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Licker M, Diaper J, Sologashvili T, Ellenberger C. Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial. BMC Anesthesiol 2019; 19:175. [PMID: 31492103 PMCID: PMC6731577 DOI: 10.1186/s12871-019-0845-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background Patients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis. Methods In this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp). Results At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P < 0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI − 4.8 to − 1.0%), 2D-LVEF (MD -2.0%, 95%CI − 2.8 to − 1.3%, 3D-LVEF (MD -3.0%, 95%CI − 4.0 to − 2.0%) and Vp (MD − 4.5 cm/s, 95%CI − 5.6 to − 3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI − 0.8 to 1.7% and + 0.4%, 95%CI − 1.3 to 2.0%), and PGLS (− 0.9, 95%CI − 1.6 to − 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (− 2.2%, 95%CI − 3.4 to − 1.0), 3D-LVEF (− 6.0%, 95%CI − 7.8 to − 4.2), and Vp (− 7.6 cm/s, 95%CI − 9.4 to − 5.9), all decreased after bypass. Conclusions Administration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement. Trial registration ClinicalTrials.gov: NCT00788242, registered on November 10, 2008.
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Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, CH-1211, Geneva, Switzerland. .,Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital Geneva & Faculty of Medicine, CH-1206, Geneva, Switzerland.
| | - John Diaper
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland
| | - Tornike Sologashvili
- Division of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland
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Ellis KL, Zhou Y, Beshansky JR, Ainehsazan E, Selker HP, Cupples LA, Huggins GS, Peter I. Genetic modifiers of response to glucose-insulin-potassium (GIK) infusion in acute coronary syndromes and associations with clinical outcomes in the IMMEDIATE trial. THE PHARMACOGENOMICS JOURNAL 2015; 15:488-95. [PMID: 25778467 DOI: 10.1038/tpj.2015.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/17/2014] [Accepted: 01/28/2015] [Indexed: 11/09/2022]
Abstract
Modifiers of response to glucose, insulin and potassium (GIK) infusion may affect clinical outcomes in acute coronary syndromes (ACS). In an Immediate Myocardial Metabolic Enhancement During Initial Assessment And Treatment In Emergency Care (IMMEDIATE) trial's sub-study (n = 318), we explored effects of 132,634 genetic variants on plasma glucose and potassium response to 12-h GIK infusion. Associations between metabolite-associated variants and infarct size (n = 84) were assessed. The 'G' allele of rs12641551, near ACSL1, as well as the 'A' allele of XPO4 rs2585897 were associated with a differential glucose response (P for 2 degrees of freedom test, P2df ⩽ 4.75 × 10(-7)) and infarct size with GIK (P2df < 0.05). Variants within or near TAS1R3, LCA5, DNAH5, PTPRG, MAGI1, PTCSC3, STRADA, AKAP12, ARFGEF2, ADCYAP1, SETX, NDRG4 and ABCB11 modified glucose response, and near CSF1/AHCYL1 potassium response (P2df ⩽ 4.26 × 10(-7)), but not outcomes. Gene variants may modify glucose and potassium response to GIK infusion, contributing to cardiovascular outcomes in ACS.
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Affiliation(s)
- K L Ellis
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - J R Beshansky
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.,Regulatory and Clinical Research Management, Regis College, Weston, MA, USA
| | - E Ainehsazan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H P Selker
- Regulatory and Clinical Research Management, Regis College, Weston, MA, USA
| | - L A Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - G S Huggins
- Molecular Cardiology Research Institute Center for Translational Genomics, Tufts Medical Center, Boston, MA, USA
| | - I Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sugizaki MM, Leopoldo AS, Okoshi MP, Bruno A, Conde SJ, Lima-Leopoldo AP, Padovani CR, Carvalho RF, Nascimento AFD, Campos DHSD, Nogueira CR, Cicogna AC. Severe food restriction induces myocardial dysfunction related to SERCA2 activity. Can J Physiol Pharmacol 2009; 87:666-73. [DOI: 10.1139/y09-060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies have shown that food restriction promotes myocardial dysfunction in rats. However, the molecular mechanisms that are responsible are unclear. We investigated the role of sarcoplasmic reticulum Ca2+-ATPase (SERCA2) on myocardial performance in food-restricted rats. Male Wistar–Kyoto rats, 60 days old, were fed a control or restricted diet (daily energy intake reduced to 50% of the control) for 90 days. Expression of Serca2a, phospholamban (PLB), Na+/Ca2+ exchanger (NCX), and thyroid hormone receptor (TRα1, TRβ1) mRNA was determined by quantitative PCR. SERCA2 activity was measured by using 20 µmol/L cyclopiazonic acid (CPA) in a left ventricular papillary muscle preparation during isometric contraction in basal conditions and during post-rest contraction. Serum concentrations of thyroxine (T4) and thyrotropin (TSH) were also determined. The 50%-restricted diet reduced body and ventricular weight and serum T4 and TSH levels. The interaction of CPA and food restriction reduced peak developed tension and maximum rate of tension decline (–dT/dt), but increased the resting tension intensity response during post-rest contraction. PLB and NCX mRNA were upregulated and TRα1 mRNA was downregulated by food restriction. These results suggest that food restriction promotes myocardial dysfunction related to impairment of sarcoplasmic reticulum Ca2+ uptake as a result of a hypothyroid state.
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Affiliation(s)
- Mário Mateus Sugizaki
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - André Soares Leopoldo
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Marina Politi Okoshi
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Alessandro Bruno
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Sandro José Conde
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Ana Paula Lima-Leopoldo
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Carlos Roberto Padovani
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Robson Francisco Carvalho
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - André Ferreira do Nascimento
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Dijon Henrique Salomé de Campos
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Célia Regina Nogueira
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Antonio Carlos Cicogna
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
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