Trial reportAnesthesiology2015
Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery: A Randomized Trial.
Trial report in Anesthesiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00524472 (The Effect of Hyperinsulinemic Glucose Control on Outcomes Following Cardiac Surgery), which is not on this map. Cited by 14 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Effect of Hyperinsulinemic Glucose Control on Outcomes Following Cardiac Surgery
Who cites it
14 citing papers in PubMed, 25 citations in OpenAlex.
- Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory Analysis.Seminars in cardiothoracic and vascular anesthesia · 2022Trial
- Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial.BMC anesthesiology · 2019Trial
- A Comparison of Global Longitudinal, Circumferential, and Radial Strain to Predict Outcomes After Cardiac Surgery.Journal of cardiothoracic and vascular anesthesia · 2019Trial
- Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite of 30-day Mortality and Serious In-hospital Complications: A Randomized Clinical Trial.Anesthesiology · 2018Trial
- Reduced Left Ventricular Global Longitudinal Strain Predicts Prolonged Hospitalization: A Cohort Analysis of Patients Having Aortic Valve Replacement Surgery.Anesthesia and analgesia · 2018Trial
- The response to Trendelenburg position is minimally affected by underlying hemodynamic conditions in patients with aortic stenosis.Journal of anesthesia · 2017Trial
- Hyperinsulinemic normoglycemia decreases glucose variability during cardiac surgery.Journal of anesthesia · 2017Trial
- Early Left and Right Ventricular Response to Aortic Valve Replacement.Anesthesia and analgesia · 2017Trial
- Perioperative glycaemic control for people with diabetes undergoing surgery.The Cochrane database of systematic reviews · 2023Review
- Diagnostic Accuracy of Global Longitudinal Strain for Detecting Exercise Intolerance in Patients with Ischemic Heart Disease.Journal of cardiovascular development and disease · 2022Article
- The dual role of the hexosamine biosynthetic pathway in cardiac physiology and pathophysiology.Frontiers in endocrinology · 2022Review
- The effect of perioperative insulin treatment on cardiodepression in mild adiposity in mice.Cardiovascular diabetology · 2016Article
- Happy 53rd Birthday GIK: Insulin, Cake, and Presents.Anesthesiology · 2015Article
- Post-cardiopulmonary bypass longitudinal strain provides higher prognostic ability than baseline strain or change in strain.Annals of cardiac anaesthesiaArticle
Corrections and comments
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Authors and funding
12 authors at 1 institution in 2 countries.
Funding
Abstract
backgroundGlucose-insulin-potassium (GIK) administration during cardiac surgery inconsistently improves myocardial function, perhaps because hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic normoglycemic clamp (HNC) technique may better enhance the myocardial benefits of GIK. The authors extended previous GIK investigations by (1) targeting normoglycemia while administering a GIK infusion (HNC); (2) using improved echocardiographic measures of myocardial deformation, specifically myocardial longitudinal strain and strain rate; and (3) assessing the activation of glucose metabolic pathways.
methodsA total of 100 patients having aortic valve replacement for aortic stenosis were randomly assigned to HNC (high-dose insulin with concomitant glucose infusion titrated to normoglycemia) versus standard therapy (insulin treatment if glucose >150 mg/dl). The primary outcomes were left ventricular longitudinal strain and strain rate, assessed using speckle-tracking echocardiography. Right atrial tissue was analyzed for activation of glycolysis/pyruvate oxidation and alternative metabolic pathways.
resultsTime-weighted mean glucose concentrations were lower with HNC (127 ± 19 mg/dl) than standard care (177 ± 41 mg/dl; P < 0.001). Echocardiographic data were adequate in 72 patients for strain analysis and 67 patients for strain rate analysis. HNC did not improve myocardial strain, with an HNC minus standard therapy difference of -1.2% (97.5% CI, -2.9 to 0.5%; P = 0.11). Strain rate was significantly better, but by a clinically unimportant amount: -0.16 s (-0.30 to -0.03 s; P = 0.007). There was no evidence of increased glycolytic, pyruvate oxidation, or hexosamine biosynthetic pathway activation in right atrial samples (HNC, n = 20; standard therapy, 22).
conclusionAdministration of glucose and insulin while targeting normoglycemia during aortic valve replacement did not meaningfully improve myocardial function.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.