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Leptin, Insulin and Glucose Levels in Menopause Women During Acute Myocardial Infarction  [PDF]
M.M.J. Mohamad,M.A. Mohammad,K.S.H. Alomari,M. Karayyem
Journal of Medical Sciences , 2009,
Abstract: The purpose of this study was to measure leptin, glucose and insulin concentration in the blood of patients during ST elevation acute myocardial infarction and to compare them with values obtained from normal subjects. Leptin concentration was measured in 31 menopause Jordanian women patients (50-72 years of age) with acute myocardial infarction and 19 normal menopause women (49-64 years of age). Leptin concentration were measured using two sites immunoradiometric assay (IRMA) principle. In normal (N = 19) leptin concentration was 15.5±5.4 ng mL-1 (Mean±SD). While, in patients with acute myocardial infarction was 22.9±5.7 ng mL-1 (Mean±SD). Data showed significant difference in both groups (p = 0.000). In addition insulin concentrations were significantly increased in patients with acute myocardial infarction (74.2±10.8 vs. 38.8±14.5 pmol L-1, p = 0.000) compared to the control group. Glucose concentrations were lower in patients with acute myocardial infarction (107.5±7.2 vs. 166.9±11.7 mg dL-1, p = 0.000) compared to the normal group. Also, both total cholesterol and triglyceride were significantly higher in patients with acute myocardial infarction compared to the control group. It was comcluded that leptin, insulin, cholesterol and triglyceride concentrations were significantly higher and glucose level was significantly lower in patients with acute ST elevation myocardial infarction compared to normal group.
The Effect of Insulin on Infarct Tissue Size in Patients with Acute Myocardial Infarction: A Randomized Clinical Trial  [cached]
Hashemian M,Vakili A.R,Akaberi A
Qom University of Medical Sciences Journal , 2012,
Abstract: Background and Objectives: Due to the high mortality of ischemic heart disease, many of these patients can be life-saving treatments.There are conflicting information on the effects of insulin in patients with myocardial infarction. We aim to evaluate the effects of insulin on infarct size in myocardial infarction thorough evaluating troponin I enzyme and echocardiography.Methods: This randomized clinical trial enrolled 74 patients with ST segment elevation myocardial infarction referred to Vaseie hospital of Sabzevar in 2009. Patients were categorized into two groups by block randomization and were treated with high dose of GIK (25% glucose, 50IU of soluble insulin per liter, and 80mmol of potassium per liter at 1ml/kg/hour) (GIK group) or normal saline (control group) as adjunct to thrombolytic therapy. We analyzed Plasma concentrations of troponin I, at baseline, 16 and 24 hours after admission. Echocardiography was done at 72 hours after admission. Data were analyzed Variables were compared using independent T tests and repeated measure ANOVA. Results: cTnI peaked to 20.13±12.46U/L in GIK group and to 20.11±10.62 U/L in controls (p=0.44). Left ventricular ejection fraction was 39% vs.41% in GIK vs. control, p=0.34. There was no significant difference between groups in cardiac enzymes and ejection fraction.Conclusion: In patients with myocardial infarction treated with streptokinase, insulin offers no effect on infarct size.
Effectiveness of glucose-insulin–potassium treatment in nondiabetic patients with acute myocardial infarction  [PDF]
Fatma Ela Keskin,Aslan ?elebi,Serkan Keskin,Erhan Sayal?
Medical Journal of Bakirk?y , 2008,
Abstract: Objective: Glucose- insulin-potassium (GIK) treatment given additional to standard therapy effectiveness was investigated in nondiabetic patients with acute myocardial infarction. Material and Method: 29 nondiabetic patients with acute myocardial infarction participated between January and June 2005 in Taksim Training and Research Hospital Coronary Care Unit. Besides standard therapy 14 patients received GIK solution while 15 patients did not. The cardiac enzyme increasing velocity differences were investigated. All patients investigated were nondiabetics. Myocardial infarction was diagnosed by chest pain, electrocardiography and cardiac enzyme assessments. Blood samples for creatin phosphokinase, CPK-MB, myoglobine, Troponin-I and C-reactive protein (CRP) were enrolled at index and further after 6th, 12th and 24th hours. Results: No difference was detected regarding age, body weight, height, application time and lipid profiles between two groups. Although index of 6th and 12th hour controls showed no difference, 24th hour values showed statistically significant difference with a p=0.0013. CRP level in GIK group was 22.56±12.95 mg/dL and 78.92±69.94 mg/dL in non-GIK group. In our assessment using DUNN’s multiple comparison test, although in the group receiving GIK, there was a statistically significant difference accordingly Troponin-I initial and 6th, 12th hours; there was no difference in the given GIK and non GIK group. In comparison of the CRP levels at index and at 24th hour p values were found less than 0,05 (p<0,05) in both groups. Conclusion: In our study, we realized that in the group given GIK; some of the myocardial injury markers were decreasing and finally decided that GIK solution could be beneficial in diabetic and nondiabetic patients.
Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report
Antonios Ziakas, Christos Basagiannis, Ioannis Stiliadis
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-115
Abstract: A 33-year-old Caucasian woman with insulin-treated diabetes presented with continuous epigastric pain of four hours duration. Her coronary heart disease risk factors apart from diabetes included hypercholesterolemia and smoking. Her initial electrocardiogram revealed ST segment elevation in the anteroseptal leads consistent with anterior myocardial infarction. Blood tests revealed hyperglycemia, hyperkalemia, metabolic acidosis and urine ketones, while a bed-side cardiac echocardiogram showed no segmental wall motion abnormality. We provisionally diagnosed diabetic ketoacidosis that was possibly precipitated by acute myocardial infarction, as there were findings in favor of (epigastric pain, electrocardiogram pattern, presence of 3 coronary heart disease risk factors) and against (young age, normal echocardiogram) the diagnosis of acute myocardial infarction. We performed cardiac angiography in order to exclude an anterior acute myocardial infarction, which could lead to myocardial damage and possible severe complications should there be a delay in treatment. Angiography revealed normal coronary arteries. During the procedure, ST segment elevation in the anteroseptal leads was still present in our patient's electrocardiogram results.ST segment elevation is a rare manifestation of hyperkalemia. In our patient, coronary spasm did not contribute to such an electrocardiography finding.It has been reported that hyperkalemia can rarely produce abnormal ST segment elevation simulating an acute myocardial infarction [1-7]. This electrolyte abnormality influences the electrocardiogram (ECG) not only through its direct myocardial effects, but also through other yet vaguely understood mechanisms, such as anoxia, acidosis, and perhaps impaired contractility [1,2]. We present the case of a patient with diabetic ketoacidosis and hyperkalemia whose initial ECG showed a pseudoinfarction pattern, but an urgent coronary angiogram revealed normal coronary arteries.A 33-year-old Caucas
Relationship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure
Gruzdeva O, Uchasova E, Dyleva Y, Belik E, Kashtalap V, Barbarash O
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy , 2013, DOI: http://dx.doi.org/10.2147/DMSO.S37830
Abstract: tionship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure Original Research (812) Total Article Views Authors: Gruzdeva O, Uchasova E, Dyleva Y, Belik E, Kashtalap V, Barbarash O Published Date February 2013 Volume 2013:6 Pages 103 - 111 DOI: http://dx.doi.org/10.2147/DMSO.S37830 Received: 06 September 2012 Accepted: 14 November 2012 Published: 18 February 2013 Olga Gruzdeva, Evgenya Uchasova, Yulia Dyleva, Ekaterina Belik, Vasily Kashtalap, Olga Barbarash Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia Background: The most common cause of myocardial infarction (MI) is stenotic atherosclerotic lesions in subepicardial coronary arteries. Artery disease progression induces clinical signs and symptoms, among which MI is the leader in mortality and morbidity. Recent studies have been trying to find new biochemical markers that could predict the evolution of clinical complications; among those markers, free fatty acids (FFA) and oxidative modification of low-density lipoproteins (oxidized LDL) have a special place. Materials and methods: Seventy-nine ST-elevation MI patients were enrolled. The first group included MI patients without the signs of acute heart failure (Killip class I) while MI patients with Killip classes II–IV made up the second group. Thirty-three individuals with no cardiovascular disease were the controls. The lipid profile, serum oxidized LDL, and their antibodies, C-peptide and insulin were measured at days 1 and 12. The level of insulin resistance was assessed with the quantitative insulin sensitivity check index (QUICKI). Results: MI patients had atherogenic dyslipidemia; however, the Killip II–IV group had the most pronounced and prolonged increase in FFA, oxidized LDL, and their antibodies. Additionally, positive correlations between FFA levels and creatine kinase activity (12 days, R = 0.301; P = 0.001) and negative correlations between the QUICKI index and FFA levels (R = –0.46; P = 0.0013 and R = –0.5; P = 0.01) were observed in the both groups. Conclusion: The development of MI complications is accompanied by a significant increase in FFA levels, which not only demonstrate myocardial injury, but also take part in development of insulin resistance. Measuring FFA levels can have a great prognostic potential for risk stratification of both acute and recurrent coronary events and choice of treatment strategy.
Relationship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure  [cached]
Gruzdeva O,Uchasova E,Dyleva Y,Belik E
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy , 2013,
Abstract: Olga Gruzdeva, Evgenya Uchasova, Yulia Dyleva, Ekaterina Belik, Vasily Kashtalap, Olga BarbarashFederal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, RussiaBackground: The most common cause of myocardial infarction (MI) is stenotic atherosclerotic lesions in subepicardial coronary arteries. Artery disease progression induces clinical signs and symptoms, among which MI is the leader in mortality and morbidity. Recent studies have been trying to find new biochemical markers that could predict the evolution of clinical complications; among those markers, free fatty acids (FFA) and oxidative modification of low-density lipoproteins (oxidized LDL) have a special place.Materials and methods: Seventy-nine ST-elevation MI patients were enrolled. The first group included MI patients without the signs of acute heart failure (Killip class I) while MI patients with Killip classes II–IV made up the second group. Thirty-three individuals with no cardiovascular disease were the controls. The lipid profile, serum oxidized LDL, and their antibodies, C-peptide and insulin were measured at days 1 and 12. The level of insulin resistance was assessed with the quantitative insulin sensitivity check index (QUICKI).Results: MI patients had atherogenic dyslipidemia; however, the Killip II–IV group had the most pronounced and prolonged increase in FFA, oxidized LDL, and their antibodies. Additionally, positive correlations between FFA levels and creatine kinase activity (12 days, R = 0.301; P = 0.001) and negative correlations between the QUICKI index and FFA levels (R = –0.46; P = 0.0013 and R = –0.5; P = 0.01) were observed in the both groups.Conclusion: The development of MI complications is accompanied by a significant increase in FFA levels, which not only demonstrate myocardial injury, but also take part in development of insulin resistance. Measuring FFA levels can have a great prognostic potential for risk stratification of both acute and recurrent coronary events and choice of treatment strategy.Keywords: myocardial infarction, free fatty acids, insulin resistance
EFFICACY OF GIKM (GLUCOSE, INSULIN, POTASSIUM, MAGNESIUM) THERAPY IN THE MANAGEMENT OF MYOCARDIAL INFARCTION COMPAIRED TO CURRENT THROMBOLYTIC THERAPY: A DOUBLE BLIND RANDOMIZED CLINICAL TRIAL  [cached]
M GARAK YARAGHI,M KIANJOO,M MORTAZAVI,N SARRAFZADEGAN
Journal of Research in Medical Sciences , 2001,
Abstract: Introduction. Although common theraputic methods for myocardial infarction are conducted, mortality and morbidity of this disease are high, yet. Therefore, finding a new economical therapies such as metabolic modulation of ischemic myocardial muscle with thrombolytic therapy can somehow improves this situation. This study investigates the effect of glucose, insulin, potassium (GIK) and Magnasium (Mg) along with thrombolytic therapy on such patients. Methods. In this double blind randomized clinical trial study, two hundred patients, with myocardial infarction who have thrombolytic therapy indication, were randomly selected and divided into 6 groups of 30. Each group were treated based on their specific treatment protocol. Finally, people in the first five groups were compared with the sixth group about mortality and morbidity both in hospital and during 3 and 6 months after their treatment.Results were statistically analysed based on the questionares. Results. The patients aged from 58.77±2.6. From these people 77 percent were men. Heart failure and in hospital arrhythmia and ejection fraction of the people at the time of discharge in the five groups which recived metabolic intervention in same way were had better conclusion than the control group. In-hospital mortality and morbidity was not significantly different in any of the groups. Three month later, mortality and morbidity of the group who received GIK and Mg was significantly less than the control group. After six month none of the patients who received high dose GIK and Mg along with thrombolytic therapy, died, while at the same time the rate of death in the control group was 44.4 percent. Discussion. The results showed that GIK infusion and Mg along with thrombolytic therapy can significantly decrease the mortality and morbidity of the patients with myocardial infarction either in hospital or after a long time.
The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616]
Iwan CC van der Horst, Jan Ottervanger, Arnoud WJ van 't Hof, Stoffer Reiffers, Kor Miedema, Jan CA Hoorntje, Jan-Henk E Dambrink, AT Marcel Gosselink, Maarten WN Nijsten, Harry Suryapranata, Menko-Jan de Boer, Felix Zijlstra
BMC Medicine , 2005, DOI: 10.1186/1741-7015-3-9
Abstract: Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge.There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 ± 228 U/L in the GIK group and 240 ± 200 U/L in the control group (NS). The mean LVEF was 43.7 ± 11.0 % in the GIK group and 42.4 ± 11.7% in the control group (P = 0.12). A LVEF ≤ 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01).Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients.It has been suggested that glucose-insulin-potassium (GIK) infusion in acute myocardial infarction (MI) has clinical benefit [1-4]. Both animal studies and early studies in patients to investigate the influence of GIK on infarct size have shown conflicting results [5-14]. Experimental studies on the effect of GIK on preservation of left ventricular function, as determined by hemodynamic parameters, demonstrated a beneficial effect [15,16]. Furthermore, in a small study in patients with acute MI treated by thrombolysis, there was a significant improvement in left ventricular function over a 10-day period [17]. Recently, a small randomized trial of 37 patients has suggested that the addition of GIK to primary percutaneous coronary intervention (PCI) has a beneficial effect [18]. Large studies of GIK in the era of reperfusion yielded some information about effects on myocardial function [1,17,19]. The Polish Glucose-Insulin-Potassium (Pol-GIK) trial with 954 patients, using low-dose GIK, found no difference between median creatini
Leukocytosis: a risk factor for myocardial infarction  [cached]
Kotla SK
Research Reports in Clinical Cardiology , 2012,
Abstract: Suman K KotlaDepartment of Internal Medicine, Memorial Medical Center, Johnstown, PA, USAAbstract: Myocardial infarction commonly results from atherosclerotic lesions in the coronary arteries. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic disease. In this case report, we present an unusual leukostatic complication in a patient with acute myeloblastic leukemia and extreme hyperleukocytosis who presented with an acute myocardial infarction that resolved after leukopheresis. Myocardial infarction as the initial presentation of acute leukemia has been reported only rarely.Keywords: leukocytosis, myocardial infarction, leukostasis
Evaluating the Association Between Insulin–Like Growth Factor-1 Values and Short-Term Survival Rates Following Acute Myocardial Infarction
Shokoufeh Hajsadeghi, Hamed Mohseni, Masoud Moradi, Elham Rahmani, Kiarash Kordshakeri, Mohammad Javad Manteghi, Masoud Tokazebani and Reza Mollahoseini
Clinical Medicine Insights: Cardiology , 2012, DOI: 10.4137/CMC.S6629
Abstract: Backgrounds: In recent years, low levels of Insulin-like Growth Factor-1 (IGF-1) have been suggested to be associated with higher risks of developing heart failure and higher long-term mortality rates following Acute Myocardial Infarction (AMI). However, the effect of IGF-1 levels on short-term survival has been rarely studied. In this study we aimed to assess any possible association between serum IGF-1 concentration following AMI and short-term survival rates. Methods: In this study, serum total IGF-1 levels were measured in 56 patients within 24 hours following AMI and were compared to 56 individuals with no cardiovascular disease. Patients were followed up to death or discharge from hospital (median = 6 days) and survival curves were compared based on median IGF-1 value. Results: Mean (±SD) of serum IGF-1 levels were 232.73 ng/ml (±81.74) and 211.00 ng/ml (±58.22) in survived and expired patients respectively and the difference was not statistically significant (P value = 0.501). The difference between survival curves was also not statistically significant (P value = 0.246). Conclusion: According to findings of this study, serum total IGF-1 concentration does not seem to be associated with short-term survival rates.
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