Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial.
Marc-Joseph LickerThomas ReynaudNajia GarofanoTornike SologashviliJohn DiaperChristoph EllenbergerPublished in: Journal of clinical monitoring and computing (2019)
Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose-insulin-potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia-reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] - 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6-7.4%, and MD + 22.2%, 95% CI 16.0-28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD - 7.5% [- 11.6 to - 3.4%], MD - 12.0% [- 15.2 to - 8.8%] and MD - 21.3% [- 25.7 to - 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.
Keyphrases
- coronary artery bypass
- left ventricular
- aortic stenosis
- ejection fraction
- heart failure
- aortic valve replacement
- percutaneous coronary intervention
- molecular dynamics
- minimally invasive
- cardiac resynchronization therapy
- randomized controlled trial
- transcatheter aortic valve implantation
- hypertrophic cardiomyopathy
- acute myocardial infarction
- left atrial
- mitral valve
- type diabetes
- patients undergoing
- coronary artery disease
- magnetic resonance
- blood glucose
- acute coronary syndrome
- blood pressure
- atrial fibrillation
- newly diagnosed
- low dose
- systematic review
- aortic valve
- glycemic control
- prognostic factors
- computed tomography
- study protocol
- patient reported outcomes
- acute heart failure
- magnetic resonance imaging
- intensive care unit
- high intensity