Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial

Abstract

Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose-insulin-potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia-reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] - 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6-7.4%, and MD + 22.2%, 95% CI 16.0-28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD - 7.5% [- 11.6 to - 3.4%], MD - 12.0% [- 15.2 to - 8.8%] and MD - 21.3% [- 25.7 to - 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.

Keywords: Cardiopulmonary bypass management; Diagnosis; Diagnosis and treatment post-CPB; Effects; Hypotension; LV failure; Peri-operative insulin; TEE.

Fig. 1

Time line of the research protocol with study interventions and data collection. GIK glucose–insulin–potassium, ICU intensive care unit, PGLS peak global longitudinal strain, POD postoperative day, TEE transesophageal echocardiography

Fig. 2

Consolidated Standards of Reporting Trials flow diagram

Fig. 3

Intraoperative changes in echocardiographic parameters occurring in patients undergoing CABG surgery. Data from 100 patients with complete high quality TEE exams (Placebo group N = 46; GIK group N = 54). *Post-drug compared with baseline, p < 0.05; ^#end of surgery compared with baseline, p < 0.05; ^†GIK compared with Placebo, p < 0.05

Fig. 4

Individual changes in fractional area changes (FAC) after drug infusion (Placebo or GIK) and after weaning from cardio-pulmonary bypass