium
Comments/Corrections

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