{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:16:55Z","timestamp":1791515815610,"version":"4.3.4"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"Abstract<\/jats:title>\n Objective<\/jats:title>\n This study investigates the efficacy of using a long-acting insulin analog, along with the infusion of regular insulin, in achieving appropriate glycemic control and correcting lactic acidosis in patients post orthotopic heart transplant who demonstrate severe lactic acidosis and insulin resistance.<\/jats:p>\n <\/jats:sec>\n Methods<\/jats:title>\n This was a retrospective study of two cohorts (IRB FLA 20-003) of patients post orthotopic heart transplant with severe lactic acidosis and insulin resistance who were admitted to a tertiary intensive care unit and treated with (group 1) or without long-acting insulin analog (group 2) within the first 24\u00a0h of admission to the intensive care unit. Insulin resistance is defined as the requirement for intravenous regular insulin infusion of more than 20 units\/h without the ability to achieve appropriate serum glucose level (120\u2013180\u00a0mg \/dL). Severe lactic acidosis is defined as arterial lactic acid of more than 10\u00a0mmol\/L. The following parameters were investigated: time to correct lactic acidosis, duration of postoperative mechanical ventilation, the need for periprocedural mechanical circulatory support, and 28-day mortality.<\/jats:p>\n <\/jats:sec>\n Results<\/jats:title>\n The 28-day mortality was zero in both groups. Two patients required periprocedural mechanical support in group one, and ten patients required mechanical support in group two (RR\u2009=\u20090.224, 95%, confidence interval 0.052\u20130.95, Z\u2009=\u20092.029, p\u2009=\u20090.042). Three patients required tracheostomy in group one, and four patients required tracheostomy in group two (RR 0.84, 95 confidence interval 0.20\u20133.48, Z\u2009=\u20090.23, P\u2009=\u20090.81). Wilcoxon rank-sum test was used to compare time to correct lactic acidosis, with lactic acid resolution being faster in group one ($$\\overline{X}$$<\/jats:tex-math>\n \n X<\/mml:mi>\n \u00af<\/mml:mo>\n <\/mml:mover>\n <\/mml:math><\/jats:alternatives><\/jats:inline-formula>1<\/jats:sub>\u2009=\u200919.7\u00a0h, SD\u2009\u00b1\u200912.6\u00a0h $$\\overline{X}$$<\/jats:tex-math>\n \n X<\/mml:mi>\n \u00af<\/mml:mo>\n <\/mml:mover>\n <\/mml:math><\/jats:alternatives><\/jats:inline-formula>2<\/jats:sub>\u2009=\u200929.3\u00a0h, SD\u2009\u00b1\u200919.6\u00a0h, Z-value \u2212\u00a02.02, p-value 0.043). The duration of mechanical ventilation was less in group one ($$\\overline{X}$$<\/jats:tex-math>\n \n X<\/mml:mi>\n \u00af<\/mml:mo>\n <\/mml:mover>\n <\/mml:math><\/jats:alternatives><\/jats:inline-formula>1<\/jats:sub>\u2009=\u200929\u00a0h, SD\u2009\u00b1\u200912.7\u00a0h, $$\\overline{X}$$<\/jats:tex-math>\n \n X<\/mml:mi>\n \u00af<\/mml:mo>\n <\/mml:mover>\n <\/mml:math><\/jats:alternatives><\/jats:inline-formula>2<\/jats:sub>\u2009=\u200955.1\u00a0h, SD\u2009\u00b1\u200944.5\u00a0h, Z-value: \u2212\u00a01.92, p-value 0.05).<\/jats:p>\n <\/jats:sec>\n Conclusion<\/jats:title>\n Administration of low-dose long-acting insulin glargine led to the resolution of the lactic acidosis, insulin resistance, and decreased requirements for pressor and inotropic support, which led to decreased need for mechanical circulatory support.<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s13019-024-02543-y","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T17:02:08Z","timestamp":1708102928000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Resolution of insulin resistance, lactic acidosis, and decrease in mechanical support requirements in patients post orthotopic heart transplant with the use of long-acting insulin glargine"],"prefix":"10.1186","volume":"19","author":[{"given":"Ribal","family":"Darwish","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Minear","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Sheffield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"issue":"2","key":"2543_CR1","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/S0003-4975(99)00014-4","volume":"67","author":"AP Furnary","year":"1999","unstructured":"Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67(2):352\u201360 (discussion 360\u2013362).","journal-title":"Ann Thorac Surg"},{"issue":"5","key":"2543_CR2","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1067\/mtc.2003.181","volume":"125","author":"AP Furnary","year":"2003","unstructured":"Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(5):1007\u201321.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2543_CR3","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1002\/ejhf.1170","volume":"20","author":"PM Seferovic","year":"2018","unstructured":"Seferovic PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, Paulus WJ, Komajda M, Cosentino F, de Boer RA, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:853\u201372.","journal-title":"Eur J Heart Fail"},{"issue":"2","key":"2543_CR4","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1093\/eurjhf\/hfq204","volume":"13","author":"N Uriel","year":"2011","unstructured":"Uriel N, et al. Improved diabetic control in advanced heart failure patients treated with left ventricular assist devices. Eur J Heart Fail. 2011;13(2):195\u20139.","journal-title":"Eur J Heart Fail"},{"issue":"1","key":"2543_CR5","doi-asserted-by":"publisher","first-page":"44","DOI":"10.4062\/biomolther.2016.128","volume":"25","author":"S Mangmool","year":"2017","unstructured":"Mangmool S, et al. beta-adrenergic receptor and insulin resistance in the heart. Biomol Ther (Seoul). 2017;25(1):44\u201356.","journal-title":"Biomol Ther (Seoul)"},{"issue":"18","key":"2543_CR6","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.1161\/CIRCULATIONAHA.110.988642","volume":"123","author":"M Ciccarelli","year":"2011","unstructured":"Ciccarelli M, et al. G protein-coupled receptor kinase 2 activity impairs cardiac glucose uptake and promotes insulin resistance after myocardial ischemia. Circulation. 2011;123(18):1953\u201362.","journal-title":"Circulation"},{"issue":"8","key":"2543_CR7","doi-asserted-by":"publisher","first-page":"2676","DOI":"10.2337\/db13-1763","volume":"63","author":"Q Fu","year":"2014","unstructured":"Fu Q, et al. Insulin inhibits cardiac contractility by inducing a Gi-biased beta2-adrenergic signaling in hearts. Diabetes. 2014;63(8):2676\u201389.","journal-title":"Diabetes"},{"key":"2543_CR8","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1093\/eurheartj\/ehp396","volume":"31","author":"SA Cook","year":"2010","unstructured":"Cook SA, Varela-Carver A, Mongillo M, Kleinert C, Khan MT, Leccisotti L, Strickland N, Matsui T, Das S, Rosenzweig A, et al. Abnormal myocardial insulin signalling in type 2 diabetes and left-ventricular dysfunction. Eur Heart J. 2010;31:100\u201311.","journal-title":"Eur Heart J"},{"issue":"1","key":"2543_CR9","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3892\/etm.2014.1688","volume":"8","author":"J Li","year":"2014","unstructured":"Li J, Feng Z, Li Q, He Y, Zhao C, He J. Insulin glargine effectively achieves glycemic control and improves insulin resistance in patients with early type 2 diabetes that exhibit a high risk for cardiovascular disease. Exp Ther Med. 2014;8(1):147\u201352. https:\/\/doi.org\/10.3892\/etm.2014.1688.","journal-title":"Exp Ther Med"},{"key":"2543_CR10","first-page":"621","volume":"16","author":"J Koglin","year":"1997","unstructured":"Koglin J, Gross T, Uberfuhr P, von Scheidt W. Time-dependent decrease of presynaptic inotropic supersensitivity: physiological evidence of sympathetic reinnervation after heart transplantation. J Heart Lung Transplant. 1997;16:621\u20138.","journal-title":"J Heart Lung Transplant"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-024-02543-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-024-02543-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-024-02543-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T17:08:02Z","timestamp":1708103282000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-024-02543-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,16]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2543"],"URL":"https:\/\/doi.org\/10.1186\/s13019-024-02543-y","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,16]]},"assertion":[{"value":"13 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"99"}}