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Fysekidis M, Cosson E, Sabouret P, Takbou K, Sutton A, Charnaux N, Banu I, Testa A, Biondi-Zoccai G, Vicaut E, Valensi P. Insulin analogs as an add-on to metformin after failure to oral treatment in type 2 diabetic patients increase diastole duration. The INSUlin Regimens and VASCular Functions (INSUVASC) study. Minerva Cardiol Angiol 2023; 71:659-672. [PMID: 37405711 DOI: 10.23736/s2724-5683.23.06139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Fast acting insulin analogues are known to improve arterial stiffness. The combination of metformin with insulin represents a widely used therapeutic strategy in diabetes. We hypothesized that insulin treatment in patients with type 2 diabetes (T2D) with long-acting, fast-acting or basal bolus insulin as an add-on to metformin would provide additional improvement of arterial stiffness. METHODS The INSUlin Regimens and VASCular Functions (INSUVASC) study is a pilot, randomized, open label three-arms study that included 42 patients with type 2 diabetes (T2D) in primary prevention, after a failure to oral antidiabetic agents. Arterial stiffness measurements were performed at fasting and after a standardized breakfast. During the first visit (V1) pre-randomization, participants took only metformin to perform the tests. The same tests were repeated after 4 weeks of insulin treatment during the second visit (V2). RESULTS Data were available for final analysis in 40 patients, with a mean age of 53.6±9.7 years and a mean duration of diabetes of 10.6±5.6 years. Twenty-one were females (52.5%), hypertension and dyslipidemia were present in 18 (45%) and 17 patients (42.5%), respectively. After insulin treatment, the metabolic control was associated to a decrease in oxidative stress and improvement of endothelial functions, with a post prandial diastole duration increased and a decrease of the peripheral arterial stiffness, with a better post prandial pulse pressure ratio and ejection duration after insulin. In hypertensive patients, insulin treatment provided positive effects by decreasing the pulse wave velocity and improving reflection time. CONCLUSIONS A short time treatment by insulin in addition to metformin improved myocardial perfusion. Moreover, insulin treatment in hypertensive patients provides a better hemodynamic profile in large arteries.
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Affiliation(s)
- Marinos Fysekidis
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France -
- Department of Diabetology-Nutrition, Research Center for Human Nutrition of Ile-de-France, Integrated Obesity Center of North Ile-de-France (CINFO), Bondy, France -
- Center of Research in Epidemiology and Statistics (UMR U1153), National Institute of Health and Medical Research (Inserm), Université Paris13, Sorbonne Paris Cité, Bobigny, France -
| | - Emmanuel Cosson
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
- Department of Diabetology-Nutrition, Research Center for Human Nutrition of Ile-de-France, Integrated Obesity Center of North Ile-de-France (CINFO), Bondy, France
- Center of Research in Epidemiology and Statistics (UMR U1153), National Institute of Health and Medical Research (Inserm), Université Paris13, Sorbonne Paris Cité, Bobigny, France
| | - Pierre Sabouret
- Heart Institute, Pitié-Salpétrière Hospital, Sorbonne University, Paris, France
- National College of French Cardiologists, Paris, France
| | - Karim Takbou
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
| | - Angela Sutton
- Biochemistry Department, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Bondy, France
| | - Nathalie Charnaux
- Biochemistry Department, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Bondy, France
| | - Isabela Banu
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
| | - Alberto Testa
- Sapienza School for Advanced Studies, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Eric Vicaut
- Clinical Research Unit, Lariboisière-St Louis, Fernand Widal Hospitals, Assistence Publique - Hôpitaux de Paris, Paris, France
| | - Paul Valensi
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
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Tadinada SM, Grzesik WJ, Kutschke W, Weiss RM, Abel ED. Acute effects of euglycemic-hyperinsulinemia on myocardial contractility in male mice. Physiol Rep 2022; 10:e15388. [PMID: 36073057 PMCID: PMC9453172 DOI: 10.14814/phy2.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023] Open
Abstract
Type 2 diabetes and obesity are associated with increased risk of cardiovascular disease, including heart failure. A hallmark of these dysmetabolic states is hyperinsulinemia and decreased cardiac reserve. However, the direct effects of hyperinsulinemia on myocardial function are incompletely understood. In this study, using invasive hemodynamics in mice, we studied the effects of short-term euglycemic hyperinsulinemia on basal myocardial function and subsequent responses of the myocardium to β-adrenergic stimulation. We found that cardiac function as measured by left ventricular (LV) invasive hemodynamics is not influenced by acute exposure to hyperinsulinemia, induced by an intravenous insulin injection with concurrent inotropic stimulation induced by β-adrenergic stimulation secondary to isoproterenol administration. When animals were exposed to 120-min of hyperinsulinemia by euglycemic-hyperinsulinemic clamps, there was a significant decrease in LV developed pressure, perhaps secondary to the systemic vasodilatory effects of insulin. Despite the baseline reduction, the contractile response to β-adrenergic stimulation remained intact in animals subject to euglycemic hyperinsulinemic clamps. β-adrenergic activation of phospholamban phosphorylation was not impaired by hyperinsulinemia. These results suggest that short-term hyperinsulinemia does not impair cardiac inotropic response to β-adrenergic stimulation in vivo.
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Affiliation(s)
- Satya Murthy Tadinada
- Department of Neuroscience and Pharmacology, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Fraternal Order of Eagles Diabetes Research Center, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - Wojciech J. Grzesik
- Fraternal Order of Eagles Diabetes Research Center, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - William Kutschke
- Abboud Cardiovascular Research Center, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - Robert M. Weiss
- Abboud Cardiovascular Research Center, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Division of Cardiology, Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - E. Dale Abel
- Department of Neuroscience and Pharmacology, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Fraternal Order of Eagles Diabetes Research Center, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Abboud Cardiovascular Research Center, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Department of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
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Goetzman E, Gong Z, Rajasundaram D, Muzumdar I, Goodchild T, Lefer D, Muzumdar R. Serum Metabolomics Reveals Distinct Profiles during Ischemia and Reperfusion in a Porcine Model of Myocardial Ischemia-Reperfusion. Int J Mol Sci 2022; 23:ijms23126711. [PMID: 35743153 PMCID: PMC9223436 DOI: 10.3390/ijms23126711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 12/16/2022] Open
Abstract
Acute myocardial infarction (MI) is one of the leading causes of death worldwide. Early identification of ischemia and establishing reperfusion remain cornerstones in the treatment of MI, as mortality and morbidity can be significantly reduced by establishing reperfusion to the affected areas. The aim of the current study was to investigate the metabolomic changes in the serum in a swine model of MI induced by ischemia and reperfusion (I/R) injury, and to identify circulating metabolomic biomarkers for myocardial injury at different phases. Female Yucatan minipigs were subjected to 60 min of ischemia followed by reperfusion, and serum samples were collected at baseline, 60 min of ischemia, 4 h of reperfusion, and 24 h of reperfusion. Circulating metabolites were analyzed using an untargeted metabolomic approach. A bioinformatic approach revealed that serum metabolites show distinct profiles during ischemia and during early and late reperfusion. Some notable changes during ischemia include accumulation of metabolites that indicate impaired mitochondrial function and N-terminally modified amino acids. Changes in branched-chain amino-acid metabolites were noted during early reperfusion, while bile acid pathway derivatives and intermediates predominated in the late reperfusion phases. This indicates a potential for such an approach toward identification of the distinct phases of ischemia and reperfusion in clinical situations.
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Affiliation(s)
- Eric Goetzman
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15260, USA; (E.G.); (Z.G.); (D.R.)
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Zhenwei Gong
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15260, USA; (E.G.); (Z.G.); (D.R.)
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Dhivyaa Rajasundaram
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15260, USA; (E.G.); (Z.G.); (D.R.)
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Ishan Muzumdar
- School of Undergraduate Study, Penn State University, State College, PA 16802, USA;
| | - Traci Goodchild
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (T.G.); (D.L.)
| | - David Lefer
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (T.G.); (D.L.)
| | - Radhika Muzumdar
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15260, USA; (E.G.); (Z.G.); (D.R.)
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Correspondence:
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PI3K/Akt pathway mediates the positive inotropic effects of insulin in Langendorff-perfused rat hearts. Sci Rep 2022; 12:9793. [PMID: 35697740 PMCID: PMC9192604 DOI: 10.1038/s41598-022-14092-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/01/2022] [Indexed: 11/08/2022] Open
Abstract
Insulin exerts positive inotropic effects on cardiac muscle; however, the relationship between cardiac contractility and phosphoinositol-3-kinase/Akt (PI3K/Akt) activation remains unclear. We hypothesized that the positive inotropic effects of insulin are dose-dependent and mediated via the PI3K/Akt pathway in isolated normal rat hearts. The Institutional Animal Investigation Committee approved the use of hearts excised from rats under pentobarbital anesthesia. The hearts were perfused at a constant pressure using the Langendorff technique. After stabilization (baseline), the hearts were randomly divided into the following four insulin (Ins) groups: 1) Ins0 (0 IU/L), 2) Ins0.5 (0.5 IU/L), 3) Ins5 (5 IU/L), and 4) Ins50 (50 IU/L) (n = 8 in each group). To clarify the role of the PI3K/Akt pathway in insulin-dependent inotropic effects, we also treated the insulin groups with the PI3K inhibitor wortmannin (InsW): 5) InsW0 (0 IU/L), 6) InsW0.5 (0.5 IU/L), 7) InsW5 (5 IU/L), and 8) InsW50 (50 IU/L). Hearts were perfused with Krebs–Henseleit buffer solution with or without wortmannin for 10 min, followed by 20 min perfusion with the solution containing each concentration of insulin. The data were recorded as the maximum left ventricular derivative of pressure development (LV dP/dt max). Myocardial p-Akt levels were measured at 3 min, 5 min, and at the end of the perfusion. In the Ins groups, LV dP/dt max in Ins5 and Ins50 increased by 14% and 48%, respectively, 3 min after insulin perfusion compared with the baseline. Tachyphylaxis was observed after 10 min in the Ins5 and Ins50 treatment groups. Wortmannin partially inhibited the positive inotropic effect of insulin; although insulin enhanced p-Akt levels at all time points compared with the control group, this increase was suppressed in the presence of wortmannin. The positive inotropic effect of insulin is dose-dependent and consistent with Akt activation. This effect mediated by high doses of insulin on cardiac tissue was temporary and caused tachyphylaxis, potentially triggered by Akt overactivation, which leads beta 1 deactivation.
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Walter E, McKinlay J, Corbett J, Kirk-Bayley J. Review of management in cardiotoxic overdose and efficacy of delayed intralipid use. J Intensive Care Soc 2017; 19:50-55. [PMID: 29456602 DOI: 10.1177/1751143717705802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 51-year-old woman admitted to our intensive care unit following an intentional overdose of a calcium channel antagonist and a beta blocker. The resultant hypotension was reversed with glucagon, noradrenaline, calcium and high-dose insulin. Despite these interventions, she remained vasoplegic and received a delayed, standard dose of intralipid. Subsequently, the vasoplegia resolved rapidly, and the vasopressor was stopped. Here, we review the management of overdose of calcium channel and beta-adrenergic receptor blockers, concentrating on the pharmacology of lipid emulsion therapy. There remain some unanswered questions about lipid emulsion therapy: treatment with lipid therapy is usually advocated as soon as possible; this case report suggests that it remains efficacious even if its administration were delayed.
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Affiliation(s)
- Edward Walter
- Department of Intensive Care, Royal Surrey County Hospital, Guildford, UK
| | - James McKinlay
- Department of Intensive Care, Royal Surrey County Hospital, Guildford, UK
| | - Jade Corbett
- Department of Intensive Care, Royal Surrey County Hospital, Guildford, UK
| | - Justin Kirk-Bayley
- Department of Intensive Care, Royal Surrey County Hospital, Guildford, UK
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Wittebole X, Hantson P. High-dose insulin therapy in a case of subarachnoid hemorrhage-related severe cardiodepression with ischemic-like electrocardiographic changes. Indian J Crit Care Med 2013; 17:195-7. [PMID: 24082624 PMCID: PMC3777381 DOI: 10.4103/0972-5229.117091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Devos J, Peeters A, Wittebole X, Hantson P. High-dose insulin therapy for neurogenic-stunned myocardium after stroke. BMJ Case Rep 2012; 2012:bcr-2012-006620. [PMID: 23175002 DOI: 10.1136/bcr-2012-006620] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 44-year-old woman with a history of complicated type 2 diabetes mellitus presented with a diagnosis of right-hemispheric ischaemic stroke. She developed acute respiratory distress with radiological evidence of pulmonary oedema. The ECG showed poorly significant ST-segment changes, with a minimal increase of cardiac biomarkers. Echocardiography showed a severely depressed left ventricular function, with also low values of cardiac output at invasive monitoring. The possibility of neurogenic-stunned myocardium was discussed and a metabolic resuscitation with high-dose insulin was proposed. An intravenous bolus of 80 units of insulin (0.72 IU/kg) was followed by a continuous infusion at the rate of 160 IU/h (1.45 IU/kg/h). The treatment led to a rapid and sustained improvement of the haemodynamic condition and was well tolerated. In comparison with dobutamine, insulin had significant inotropic effects without tachycardia. The patient unfortunately died on day 35, from respiratory complications after poor neurological recovery.
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Affiliation(s)
- Justine Devos
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
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Winhofer Y, Krššák M, Janković D, Anderwald CH, Reiter G, Hofer A, Trattnig S, Luger A, Krebs M. Short-term hyperinsulinemia and hyperglycemia increase myocardial lipid content in normal subjects. Diabetes 2012; 61:1210-6. [PMID: 22396203 PMCID: PMC3331780 DOI: 10.2337/db11-1275] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increased myocardial lipid content (MYCL) recently has been linked to the development of cardiomyopathy in diabetes. In contrast to steatosis in skeletal muscle and liver, previous investigations could not confirm a link between MYCL and insulin resistance. Thus, we hypothesized that cardiac steatosis might develop against the background of the metabolic environment typical for prediabetes and early type 2 diabetes: combined hyperglycemia and hyperinsulinemia. Therefore, we aimed to prove the principle that acute hyperglycemia (during a 6-h clamp) affects MYCL and function (assessed by (1)H magnetic resonance spectroscopy and imaging) in healthy subjects (female subjects: n = 8, male subjects: n = 10; aged 28 ± 5 years; BMI 22.4 ± 2.6 kg/m(2)). Combined hyperglycemia (202.0 ± 10.6 mg/dL) and hyperinsulinemia (110.6 ± 59.0 μU/mL) were, despite insulin-mediated suppression of free fatty acids, associated with a 34.4% increase in MYCL (baseline: 0.20 ± 0.17%, clamp: 0.26 ± 0.22% of water signal; P = 0.0009), which was positively correlated with the area under the curve of insulin (R = 0.59, P = 0.009) and C-peptide (R = 0.81, P < 0.0001) during the clamp. Furthermore, an increase in ejection fraction (P < 0.0001) and a decrease in end-systolic volume (P = 0.0002) were observed, which also were correlated with hyperinsulinemia. Based on our findings, we conclude that combined hyperglycemia and hyperinsulinemia induce short-term myocardial lipid accumulation and alterations in myocardial function in normal subjects, indicating that these alterations might be directly responsible for cardiac steatosis in metabolic diseases.
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Affiliation(s)
- Yvonne Winhofer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Martin Krššák
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Draženka Janković
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian-Heinz Anderwald
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Metabolic Unit, Institute of Biomedical Engineering-National Research Council, Padova, Italy
- Medical Direction, Agathenhof, Specialized Hospital for Metabolic Diseases, Micheldorf, Austria
| | | | - Astrid Hofer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Radiodiagnostics, Centre of Excellence High-Field Magnetic Resonance, Medical University of Vienna, Vienna, Austria
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Corresponding author: Michael Krebs,
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Hantson P, Beauloye C. Myocardial metabolism in toxin-induced heart failure and therapeutic implications. Clin Toxicol (Phila) 2012; 50:166-71. [DOI: 10.3109/15563650.2012.658472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Klein LJ, van Campen CMC, Sieswerda GT, Kamp O, Visser FC. Effects of high-dose insulin infusion on left ventricular function in normal subjects. Neth Heart J 2011; 18:183-9. [PMID: 20428416 DOI: 10.1007/bf03091759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background. Only a few studies have reported on the effect of high-dose insulin (HDI) infusion on cardiac function in healthy volunteers. Methods. We studied ten healthy volunteers with low-dose dobutamine (LDD, 10 mug/kg/min) echo-cardio-graphy and HDI echocardiography (insulin administration for one hour) by volume and Doppler analysis. Results. During LDD, cardiac output increased from 5.7+/-1.3 l/min to 9.0+/-2.1 l/min (p<0.001) and during HDI from 5.5+/-1.2 l/min to 6.2+/-1.1 l/min (p=0.048). Increase was not only due to increase in frequency, which was only present in the LDD study, but also due to increase in stroke volume (from 82+/-15 ml to 110+/-23 ml, p<0.001 during LDD and from 82+/-16 ml to 93+/-24 ml, p=0.014 during HDI). The increase in stroke volume was the result of a decrease in end-systolic volume with an unchanged end-diastolic volume. Conclusion. High-dose insulin infusion results in increased cardiac output by improving systolic myocardial function. (Neth Heart J 2010;18:183-9.).
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Affiliation(s)
- L J Klein
- Department of Cardiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
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