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JACC Cardiovasc Interv. 2015 Feb;8(2):292-301. doi: 10.1016/j.jcin.2014.09.014.

Pre-treatment with glucagon-like Peptide-1 protects against ischemic left ventricular dysfunction and stunning without a detected difference in myocardial substrate utilization.

Author information

1
Department of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
2
Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom.
3
Department of Medical Physics and Clinical Engineering, Cambridge University Hospital National Health Service Foundation Trust, Cambridge, United Kingdom.
4
Department of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom. Electronic address: dpd24@medschl.cam.ac.uk.

Abstract

OBJECTIVES:

This study sought to determine whether pre-treatment with intravenous glucagon-like peptide-1 (GLP-1)(7-36) amide could alter myocardial glucose use and protect the heart against ischemic left ventricular (LV) dysfunction during percutaneous coronary intervention.

BACKGROUND:

GLP-1 has been shown to have favorable cardioprotective effects, but its mechanisms of action remain unclear.

METHODS:

Twenty patients with preserved LV function and single-vessel left anterior descending coronary artery disease undergoing elective percutaneous coronary intervention were studied. A conductance catheter was placed into the LV, and pressure-volume loops were recorded at baseline, during 1-min low-pressure balloon occlusion (BO), and at 30-min recovery. Patients were randomized to receive an infusion of either GLP-1(7-36) amide at 1.2 pmol/kg/min or saline immediately after baseline measurements. Simultaneous coronary artery and coronary sinus blood sampling was performed at baseline and after BO to assess transmyocardial glucose concentration gradients.

RESULTS:

BO caused both ischemic LV dysfunction and stunning in the control group but not in the GLP-1 group. Compared with control subjects, the GLP-1 group had a smaller reduction in LV performance during BO (delta dP/dTmax, -4.3 vs. -19.0%, p = 0.02; delta stroke volume, -7.8 vs. -26.4%, p = 0.05), and improved LV performance at 30-min recovery. There was no difference in transmyocardial glucose concentration gradients between the 2 groups.

CONCLUSIONS:

Pre-treatment with GLP-1(7-36) amide protects the heart against ischemic LV dysfunction and improves the recovery of function during reperfusion. This occurs without a detected change in myocardial glucose extraction and may indicate a mechanism of action independent of an effect on cardiac substrate use. (Effect of Glucgon-Like-Peptide-1 [GLP-1] on Left Ventricular Function During Percutaneous Coronary Intervention [PCI]; ISRCTN77442023).

KEYWORDS:

angioplasty; cardioprotection; glucagon-like peptide-1; myocardial ischemia; myocardial stunning; myocardial substrate use

PMID:
25700752
DOI:
10.1016/j.jcin.2014.09.014
[Indexed for MEDLINE]
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