{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T09:56:26Z","timestamp":1760608586179},"reference-count":31,"publisher":"Portland Press Ltd.","issue":"1","content-domain":{"domain":["portlandpress.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2010,7,1]]},"abstract":"<jats:p>Despite the evidence in experimental animal models that insulin, or GIK (glucose\u2013insulin\u2013potassium), improves left ventricular function and perfusion during both acute and chronic ischaemia, clinical studies have generated conflicting results. We tested the hypothesis that pretreatment with GIK attenuates the vascular and functional effects of stress-induced myocardial ischaemia in humans. Twenty-two patients with evidence of inducible myocardial ischaemia were enrolled; 11 patients with normal ventricular function underwent two dipyridamole echocardiography tests, and 11 with regional contractility defects from previous myocardial infarction were submitted to two ECG exercise tests combined with 201Tl myocardial perfusion scintigraphy; the tests were preceded by 60\u00a0min of either normal saline or an isoglycaemic GIK infusion. On a stress echocardiogram, a 30% reduction in the severity of ischaemia was observed. On ECG ergometry, GIK infusion slightly increased the time to ischaemia (+0.6\u00a0min, P=0.07); however, the higher workload (+8%, P=0.07) was achieved at a similar rate\u2013pressure plateau. On scintigraphy, an increase in ischaemic segments (+48%, P&amp;lt;0.001) was imaged mainly at the expense of viable (but non-ischaemic) and non-viable segments, which were reduced by 60%. GIK affected stress-induced left ventricular underperfusion only marginally (GIK: 39.7\u00b12.5 compared with saline: 35.4\u00b12.2\u00a0units, P&amp;lt;0.05), but significantly improved its acute reversibility (\u221242\u00b14 compared with \u221225\u00b14%, P&amp;lt;0.001). We conclude that GIK pretreatment attenuates the effect of ischaemia on myocardial contractility, slightly improves exercise tolerance and causes a more rapid and diffuse recovery of post-ischaemic reperfusion.<\/jats:p>","DOI":"10.1042\/cs20090438","type":"journal-article","created":{"date-parts":[[2009,12,16]],"date-time":"2009-12-16T10:48:09Z","timestamp":1260960489000},"page":"37-44","update-policy":"http:\/\/dx.doi.org\/10.1042\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effects of GIK (glucose\u2013insulin\u2013potassium) on stress-induced myocardial ischaemia"],"prefix":"10.1042","volume":"119","author":[{"given":"Stefano","family":"Di\u00a0Marco","sequence":"first","affiliation":[{"name":"Division of Cardiology, Pescia General Hospital, Pescia, Italy"}]},{"given":"Beatrice","family":"Boldrini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Pisa, Pisa, Italy"}]},{"given":"Umberto","family":"Conti","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, S. Chiara Hospital, Pisa, Italy"}]},{"given":"Gabriella","family":"Marcucci","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Prato General Hospital, Prato, Italy"}]},{"given":"Cecilia","family":"Morgantini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Pisa, Pisa, Italy"}]},{"given":"Ele","family":"Ferrannini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Pisa, Pisa, Italy"}]},{"given":"Andrea","family":"Natali","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Pisa, Pisa, Italy"}]}],"member":"288","published-online":{"date-parts":[[2010,4,7]]},"reference":[{"key":"2021113010123801000_B1","first-page":"E308","article-title":"Metabolic and hemodynamic effects of insulin on human hearts","volume":"264","author":"Ferrannini","year":"1993","journal-title":"Am. J. Physiol."},{"key":"2021113010123801000_B2","doi-asserted-by":"crossref","first-page":"2911","DOI":"10.1161\/01.CIR.92.10.2911","article-title":"Effect of insulin on acetylcholineinduced vasodilation in normal subjects and in patients with essential hypertension","volume":"92","author":"Taddei","year":"1995","journal-title":"Circulation"},{"key":"2021113010123801000_B3","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.1007\/s001250100025","article-title":"Glucose\u2013insulin\u2013potassium treatment in combination with dipyridamole inhibits ischaemia\u2013reperfusion-induced damage","volume":"44","author":"Bertuglia","year":"2001","journal-title":"Diabetologia"},{"key":"2021113010123801000_B4","first-page":"H554","article-title":"Modulation of transmembrane potential of isolated cardiac myocytes by insulin and isoproterenol","volume":"259","author":"Eckel","year":"1990","journal-title":"Am. J. Physiol."},{"key":"2021113010123801000_B5","first-page":"E17","article-title":"Insulin action on membrane potential and glucose uptake: effects of high potassium","volume":"249","author":"Zierler","year":"1985","journal-title":"Am. J. Physiol."},{"key":"2021113010123801000_B6","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1161\/01.RES.52.5.515","article-title":"Determinants of a protective effect of glucose and insulin on the ischemic myocardium. Effects on contractile function, diastolic compliance, metabolism, and ultrastructure during ischemia and reperfusion","volume":"52","author":"Apstein","year":"1983","journal-title":"Circ. Res."},{"key":"2021113010123801000_B7","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1172\/JCI109027","article-title":"Sustained effect of glucose\u2013insulin\u2013potassium on myocardial performance during regional ischemia. Role of free fatty acid and osmolality","volume":"61","author":"Ahmed","year":"1978","journal-title":"J. Clin. Invest."},{"key":"2021113010123801000_B8","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1023\/A:1006886601825","article-title":"Free fatty acid metabolism during myocardial ischemia and reperfusion","volume":"166","author":"Hendrickson","year":"1997","journal-title":"Mol. Cell. Biochem."},{"key":"2021113010123801000_B9","first-page":"E953","article-title":"Independent stimulation of glucose metabolism and Na+\/K+ exchange by insulin in the human forearm","volume":"255","author":"Ferrannini","year":"1988","journal-title":"Am. J. Physiol."},{"key":"2021113010123801000_B10","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1161\/01.CIR.93.7.1403","article-title":"Insulin modulation of \u03b2-adrenergic vasodilator pathway in human forearm","volume":"93","author":"Lembo","year":"1996","journal-title":"Circulation"},{"key":"2021113010123801000_B11","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1001\/jama.293.4.437","article-title":"Effect of glucose\u2013insulin\u2013potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial","volume":"293","author":"Mehta","year":"2005","journal-title":"JAMA, J. Am. Med. Assoc."},{"key":"2021113010123801000_B12","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1093\/eurheartj\/ehi199","article-title":"Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity","volume":"26","author":"Malmberg","year":"2005","journal-title":"Eur. Heart J."},{"key":"2021113010123801000_B13","doi-asserted-by":"crossref","first-page":"H595","DOI":"10.1152\/ajpheart.2000.278.2.H595","article-title":"Glucose\u2013insulin\u2013potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs","volume":"278","author":"Zhu","year":"2000","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"2021113010123801000_B14","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.amjcard.2005.07.060","article-title":"Effect of glucose\u2013insulin\u2013potassium infusion on myocardial damage due to percutaneous coronary revascularization","volume":"96","author":"Yazici","year":"2005","journal-title":"Am. J. Cardiol."},{"key":"2021113010123801000_B15","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/0002-9149(62)90035-8","article-title":"Effects of an intravenous infusion of a potassium\u2013glucose\u2013insulin solution on the electrocardiographic signs of myocardial infarction. A preliminary clinical report","volume":"9","author":"Sodi-Pallares","year":"1962","journal-title":"Am. J. Cardiol."},{"key":"2021113010123801000_B16","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1161\/01.CIR.49.6.1028","article-title":"Ineffectiveness of glucose, potassium, and insulin infusion during pacing stress in chronic ischemic heart disease","volume":"49","author":"Lesch","year":"1974","journal-title":"Circulation"},{"key":"2021113010123801000_B17","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1161\/01.CIR.61.2.266","article-title":"Effects of low and high glucose in a glucose\u2013insulin\u2013potassium infusion on hemodynamics and exercise tolerance in patients with angina pectoris","volume":"61","author":"Thadani","year":"1980","journal-title":"Circulation"},{"key":"2021113010123801000_B18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1136\/heart.89.1.61","article-title":"Effects of glucose\u2013insulin\u2013potassium infusion on chronic ischaemic left ventricular dysfunction","volume":"89","author":"Khoury","year":"2003","journal-title":"Heart"},{"key":"2021113010123801000_B19","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.echo.2006.01.013","article-title":"Glucose\u2013insulin\u2013potassium echocardiography detects improved segmental myocardial function and viable tissue shortly after acute myocardial infarction","volume":"19","author":"Klein","year":"2006","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"2021113010123801000_B20","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00259-005-1779-y","article-title":"EANM\/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology","volume":"32","author":"Hesse","year":"2005","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"2021113010123801000_B21","first-page":"508","article-title":"Beneficial haemodynamic effects of insulin in chronic heart failure","volume":"85","author":"Parsonage","year":"2001","journal-title":"Heart"},{"key":"2021113010123801000_B22","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.ahj.2008.06.009","article-title":"Effects of exogenous metabolic substrate modulation on exercise-induced myocardial ischemia","volume":"156","author":"Bogaty","year":"2008","journal-title":"Am. Heart. J."},{"key":"2021113010123801000_B23","doi-asserted-by":"crossref","first-page":"H1345","DOI":"10.1152\/ajpheart.2000.278.4.H1345","article-title":"Myocardial substrate metabolism influences left ventricular energetics in vivo","volume":"278","author":"Korvald","year":"2000","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"2021113010123801000_B24","first-page":"1377","article-title":"Detecting hibernated myocardium with SPECT and thallium\u2013glucose\u2013insulin infusion","volume":"36","author":"Tartagni","year":"1995","journal-title":"J. Nucl. Med."},{"key":"2021113010123801000_B25","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1161\/01.CIR.60.4.776","article-title":"Myocardial kinetics of thallium and potassium in man","volume":"60","author":"L'Abbate","year":"1979","journal-title":"Circulation"},{"key":"2021113010123801000_B26","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1161\/01.CIR.56.2.188","article-title":"The extraction of thallium-201 by the myocardium","volume":"56","author":"Weich","year":"1977","journal-title":"Circulation"},{"key":"2021113010123801000_B27","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1161\/01.CIR.68.1.203","article-title":"Effect of glucose\u2013insulin\u2013potassium infusion on thallium myocardial clearance","volume":"68","author":"Wilson","year":"1983","journal-title":"Circulation"},{"key":"2021113010123801000_B28","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1378\/chest.89.2.195","article-title":"The effect of eating on thallium myocardial imaging","volume":"89","author":"Wilson","year":"1986","journal-title":"Chest"},{"key":"2021113010123801000_B29","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/BF02984561","article-title":"Evaluation of myocardial viability following acute myocardial infarction using 201Tl SPECT after thallium\u2013glucose\u2013insulin infusion: comparison with 18F-FDG positron emission tomography","volume":"18","author":"Toyama","year":"2004","journal-title":"Ann. 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