February 24, 2004
View Full PaperEffects of Glucagon-Like Peptide-1 in Patients With Acute Myocardial Infarction and Left Ventricular Dysfunction After Successful Reperfusion
Structured PICO
Does a 72-hour infusion of GLP-1 improve left ventricular function in patients with acute myocardial infarction and LVEF <40% after successful primary angioplasty?
P
Population
21 patients with acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) <40% after successful primary angioplasty. Both groups had severe LV dysfunction at baseline (LVEF=29+/-2%).
I
Intervention
72-hour infusion of glucagon-like peptide-1 (GLP-1) at 1.5 pmol/kg per minute added to background therapy.
C
Comparator
Control group receiving background therapy.
O
Outcome
Change in left ventricular ejection fraction (LVEF) measured by echocardiogram after completion of the 72-hour infusion.surrogate
A 72-hour infusion of GLP-1 added to standard therapy significantly improved regional and global left ventricular function in patients with AMI and severe systolic dysfunction after successful primary angioplasty.
Abstract
BACKGROUND: Glucose-insulin-potassium infusions are beneficial in uncomplicated patients with acute myocardial infarction (AMI) but are of unproven efficacy in AMI with left ventricular (LV) dysfunction because of volume requirements associated with glucose infusion. Glucagon-like peptide-1 (GLP-1) is a naturally occurring incretin with both insulinotropic and insulinomimetic properties that stimulate glucose uptake without the requirements for concomitant glucose infusion. METHODS AND RESULTS: We investigated the safety and efficacy of a 72-hour infusion of GLP-1 (1.5 pmol/kg per minute) added to background therapy in 10 patients with AMI and LV ejection fraction (EF) 1.63+/-0.09, P2.02+/-0.11, P<0.01) compared with control subjects. The benefits of GLP-1 were independent of AMI location or history of diabetes. GLP-1 was well tolerated, with only transient gastrointestinal effects. CONCLUSIONS: When added to standard therapy, GLP-1 infusion improved regional and global LV function in patients with AMI and severe systolic dysfunction after successful primary angioplasty.