Anticipatory treatment with intravenous glucose-insulin-potassium significantly improved the recovery of regional systolic, diastolic, and global left ventricular function in pigs (all P < 0.05).
Does anticipatory treatment with intravenous glucose-insulin-potassium (GIK) attenuate systolic and diastolic LV dysfunction resulting from ischemia and reperfusion in a porcine model?
Anticipatory treatment with GIK preserves systolic and diastolic function during ischemia and reperfusion in a porcine model, suggesting potential utility for metabolic protection in patients at risk for recurrent ischemia.
p-value: p=<0.05
Clinical and experimental studies have suggested benefit of treatment with intravenous glucose-insulin-potassium (GIK) in acute myocardial infarction. However, patients hospitalized with acute coronary syndromes often experience recurrent myocardial ischemia without infarction that may cause progressive left ventricular (LV) dysfunction. This study tested the hypothesis that anticipatory treatment with GIK attenuates both systolic and diastolic LV dysfunction resulting from ischemia and reperfusion without infarction in vivo. Open-chest, anesthetized pigs underwent 90 min of moderate regional ischemia (mean subendocardial blood flow 0.3 ml x g(-1) x min(-1)) and 90 min reperfusion. Eight pigs were treated with GIK (300 g/l glucose, 50 U/l insulin, and 80 meq/l KCl; infused at 2 ml x kg(-1) x h(-1)) beginning 30 min before ischemia and continuing through reperfusion. Eight untreated pigs comprised the control group. Regional LV wall area was measured with orthogonal pairs of sonomicrometry crystals. GIK significantly increased myocardial glucose uptake and lactate release during ischemia. After reperfusion, indexes of regional systolic function (external work and fractional systolic wall area reduction), regional diastolic function (maximum rate of diastolic wall area expansion), and global LV function (LV positive and negative maximum rate of change in pressure with respect to time) recovered to a significantly greater extent in GIK-treated pigs than in control pigs (all P < 0.05). The findings suggest that the clinical utility of GIK may extend beyond treatment of acute myocardial infarction to anticipatory metabolic protection of myocardium in patients at risk for recurrent episodes of ischemia.
Zhu et al. (2000) studied Ischemia and reperfusion (n=16). Glucose-insulin-potassium (GIK) vs. Untreated was evaluated on Recovery of regional systolic function, regional diastolic function, and global LV function (p=<0.05). Anticipatory treatment with intravenous glucose-insulin-potassium significantly improved the recovery of regional systolic, diastolic, and global left ventricular function in pigs (all P < 0.05).