Enhancement of myocardial energy potentials in man by glucose-insulin treatment before and after ischaemic heart arrest.
Thirty-six patients undergoing aortic valve replacement were investigated to ascertain whether the addition of glucose-insulin before and after ischaemic heart arrest could aid to the functional recovery of hearts following global ischaemia. One group of patients (n = 14) received glucose plus insulin from the onset of anaesthesia until crossclamping of the aorta (1 g + 1.5 U/kg bw X h). A second dose (0.5 g + 1.0 U/kg bw) was given at the end of ischaemia. 22 patients, serving as control received glucose in the same manner but without insulin. Needle biopsies from the left ventricular apex region were obtained: before starting cardiopulmonary bypass; at the end of ischaemia; and after 10 minutes of reperfusion and analyzed for its content of ATP, CP ADP and lactate. In both groups ATP and CP were significantly decreased after ischaemia and increased after reperfusion. ADP and lactate levels were elevated after ischaemia and decreased after reperfusion in the insulin-group but not in the control-group. During the total investigation period ATP- and CP-concentrations in the insulin-group were higher compared to the control-group, whereas ADP and lactate of the control-group were above the insulin-group.
D000244:Adenosine Diphosphate / Q000378:metabolism; D000255:Adenosine Triphosphate / Q000378:metabolism; D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D004734:Energy Metabolism; D005112:Extracorporeal Circulation; D005947:Glucose / Q000627:therapeutic use*; D006324:Heart Arrest, Induced; D006350:Heart Valve Prosthesis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007773:Lactates / Q000378:metabolism; D019344:Lactic Acid; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000378:metabolism*; D010725:Phosphocreatine / Q000378:metabolism; D011182:Postoperative Care; D011300:Preoperative Care; D011897:Random Allocation
D007328:Insulin; D007773:Lactates; D010725:Phosphocreatine; D019344:Lactic Acid; D000244:Adenosine Diphosphate; D000255:Adenosine Triphosphate; D005947:Glucose