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Glycemic Control in Coronary Revascularization.
Curr Treat Options Cardiovasc Med
February 2016
VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.
Hyperglycemia in the setting of coronary revascularization is associated with increased adverse cardiovascular events in patients with or without diabetes mellitus. Data suggest that acute peri-procedural hyperglycemia causes an increase in inflammation, platelet activity, and endothelial dysfunction and is associated with plaque instability and infarct size. While peri-procedural blood glucose level is an independent predictor of adverse outcomes in patients undergoing coronary revascularization, treatment strategies remain uncertain.
View Article and Find Full Text PDFHyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery: A Randomized Trial.
Anesthesiology
August 2015
From the Departments of Cardiothoracic Anesthesia (A.E.D., A.A., S. Sale), Outcomes Research (A.E.D., B.K.K., S. Sarwar, A.S., D.Y., D.I.S.), Molecular Cardiology (O.S.-A., S.C.), Quantitative Health Sciences (D.Y.), Cardiovascular Medicine (J.D.T.), and Cardiac Surgery (M.G.), Cleveland Clinic, Cleveland, Ohio. Current affiliations: Department of Anesthesiology, Northwestern University, Chicago, Illinois (B.K.K.); Department of Family Medicine, Case Medical Center, University Hospitals of Cleveland, Cleveland, Ohio (S.Sarwar); Hepatobiliary Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada (A.S.); Case Western Reserve University, Cleveland, Ohio (S.C.); and Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois (J.D.T.).
Background: Glucose-insulin-potassium (GIK) administration during cardiac surgery inconsistently improves myocardial function, perhaps because hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic normoglycemic clamp (HNC) technique may better enhance the myocardial benefits of GIK. The authors extended previous GIK investigations by (1) targeting normoglycemia while administering a GIK infusion (HNC); (2) using improved echocardiographic measures of myocardial deformation, specifically myocardial longitudinal strain and strain rate; and (3) assessing the activation of glucose metabolic pathways.
View Article and Find Full Text PDFGlucagon-like peptide-1 and myocardial protection: more than glycemic control.
Clin Cardiol
May 2009
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Pharmacologic intervention for the failing heart has traditionally targeted neurohormonal activation and ventricular remodeling associated with cardiac dysfunction. Despite the multitude of agents available for the treatment of heart failure, it remains a highly prevalent clinical syndrome with substantial morbidity and mortality, necessitating alternative strategies of targeted management. One such area of interest is the ability to modulate myocardial glucose uptake and its impact on cardioprotection.
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