The beneficial effect of insulin, glucose, and dipyridamole on regional left ventricular function early after acute myocardial infarction.
BACKGROUND
High-dose glucose-insulin-potassium (GIK) solution has beneficial effects on reducing mortality in acute myocardial infarction. Dipyridamole (DIP) is a powerful antioxidant and increases adenosine concentration. Experimentally, GIK and DIP have additive protective effects in ischemia-reperfusion injury.


OBJECTIVE
This work aims to assess the acute effects of DIP alone, GIK alone, and GIK+DIP on left ventricular function in patients evaluated early after an acute myocardial infarction.


METHODS
Ten male patients (age 63+/-11 years) with uncomplicated acute myocardial infarction were evaluated within 3 days after admission. All had been treated with systemic thrombolysis and were on full therapy (including beta-blockers) at the time of testing. They underwent stress echocardiography [2D echo, with wall motion score index (WMSI) evaluated in a 16-segment model of the left ventricle, with each segment scored from 1=normal to 4=dyskinetic] during low-dose DIP alone (0.28 mg/kg in 4 min); GIK alone (4-h infusion of glucose 30%, 25 insulin units, and 40 mEq of KCl, at an infusion rate of 1.5 ml/kg/h); and GIK+DIP.


RESULTS
Regional systolic function (baseline WMSI=1.69+/-0.2) improved after DIP (1.54+/-0.1), GIK (1.54+/-0.1), and, to a greater extent, after GIK+DIP (1.33+/-0.2; p<0.001 vs. baseline; p<0.05 vs. DIP; p<0.05 vs. GIK).


CONCLUSIONS
High-dose GIK has an acute beneficial effect on regional left ventricular function in patients with acute myocardial infarction. This beneficial effect is potentiated by low-dose DIP coadministration.
Cardiology Division, Imola Hospital, Italy.
Gigliola
G
Bedetti
Carmine
C
Pizzi
Luca
L
Gabrieli
Albert
A
Varga
Emilio
E
Pasanisi
Raffaele
R
Bugiardini
Eugenio
E
Picano
D004176:Dipyridamole / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D011188:Potassium / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects*
D007328:Insulin; D014665:Vasodilator Agents; C030396:glucose-insulin-potassium cardioplegic solution; D004176:Dipyridamole; D005947:Glucose; D011188:Potassium