Effects of Glucose-Insulin-Potassium Solution on Cardiac Cytokines and Enzymes

Abstract

Objective: The aim of this study was to assess the effects of glucose-insulin-potassium (GIK) solution on intraoperative cardiac cytokines and cardiac enzymes in coronary artery bypass surgery patients. Methods: The study group consisted of 49 patients with unstable angina who required urgent CABG. Patients were randomized to a GIK (n = 25) or a non-GIK (n = 24) group. The GIK group received 500 ml of 30 % dextrose solution, containing 100 IU insulin and 80 mEq of potassium, at a rate of 1 ml × kg ^-1 × h^-1. The control group received an equivalent rate of 5 % dextrose. Serum cytokine levels were measured in blood samples obtained from coronary sinus blood samples. Cardiac enzymes such as creatinin kinase (CK), myocardial band of creatinin kinase (CK‐MB) and Troponin-T were measured immediately after operation and at 6, 24 and 48 hours after operation. Results: No patient in the two groups developed ECG or enzyme changes after surgery suggestive of acute myocardial infarction and myocyte damage. Interleukin-10 concentrations were greater in the GIK group (31.10 ± 3.36) than in the non-GIK group (19.10 ± 4.32) (p < 0.05). Conclusion: We conclude that a GIK solution increases the serum cardioprotective interleukin-10 concentrations in CABG patients with unstable angina pectoris. We found no significant difference in any of the other parameters respecting myocyte damage.

Coronary bypass surgery - myocardial infarction - myocardial protection

References

• 1 Sodi-Pallares D, Testelli M R, Fishleder B L, Bisteni A, Medrano G A, Friedland C, De Micheli A. Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction. A preliminary clinical report.  Am J Cardiol. 1962;  9 166-181
• 2 Diaz R, Paolasso E A, Piegas L S, Tajer C D, Moreno M G, Corvalan R, Isea J E, Romero G. Metabolic modulation of acute myocardial infarction. The ECLA (Estudios Cardiologicos Latinoamerica) Collaborative Group.  Circul. 1998;  98 2227-2234
• 3 Lazar H L, Philippides G, Fitzgerald C, Lancaster D, Shemin R J, Apstein C. Glucose-insulin-potassium solutions enhance recovery after urgent coronary artery bypass grafting.  J Thorac Cardiovasc Surg. 1997;  113 354-362
• 4 Svedjeholm R, Hakanson E, Vanhanen I. Rationale for metabolic support with amino acids and glucose-insulin-potassium (GIK) in cardiac surgery.  Ann Thorac Surg. 1995;  59 (Suppl 2) 15-22
• 5 Gradinac S, Coleman G, Taegtmeyer H, Sweeney M, Frazier O H. Improved cardiac function with glucose-insulin-potassium after aortocoronary bypass grafting.  Ann Thorac Surg. 1989;  48 484-489
• 6 Jacquet L, Noirhomme P, El Khoury G, Goenen M, Philippe M, Col J, Dion R. Cardiac troponin I as an early marker of myocardial damage after coronary bypass surgery.  Eur J Cardiothorac Surg. 1998;  13 378-384
• 7 Wan S, LeClere J L, Vincent J L. Inflammatory response to cardiopulmonary bypass: mechanism involved and possible therapeutic strategies.  Chest. 1997;  112 676-692
• 8 Jeremy R W, Ambrosio G, Pike M M, Jacobus W E, Becker L C. The functional recovery of post-ischemic myocardium requires glycolysis during early reperfusion.  J Mol Cell Cardiol. 1993;  25 261-276
• 9 Eberli F R, Weinberg E O, Grice W N, Horowitz G L, Apstein C S. Protective effect of increased glycolytic substrate against systolic and diastolic dysfunction and increased coronary resistance from prolonged global underperfusion and reperfusion in isolated rabbit hearts perfused with erythrocyte suspensions.  Circ Res. 1991;  68 466-481
• 10 Hess M L, Okabe E, Poland J, Warner M, Stewart J R, Greenfield L J. Glucose-insulin-potassium protection during the course of hypothermic global ischemia and reperfusion: a new proposed mechanism by the scavenging of free radicals.  J Cardiovasc Pharmacol. 1983;  5 35-43
• 11 Oliver M F, Opie L H. Effects of glucose and fatty acids on myocardial ischemia and arrhythmias.  Lancet. 1994;  343 155-158
• 12 Wan S, LeClere J L, Vincent J L. Cytokine responses to cardiopulmonary bypass: lessons learned from cardiac transplantation.  Ann Thorac Surg. 1997;  63 269-276
• 13 Hirota H, Izumi M, Hamaguchi T, Sugiyama S, Murakami E, Kunisada K, Fujio Y, Oshima Y, Nakaoka Y, Yamauchi-Takihara K. Circulating interleukin-6 family cytokines and their receptors in patients with congestive heart failure.  Heart Vessels. 2004;  19 237-241
• 14 Hayward R, Nossuli T O, Scalia R, Lefer A M. Cardioprotective effect of interleukin-10 in murine myocardial ischemia-reperfusion.  Eur J Pharmacol. 1997;  334 157-163
• 15 Khoury V K, Haluska B, Prins J, Marwick T H. Effects of glucose-insulin-potassium infusion on chronic ischemic left ventricular dysfunction.  Heart. 2003;  89 61-65
• 16 Saraste A, Pulkki K, Kallojoki M, Henriksen K, Parvinen M, Voipio-Pulkki L M. Apoptosis in human acute myocardial infarction.  Circulation. 1997;  95 320-323
• 17 Zhang H F, Fan Q, Qian X X, Lopez B L, Christopher T A, Ma X L, Gao F. Role of insulin in the anti-apoptotic effect of glucose-insulin-potassium in rabbits with acute myocardial ischemia and reperfusion.  Apoptosis. 2004;  9 777-783
• 18 Bruemmer-Smith S, Avidan M S, Harris B, Sudan S, Sherwood R, Desai J B, Sutherland F, Ponte J. Glucose, insulin and potassium for heart protection during cardiac surgery.  Br J Anaesthesia. 2002;  88 489-495
• 19 Penttila H J, Leopojarvi M VK, Kiviluoma K T, Kaukoranta P K, Hassinen I E, Peuhkurinen P J. Myocardial preservation during coronary surgery with and without cardiopulmonary bypass.  Ann Thorac Surg. 2001;  71 565-571
• 20 Rao V, Mississauga O N, Merante F. Insulin cardioplegia for coronary bypass surgery.  Circul. 1998;  98 (SuppI) 612
• 21 Doenst T, Bothe W, Beyersdorf F. Therapy with insulin in cardiac surgery: Controversies and possible solutions.  Ann Thorac Surg. 2003;  75 721-728