title: Poor preoperative left ventricular function is associated with decreased insulin sensitivity during cardiac surgery.
abstract: OBJECTIVE
  To investigate the association between preoperative left ventricular ejection function (LVEF) and whole-body insulin sensitivity during cardiac surgery.
  
  
  METHODS
  A prospective, non-randomized trial.
  
  
  METHODS
  A tertiary care hospital setting.
  
  
  METHODS
  Patients undergoing elective cardiac surgery.
  
  
  METHODS
  Consenting, non-diabetic patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB) were assigned either to a group with normal LVEF (EF≥55%) or one with low LVEF (EF≤45%) as assessed by coronary angiography. Insulin sensitivity was assessed by the hyperinsulinemic-normoglycemic clamp technique before and towards the end of CPB. The association between LVEF and insulin sensitivity was tested using Student t-test.
  
  
  RESULTS
  One hundred forty patients were studied, with 48 patients in the low and 92 patients in the normal LVEF group. Patient demographics were similar in both groups except for preoperative LVEF (p<0.001). Before CPB, patients with normal LVEF showed higher insulin sensitivity when compared to patients with low LVEF (p = 0.04). Insulin sensitivity decreased towards the end of CPB (p<0.001) in both groups, resulting in similar values.
  
  
  CONCLUSIONS
  Poor preoperative left ventricular function is associated with reduced insulin sensitivity before the onset of CPB in cardiac surgery.
authors.affiliation: Department of Anesthesia, McGill University, Montreal QC, Canada. Electronic address: takumi.coderemaruyama@mail.mcgill.ca.
authors.forename: Takumi
authors.initials: T
authors.lastname: Codère-Maruyama
authors.affiliation: Department of Anesthesiology, Yamanashi University, Yamanashi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Endocrinology, Yamanashi University, Yamanashi, Japan.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Anesthesia, McGill University, Montreal QC, Canada.
authors.forename: Roupen
authors.initials: R
authors.lastname: Hatzakorzian
authors.affiliation: Department of Cardiac Surgery, McGill University, Montreal QC, Canada.
authors.forename: Dominique
authors.initials: D
authors.lastname: Shum-Tim
authors.affiliation: Department of Anesthesia, McGill University, Montreal QC, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schricker
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D001786:Blood Glucose
keywords: cardiac surgery; ejection fraction; glucose; insulin; insulin sensitivity