Published online before print February 23, 2004, doi: 10.1161/01.CIR.0000120505.91348.58
(Circulation. 2004;109:962-965.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
Effects of Glucagon-Like Peptide-1 in Patients With Acute Myocardial Infarction and Left Ventricular Dysfunction After Successful Reperfusion
From the Cardiovascular Research Institute, Allegheny General Hospital, Pittsburgh, Pa (L.A.N., S.M., G.G.S., G.M., A.S., R.P.S.), and the University of Massachusetts Medical Center, Worcester, Mass (D.E.).
Correspondence to Dr Richard P. Shannon, Department of Medicine, Allegheny General Hospital, 320 E North Avenue, Pittsburgh, PA 15212. E-mail rshannon{at}wpahs.org
Received October 9, 2003; de novo received November 21, 2003; revision received January 13, 2004; accepted January 14, 2004.
Background— Glucose-insulin-potassium infusions are beneficial in uncomplicated patients with acute myocardial infarction (AMI) but are of unproven efficacy in AMI with left ventricular (LV) dysfunction because of volume requirements associated with glucose infusion. Glucagon-like peptide-1 (GLP-1) is a naturally occurring incretin with both insulinotropic and insulinomimetic properties that stimulate glucose uptake without the requirements for concomitant glucose infusion.
Methods and Results— We investigated the safety and efficacy of a 72-hour infusion of GLP-1 (1.5 pmol/kg per minute) added to background therapy in 10 patients with AMI and LV ejection fraction (EF) <40% after successful primary angioplasty compared with 11 control patients. Echocardiograms were obtained after reperfusion and after the completion of the GLP-1 infusion. Baseline demographics and background therapy were similar, and both groups had severe LV dysfunction at baseline (LVEF=29±2%). GLP-1 significantly improved LVEF (from 29±2% to 39±2%, P<0.01), global wall motion score indexes (1.94±0.11
1.63±0.09, P<0.01), and regional wall motion score indexes (2.53±0.082.02±0.11, P<0.01) compared with control subjects. The benefits of GLP-1 were independent of AMI location or history of diabetes. GLP-1 was well tolerated, with only transient gastrointestinal effects.
Conclusions— When added to standard therapy, GLP-1 infusion improved regional and global LV function in patients with AMI and severe systolic dysfunction after successful primary angioplasty.
Key Words: myocardial infarction • insulin • heart failure • angioplasty
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