BACKGROUND Patients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis. METHODS In this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp). RESULTS At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P <  0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI - 4.8 to - 1.0%), 2D-LVEF (MD -2.0%, 95%CI - 2.8 to - 1.3%, 3D-LVEF (MD -3.0%, 95%CI - 4.0 to - 2.0%) and Vp (MD - 4.5 cm/s, 95%CI - 5.6 to - 3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI - 0.8 to 1.7% and + 0.4%, 95%CI - 1.3 to 2.0%), and PGLS (- 0.9, 95%CI - 1.6 to - 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (- 2.2%, 95%CI - 3.4 to - 1.0), 3D-LVEF (- 6.0%, 95%CI - 7.8 to - 4.2), and Vp (- 7.6 cm/s, 95%CI - 9.4 to - 5.9), all decreased after bypass. CONCLUSIONS Administration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement. TRIAL REGISTRATION ClinicalTrials.gov: NCT00788242 , registered on November 10, 2008.

中文翻译：

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葡萄糖-胰岛素-钾改善主动脉瓣置换术后左心室性能：随机对照试验的二次分析。

背景左心室（LV）肥厚患者在心脏手术时可能遭受缺血再灌注损伤，左心室功能受损。使用经食道超声心动图 (TEE)，我们评估了葡萄糖 - 胰岛素钾 (GIK) 对因主动脉瓣狭窄而接受瓣膜置换术的患者的 LV 性能的影响。方法 在这项双盲随机试验的二次分析中，中高风险患者被分配接受 GIK（20 IU 胰岛素和 10 mEq KCL 的 50 ml 葡萄糖 40%）或生理盐水，麻醉诱导时间超过 60 分钟。主要结果是 2 维和 3 维左心室射血分数（2D 和 3D-LVEF）、峰值全局纵向应变 (PGLS) 和二尖瓣血流传播速度 (Vp) 的早期变化。结果 在 GIK 输注结束时，LV-FAC 和 2D-​​和 3D-LVEF 没有变化，而 Vp（平均差异 [MD + 7.9%，95% 置信区间 [CI] 3.2 至 12.5%；P < 0.001）与基线值相比增加。安慰剂输注后，LV-FAC (MD -2.9%, 95%CI - 4.8 to - 1.0%), 2D-LVEF (MD -2.0%, 95%CI - 2.8 to - 1.3%, 3D- LVEF (MD -3.0%, 95%CI - 4.0 to - 2.0%) and Vp (MD - 4.5 cm/s, 95%CI - 5.6 to - 3.3 cm/s).体外循环后，GIK预处理与保留2D 和 3D-LVEF（+ 0.4%、95% 95%CI - 0.8 至 1.7% 和 + 0.4%、95%CI - 1.3 至 2.0%）和 PGLS（- 0.9、95%CI - 1.6 至 - 0.2）以及与基线相比更高的 Vp（+ 5.1 cm/s，95%CI 2.9 至 7.3）。相比之下，在安慰剂组中，2D-LVEF（- 2.2%，95%CI - 3.4 至 - 1.0）， 3D-LVEF (- 6.0%, 95%CI - 7.8 to - 4.2), and Vp (- 7.6 cm/s, 95%CI - 9.4 to - 5.9), 旁路后均下降。结论在主动脉交叉钳闭前给予 GIK 可以更好地保护接受主动脉瓣置换术的 LV 肥厚患者的收缩和舒张心室功能。试验注册 ClinicalTrials.gov：NCT00788242，2008 年 11 月 10 日注册。