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2006, Number S4

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Arch Cardiol Mex 2006; 76 (S4)

Metabolicc support of the ischemic heart during cardiac surgery

Luna OP, Serrano VX, Rojas PE, de Micheli A

Language: Spanish
References: 68
Page: 121-136
PDF size: 178.00 Kb.


ABSTRACT

We examine [ibm1] the basic principles and clinical results of the metabolic intervention with glucose-insulin-potassium (GIK) solutions in the field of cardiovascular surgery. On the basis of many international publications concerning this subject, and the experience obtained in the operating room of the Instituto Nacional de Cardiología “Ignacio Chávez”, we conclude that the metabolic support wit GIK is a powerful system that provides very useful energy to protect the myocardium during cardiac and non-cardiac surgery. The most recent publications indicate their effects in reducing low output syndromes, due to interventions on the coronary arteries, as well as producing a significant reduction of circulating fatty acids. These effects are produced also in the field of interventional cardiology, where GIK solutions protect the myocardium against damage due to impaired microcirculation. It is evident that these solutions must be utilized in higher concentrations that the initial ones, equal to those employed in laboratory animals. On the other side, it is worthy to remember that it has been always underlined that this treatment represents only a protection for the myocardium. Therefore, its association with other drugs or treatments favoring a good myocardial performance is not contraindicated –on the contrary, it yields better results. The present review presents pharmacological approaches, such as the use of glutamato, aspartate, piruvato, trimetazidina ranolazine and taurine to optimize cardiac energy metabolism, for the management of ischemic heart disease.


REFERENCES

  1. Stanley WC, Lopaschuk GD, Hall JL: Regulation of myocardial carbohydrate metabolism under normal and ischemic conditions: potencial for pharmacological interventions. Cardiovasc Res l997; 33: 243-57.

  2. Balaban RS, Kantor HL, Katz LA, Briggs RW: Relation between work and phosphate metabolite in the in vivo paced mammalian heart. Science 1986; 232: 1121-3.

  3. Wisneski JA, Stanley WC, Gertz EW, Neese RA: Effects of hyperglycemia on myocardial glycolytic activity in normal humans. J Clin Invest 1990; 85: 1648-56.

  4. Wisneski JA, Gertz EW, Neese RA: Myocardial metabolism of free fatty acid. J Clin Invest 1987; 79: 359-66.

  5. Lopaschuk GD, Belke DD, Gamble J, Itoi T, Schonekess BO: Regulation of fatty acid oxidation in the mammalian heart in health and disease. Biochem Byophys Acta 1994; 1213: 263-76.

  6. Hansford RG, Cohen L: Relative importance of piruvate dehydrogenase intercorversion and feed- back inhibition in the effect of fatty acids on piruvate oxidation by rat heart mitochondria. Arch Biochem Byophis 1978; 191: 65-81.

  7. Lassers BW, Wahlqvist ML, Kaijser L: Effect of nicotinic acid on myocardial metabolism in man at rest and during exercise. J Appl Physiol 1972; 33: 72-80.

  8. Schwartz GG, Greyson G, Wisneski JA: Inhibition of fatty acid metabolism alters myocardial high-energy phosphates in vivo. Am J Physiol 1994; 267: H224-31.

  9. Kantor PF, Lucien A, Kozak R, Lopaschuk GD: The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucosa oxidation by inhibiting mitochondrial long-chain 3-ketoacyl coenzyme A thiolase. Circ Res 2000; 86: 580-8.

  10. Stone CK, Holden J, Stanley WC: Effects of substrate availability upon cardiac glucose uptake. J Nucl Med 1995; 36: 996-1002.

  11. Bolukoglu H, Goodwin GW, Guthrie PH: Metabolic fate of glucose in reversible low-flow ischemia of the isolated working rat heart. Am J Physiol 1996; 270: H817-H826.

  12. Stanley WC , Hall JL, Stone CK: Acute myocardial ischemia causes a transmural gradient in glucose extraction but not glucose uptake. Am J Physiol 1992; 262: H91-H96.

  13. King LM, Boucher F, Opie LH: Coronary flow and glucose delivery as determinant of contracture in the ischemic myocardium. J Mol Cell Cardiol 1995; 27: 701-720.

  14. Ren-fu Y, Hu X, Russel R: Translocation of glucosa transporter isoform in vivo: Effects of hyperinsulinemia and low flow ischemia in the canine heart. Abstract Circulation 1995; 92(Supl1): 769.

  15. Goulston A: West indian cane sugar in the treatment of certain forms of heart disease. BMJ 1912, ii: 693-695.

  16. Budingen E: Uber die Möglichkeit einer Ernahrungs-behandlung des Herzmuskels durch Einbringung von Traubenzuckerlosungen. Arch Klin Med 1914; 114: 534-579.

  17. Sodi-Pallares D, Testelli MR, Fishleder BL, Bisteni A, Medrano GA, Friedland C Michelli AD: Effects of intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol 1962; 9: 166-18.

  18. Gradinac S, Coleman GM, Taegtmeyer H, Sweeney MS, Frazier OH: Improved cardiac function with glucose-insulin-potassium after coronary bypass surgery. Ann Thorac Surg 1989; 48: 84-489.

  19. Taegtmeyer H: Metabolic support for the postischemic heart. Lancet 1995; 345: 1552-1555.

  20. Diaz R, Paolasso E, Piegas LS, Tajer CD, Gil Moreno M, Corvalan R, Isea J, Romero G: Metabolic modulation of acute myocardial infarction. The ECLA glucose-insulin-potassium pilot trial. Circulation 1998; 98: 2227-34.

  21. Fait-Ordoubadi F, Beatt KJ: Glucose-insulin-potassium therapy for treatment of acute myocardial infarction. Circulation 1997; 96: 1152-6.

  22. Lazar HL, Zhang X, Rivers S, Bernard S, Shemin RJ: Limiting ischemic damage during urgent revascularization using glucose-insulin-potassium solutions. Ann Thorac Surg 1995; 60: 411-6.

  23. Lazar HL, Philippides G, Fitzgerald C, LancasterD, Shemin RJ, Apstein C: Glucose-insulin-potassium solutions enhance recovery following urgent CABG surgery. J Thorac Cardiovasc Surg 1997; 113: 354-62.

  24. Lazar HL, Chipkin S, Pilippides G, Bao Y, Apstein C: Glucose–insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations. Ann Thorac Surg 2000; 70: 145-50.

  25. De Micheli A, Medrano GA: Utlidad de la terapéutica metabólica GIK en cirugía de cardíacos. Arch Cardiol Mex 2004; 74(3): 215-219.

  26. Hess ML, O’Kabe E, Poland J, Werner M, Steweret JR, Grenfield LJ: Glucose Insulin, potassium protection during the course of hypothermic global ischemia and reperfusion; a new proponed mechanism by the scavenging of free radicals. J Cardiovasc Pharmacol. 1983; 5: 35-42.

  27. De Micheli A, Cháves E: Consideraciones sobre el daño miocárdico por isquemia y reperfusión. Arch Cardiol Mex 2003; 73(4): 284-290.

  28. Opie LH: The Heart physiology, from cell to circulation. 3rd Ed. Philadelphia. Lippincott-Raven, 1998.

  29. Cahill GF: Starvation in man. New Engl J Med 1970; 282: 668-675.

  30. Persson E, Nordenstrom J, Nilsson-Ehle P, Hagenfeldt L, Wahren J: Plasma lipolytic activity and substrate oxidation after intravenous administration of heparin and a low molecular weight heparin fragment. Clin Physiol 1990; 10: 573-583.

  31. Malmstrom R, Packard CJ, Caslake M. Bedford D, Stewart P, Shepherd J, Taskinen MR: Effect of heparin-stimulated plasma lipolytic activity on VLDL APO B subclass metabolism in normal subjects. Atherosclerosis 1999; 146: 381-390.

  32. Oliver MF: Metabolic causes and prevention of ventricular fibrillation during acute coronary syndromes. Am J Med 2002; 112: 305-311.

  33. Neely JR, Morgan HE: Relationship between carbohydrate and lipid metabolism and the energy balance of the heart muscle. Ann Rev Physiol 1974; 36: 413-459.

  34. Lopaschuk GD, Wambolt RB, Barr RL: An imbalance between glycolysis and glucose oxidation is a possible explanation for the detrimental effects of high levels of fatty acids during aerobic reperfusion of ischemic heart. J Pharm Exp Ther 1993; 264: 135-144.

  35. Longnus SL, Wambolt RB, Barr RL, Lopaschuk GD, Allard MF: Regulation of myocardial fatty acid oxidation by substrate supply. Am J Physiol Heart Cir Physiol 2001; 281: H1561-H1567.

  36. Bothe W, Olschewski M, Beyersdorf F. Doenst TL: Glucose-Insulin-Potassium in Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg 2004; 78: 1650-8

  37. Schwaiger M, Neese RA, Araujo L, Araujo L, Wyns W, Wisneski JA: Sustained nonoxidative glucose utilization and depletion of glycogen in reperfused canine myocardium. J Am Coll Cardiol 1989; 13: 745-754.

  38. Zhu P, Lu L, Xu Y: Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol 2000; 278: H595-H603.

  39. King LM, Opie LH: Glucose delivery is a major determinant of glucose utilization in the ischemic myocardium with a residual coronary flow. Cardiov Res 1998; 39: 381-392.

  40. Egert S, Nguyen N, Schwaiger M: Contribution of alpha adrenergic and beta adrenergic stimulation to ischemia induced glucose transporter GLUT 4 and GLUT 1 translocation in the isolated perfused rat heart. Circ Res 1999; 84; 1407-1415.

  41. Russel RR, Bergeron R, Shulman GI, et al: Translocation of myocardial GLUT 4 and increased glucose uptake through activation of AMPK by AICAR. Am J Physiol Heart Circ Physiol. 1999; 277: H643-H649.

  42. Brinkman JF, Abumrad NA, Ibrahimi A: New insights into long-chain fatty acid uptake by heart muscle: A crucial role for fatty acid translocase/CD36. Biochem J 2002; 367: 561-570.

  43. Lopaschuk GD, Belke DD, Gamble J, et al: Regulation of fatty acid oxidation in the mammalian heart in health and disease. Biochem Byophys Acta 1994; 1213: 263-276.

  44. Terrand J, Papageorgiou I, Rosenblat-Velin N, et al: Calcium-mediated activation of pyruvate dehydrogenase in severely injured postischemic myocardium. Am J Physiol Heart Circ Physiol 2001; 281: H722-H730.

  45. Montessuit C, Papageorgiou I, Tardy-Cantalupi I, et al: Postischemic recovery of heart metabolism and function: Role of mitochondrial fatty acid transfer. J Appl Physol 2000; 89: 11-119.

  46. Pietersen HG, Langenberg CJM, Geskes G, Kester A, de Lange S Van der Vusse JG: Myocardial substrate uptake and oxidation during and after routine cardiac surgery. J Thorac Cardiovasc Surg 1999; 118: 71-84.

  47. Khoury VK, Haluska B, Prins J, Marwick T H: Effects of glucose –insulin-potassium infusion on chronic ischaemic left ventricular dysfunction. Heart 2003; 89: 61-65.

  48. Das UN: Is Insulin an endogenous cardioprotector? Critical Care 2002; 6: 389-393.

  49. Lopaschuk GD, Rebeyka IM, Allard MF: Metabolic modulation. A means to mend a broken heart. Circulation 2002; 105: 140-142.

  50. Lopaschuk GD, Stanley WC: Glucose metabolism in the ischemic heart. Circulation 1997; 95: 313-315.

  51. El Banani H, Bernard M, Baetz D: Changes in intracellular sodium and PH during ischemia-reperfusion are attenuated by trimetazidine. Cardiovasc Res 2000; 4: 688-696.

  52. Kjellman U, Bjork K, Ekroth R: Alpha-ketoglutarat for myocardial protection in heart surgery. Lancet 1995; 345: 552-553.

  53. Svedjeholm R, Huljebrant I, Hakanson E: Glutamate and high-dose glucose-insulin-potassium in the treatment of severe cardiac failure after cardiac operations. Ann Thorac Surg 1995; 59: 523-530.

  54. Mentzer RM, van Wylen DGL, Sodhi J Weiss RJ, Lasley RD, Willis J: Effects of piruvate on regional ventricular function in normal and stunned myocardium. Ann Surg 1989; 209: 629-634.

  55. Yazici M, Demircan S, Durna K, Yasar E, Zeydin Acar , Shain M: Effect of Glucose-Insulin-Potassium Infusion on Myocardial Damage Due to Percutaneous Coronary Revascularization. Am J Cardiol 2005; 96: 1517-1520.

  56. Krljanac G, Vasiljevié Z, Radovanovié M, Stankovie G, Milie N, Stefanovie B: Effects of Glucose-Insulin-Potassium Infusion on ST-Elevation Myocardial Infarction in Patients Treated With Thromboytic Therapy. Am J Cardiol 2005; 96: 1053-1058.

  57. van der Horst ICC, Zijlstra F, van J van’t Hof AWJ, Carine JM, Menko-Jan de Boer, Suryapranata H: Glucose-Insulin –Potassium Infusion in Patients treated with Primary Angioplasty for acute myocardial infarction. J Am Coll Cardiol 2003; 42: 784-91.

  58. Khatta M, Alexander BS, Krichten CM, Fhisher ML, Freudenberger R, Robinson SW: The effect of coenzyme Q 10 in patients with congestive heart failure. Ann Int Med 2000; 132: 636-640.

  59. Bünger R, Mallet RT, Hartman DA: Pyruvate-enhanced phosphorylation potencial and inotropism in normoxic and postischemic isolated working heart. Eur J Biochem 1988; 180: 221-233.

  60. Mentzer RM, van Wylen DGL, Sodhi J, Weiss RJ, Lasley RD, Wilis J: Effect of pyruvate on regional ventricular function in normal and stunned myocardium. Ann of Surg 1989; 209: 629-634.

  61. Hermann HP, Pieske B, Schwarzmüller E, Keul J, Just H, Hasenfuss G: Haemodynamic effects of intracoronary pyruvate in patients with congestive heart failure. Lancet 1999; 353: 1321-1323.

  62. Hermann HP, Zeitz O, Keweloh B, Hasenfuss G, Janssen PML: Pyruvate potentiates inotropic effects of isoproterenol and Ca2 + in rabbit cardiac muscle preparations. Am J Physiol Heart Circ Physiol 2000; 279: H702-H708.

  63. Lopaschuk, GD, Marzilli M: Mode of Action of trimetazidine and other new metabolic agents in the treatment of ischemic heart disease. Seminars in cardiothoracic and Vasc Anesth 2003; 7(1): 91-96.

  64. Milei J, Ferreira R, Llesu S, et al: Reduction of reperfusion injury with preoperative rapid intravenous infusion of taurine during myocardial revascularization. Am Heart J 1992; 123: 339-345.

  65. Folkers K, Langsjoen P, Langsjoen PH: Therapy with coenzyme Q 10 of patients in heart failure who are eligible or in eligible for a transplant. Biochem Biophys Res Commun 1992; 182: 247-253.

  66. Quinn DW, Pagano D, Bonser RS, Rooney SJ, Graham TR, Wilson IC: Study Investigators . Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial. J Thorac Cardiovasc Surg. 2006; 131: 34-42.

  67. Ranasinghe AM, McCabe CJ, Quinn DW, James SR, Pagano D, Franklyn JA, Bonser RS: How does glucose-insulin-potassium improve hemodynamic performance? Evidence for altered expression of Beta-Adrenoceptor and Calcium handling genes. Circulation 2006; 114(Suppl I): I239-I244.

  68. Ranasinghe AM, Quinn DW, Pagano D, Edwards N, Faroqui M, Graham TR: Glucose-insulin-potassium and Tri-Iodothyronine individually improve hemodynamic performance and are associated with reduced Troponin I release after On-pump coronary artery bypass grafting. Circulation 2006; 114(Suppl I): I245-I250.




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