title: Glucose-insulin-potassium echocardiography detects improved segmental myocardial function and viable tissue shortly after acute myocardial infarction.
abstract: Previous studies showed that glucose-insulin-potassium (GIK) increases cardiac output in patients after cardiac surgery and improves segmental myocardial wall motion. We hypothesized that GIK improves regional wall motion, detects contractile reserve, and predicts functional recovery at follow-up to a similar extent as low-dose dobutamine (LDD) in patients with recent myocardial infarction. Forty-one patients underwent LDD and GIK echocardiography. Data were analyzed according to a 13-segment model. Segments were scored from 0 (normokinesia) to 2 (a-/dyskinesia). Wall motion score index was calculated for baseline and intervention. During GIK, wall motion score index improved from 0.60 +/- 0.25 to 0.39 +/- 0.20 (P < .0001) and from 0.58 +/- 0.25 to 0.39 +/- 0.21 (P < .0001) during LDD. Overall agreement between GIK and LDD echocardiography to detect contractile reserve (improvement of segmental function by >or= 1 point) was 93% with a kappa value of 0.88. Sensitivity, specificity, and positive and negative predictive values of GIK echocardiography to predict functional recovery at follow-up (mean time to follow-up, 13 months) were 74%, 84%, 85%, and 72% respectively, and values were similar to LDD echocardiography. Thus, GIK infusion improves regional left ventricular function and allows the detection of myocardial viability to a similar extent as LDD in patients shortly after infarction.
authors.affiliation: Department of Cardiology, Institute for Cardiovascular Research-VU, VU University Medical Center, Amsterdam, The Netherlands. lj.klein@vumc.nl
authors.forename: Lucas J
authors.initials: LJ
authors.lastname: Klein
authors.forename: Linda C M C
authors.initials: LC
authors.lastname: van Campen
authors.forename: Gertjan T
authors.initials: GT
authors.lastname: Sieswerda
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Cees A
authors.initials: CA
authors.lastname: Visser
authors.forename: Frans C
authors.initials: FC
authors.lastname: Visser
mesh_terms: D002314:Cardioplegic Solutions / Q000627:therapeutic use; D004280:Dobutamine; D005080:Exercise Test; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011188:Potassium / Q000627:therapeutic use; D011379:Prognosis; D020127:Recovery of Function / Q000187:drug effects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*
chemical_list: D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D004280:Dobutamine; D005947:Glucose; D011188:Potassium