High-dose insulin administration improves left ventricular function after coronary artery bypass graft surgery

Area of Science:

• Cardiology
• Anesthesiology
• Metabolic Medicine

Background:

• Coronary artery bypass graft (CABG) surgery can impact myocardial function.
• Maintaining normoglycemia is crucial during and after cardiac surgery.
• The role of high-dose insulin therapy in improving cardiac function post-CABG requires further investigation.

Purpose of the Study:

• To evaluate the effect of glucose-insulin-natrionate (GIN) therapy on myocardial function in patients undergoing CABG surgery.
• To test the hypothesis that intravenous high-dose insulin administration improves cardiac function while maintaining normoglycemia.

Main Methods:

• Prospective, randomized clinical trial involving 40 patients undergoing elective CABG surgery.
• GIN group received insulin at 5 mU/kg/min with 20% glucose infusion to maintain blood glucose (BG) between 4.0-6.0 mmol/L.
• Control group received insulin on a sliding scale to maintain normoglycemia.

Main Results:

• GIN therapy resulted in significantly increased cardiac index (CI) post-surgery compared to the control group (p = 0.005).
• GIN therapy was associated with improved myocardial performance index (MPI) and fractional area change (FAC), indicating better global and systolic left ventricular function.
• No significant differences were observed in left ventricular diastolic function parameters between groups.

Conclusions:

• Intraoperative glucose-insulin-natrionate (GIN) therapy effectively improves global and systolic left ventricular function after CABG surgery.
• GIN therapy represents a potential strategy to optimize myocardial recovery following cardiac procedures.