Journal article
An Experimental Series Investigating the Effects of Hyperinsulinemic Euglycemia on Myocardial Blood Flow Reserve in Healthy Individuals and on Myocardial Perfusion Defect Size following ST-Segment Elevation Myocardial Infarction
Journal of the American Society of Echocardiography, Vol.33(7), pp.868-877
2020
Abstract
Background: Incomplete restoration of myocardial blood flow (MBF) is reported in up to 30% of ST-segment elevation myocardial infarction (STEMI) despite prompt mechanical revascularization. Experimental hyperinsulinemic euglycemia (HE) increases MBF reserve (MBFR). If fully exploited, this effect may also improve MBF to ischemic myocardium. Using insulin-dextrose infusions to induce HE, we conducted four experiments to determine (1) how insulin infusion duration, dose, and presence of insulin resistance affect MBFR response; and (2) the effect of an insulin-dextrose infusion given immediately following revascularization of STEMI on myocardial perfusion. Methods: The MBFR was determined using myocardial contrast echocardiography. Experiment 1 (insulin duration): 12 participants received an insulin-dextrose or saline infusion for 120 minutes. MBFR was measured at four time intervals during infusion. Experiment 2 (insulin dose): 22 participants received one of three insulin doses (0.5, 1.5, 3.0 mU/kg/minute) for 60 minutes. Baseline and 60-minute MBFRs were determined. Experiment 3 (insulin resistance): five metabolic syndrome and six type 2 diabetes (T2DM) participants received 1.5 mU/kg/minute of insulin-dextrose for 60 minutes. Baseline and 60-minute MBFRs were determined. Experiment 4 (STEMI): following revascularization for STEMI, 20 patients were randomized to receive either 1.5 mU/kg/minute insulin-dextrose infusion for 120 minutes or standard care. Myocardial contrast echocardiography was performed at four time intervals to quantify percentage contrast defect length. Results: Experiment 1: MBFR increased with time through to 120 minutes in the insulin-dextrose group and did not change in controls. Experiment 2: compared with baseline, MBFR increased in the 1.5 (2.42±0.39 to 3.25±0.77, P = .002), did not change in the 0.5, and decreased in the 3.0 (2.64±0.25 to 2.16±0.33, P = .02) mU/kg/minute groups. Experiment 3: compared with baseline, MBFR increase was only borderline significant in metabolic syndrome and T2DM participants (1.98±0.33 to 2.59±0.45, P = .04, and 1.67±0.35 to 2.14±0.21, P = .05). Experiment 4: baseline percentage contrast defect length was similar in both groups but with insulin decreased with time and was significantly lower than in controls at 60 minutes (2.8±5.7 vs 13.7±10.6, P = .02). Conclusions: Presence of T2DM, insulin infusion duration, and dose are important determinants of the MBFR response to HE. When given immediately following revascularization for STEMI, insulin-dextrose reduces perfusion defect size at one hour. Hyperinsulinemic euglycemia may improve MBF following ischemia, but further studies are needed to clarify this.
Details
- Title
- An Experimental Series Investigating the Effects of Hyperinsulinemic Euglycemia on Myocardial Blood Flow Reserve in Healthy Individuals and on Myocardial Perfusion Defect Size following ST-Segment Elevation Myocardial Infarction
- Authors
- Michael C Y Nam (Author) - Sunshine Coast University Hospital (Australia)Annelise L Meneses (Author) - University of the Sunshine CoastC D Byrne (Author) - University of SouthamptonTuppence Richman (Author) - Sunshine Coast University Hospital (Australia)J X Quah (Author) - Sunshine Coast University Hospital (Australia)Tom G Bailey (Author) - University of the Sunshine CoastI Hickman (Author) - The University of QueenslandChris Anstey (Author) - Sunshine Coast Hospital and Health ServiceChristopher D Askew (Author) - University of the Sunshine CoastR Senior (Author) - The University of QueenslandTony Stanton (Author) - Sunshine Coast Hospital and Health ServiceAnthony W Russell (Author) - The University of QueenslandKim Greaves (Author) - University of the Sunshine Coast
- Publication details
- Journal of the American Society of Echocardiography, Vol.33(7), pp.868-877
- Publisher
- Elsevier Inc.
- Date published
- 2020
- DOI
- 10.1016/j.echo.2020.01.010
- ISSN
- 0894-7317
- Copyright note
- Copyright © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
- Organisation Unit
- Faculty of Science, Health, Education and Engineering; UniSC Clinical Trials Centre; University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; Cancer Research Cluster; School of Health - Sports & Exercise Science; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99450812702621
- Output Type
- Journal article
Metrics
54 File views/ downloads
142 Record Views
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Collaboration types
- Domestic collaboration
- International collaboration
- Web Of Science research areas
- Cardiac & Cardiovascular Systems
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Source: InCites