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Article ; Online: Glucose-insulin-potassium infusion and mortality in the CREATE-ECLA trial.

Apstein, Carl S

2005 Volume 293, Issue 21, Page(s) 2596–7; author reply 2598

MeSH term(s)	Cardioplegic Solutions/therapeutic use ; Glucose/therapeutic use ; Humans ; Insulin/therapeutic use ; Myocardial Infarction/drug therapy ; Myocardial Infarction/mortality ; Potassium/therapeutic use
Chemical Substances	Cardioplegic Solutions ; Insulin ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2005-06-01
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.293.21.2596
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Article: The benefits of glucose-insulin-potassium for acute myocardial infarction (and some concerns).

Apstein, Carl S

Journal of the American College of Cardiology

2003 Volume 42, Issue 5, Page(s) 792–795

MeSH term(s)	Angioplasty, Balloon, Coronary ; Combined Modality Therapy ; Diabetes Complications ; Fluid Therapy/methods ; Glucose/therapeutic use ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/therapeutic use ; Myocardial Infarction/complications ; Myocardial Infarction/metabolism ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy ; Netherlands/epidemiology ; Potassium/therapeutic use ; Survival Analysis ; Texas/epidemiology ; Time Factors ; Treatment Outcome
Chemical Substances	Hypoglycemic Agents ; Insulin ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2003-09-03
Publishing country	United States
Document type	Comment ; Editorial ; Review
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/s0735-1097(03)00844-1
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 196: Show issues

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Article: A challenge to the metabolic approach to myocardial ischaemia.

Apstein, Carl S / Opie, Lionel H

European heart journal

2005 Volume 26, Issue 10, Page(s) 956–959

Abstract: The negative results of glucose-insulin-potassium (GIK) in the very large CREATE-ECLA trial that studied 20,201 patients with ST-elevation acute myocardial infarction (AMI), are disappointing and warrant thorough evaluation. We attempt to put the new ... ...

Abstract	The negative results of glucose-insulin-potassium (GIK) in the very large CREATE-ECLA trial that studied 20,201 patients with ST-elevation acute myocardial infarction (AMI), are disappointing and warrant thorough evaluation. We attempt to put the new data into perspective and uncover the serious flaws in the trial design, otherwise the whole metabolic concept will be disparaged. The crucial issue, developed from basic science data, is that GIK should be initiated very early, before, or at the time of reperfusion. Another problem with CREATE-ECLA is that the mortality in Killip class 1 reperfused patients was 7.1%, much higher than that of a recent Dutch study in which mortality was only 1.2%. Nonetheless, there was a strong trend towards a lower mortality in the sub-groups that received the best reperfusion therapy in CREATE-ECLA, as well as in the first of two rather small Dutch GIK trials. In the future, the ideal protocol to test would be if GIK were given in the ambulance as the patient is being transported to a specialized centre of percutaneous coronary intervention (PCI), with the aim of expanding the time window between pain onset and actual PCI.
MeSH term(s)	Cardiotonic Agents/therapeutic use ; Drug Combinations ; Follow-Up Studies ; Glucose/therapeutic use ; Humans ; Insulin/therapeutic use ; Myocardial Ischemia/drug therapy ; Myocardial Ischemia/metabolism ; Myocardial Reperfusion ; Potassium/therapeutic use ; Randomized Controlled Trials as Topic/standards
Chemical Substances	Cardiotonic Agents ; Drug Combinations ; Insulin ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2005-05
Publishing country	England
Document type	Journal Article
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehi200
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Zs.A 1563: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 640: Show issues

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Article: The sting of salt on an old, but open, wound--is Na(+) the cause of mitochondrial and myocardial injury during ischemia/reperfusion?

Sawyer, Douglas B / Suter, Thomas M / Apstein, Carl S

Journal of molecular and cellular cardiology

2002 Volume 34, Issue 7, Page(s) 699–702

MeSH term(s)	Calcium/metabolism ; Humans ; Mitochondria, Heart/metabolism ; Mitochondria, Heart/pathology ; Myocardial Ischemia/etiology ; Myocardial Ischemia/metabolism ; Myocardial Ischemia/pathology ; Myocardial Reperfusion Injury/etiology ; Myocardial Reperfusion Injury/metabolism ; Myocardial Reperfusion Injury/pathology ; Sodium/metabolism
Chemical Substances	Sodium (9NEZ333N27) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2002-07-01
Publishing country	England
Document type	Comment ; Editorial
ZDB-ID	80157-4
ISSN	1095-8584 ; 0022-2828
ISSN (online)	1095-8584
ISSN	0022-2828
DOI	10.1006/jmcc.2002.2030
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Zs.A 426: Show issues

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Article: Mechanisms underlying ischemic diastolic dysfunction: relation between rigor, calcium homeostasis, and relaxation rate.

Varma, Niraj / Morgan, James P / Apstein, Carl S

American journal of physiology. Heart and circulatory physiology

2002 Volume 284, Issue 3, Page(s) H758–71

Abstract: Increased diastolic chamber stiffness (upward arrow DCS) during ischemia may result from increased diastolic calcium, rigor, or reduced velocity of relaxation. We tested these potential mechanisms during severe ischemia in isolated red blood cell- ... ...

Abstract	Increased diastolic chamber stiffness (upward arrow DCS) during ischemia may result from increased diastolic calcium, rigor, or reduced velocity of relaxation. We tested these potential mechanisms during severe ischemia in isolated red blood cell-perfused isovolumic rabbit hearts. Ischemia (coronary flow reduced 83%) reduced left ventricular (LV) contractility by 70%, which then remained stable. DCS progressively increased. When LV end-diastolic pressure had increased 5 mmHg, myofilament calcium responsiveness was altered with 50 mmol/l NH(4)Cl or 10 mmol/l butanedione monoxime. These affected contractility (i.e., a calcium-mediated force) but not upward arrow DCS. Second, quick length changes reversed upward arrow DCS, supporting a rigor mechanism. Third, ischemia increased the time constant of isovolumic pressure decline from 47 +/- 3 to 58 +/- 3 ms (P < 0.02) but concomitantly abbreviated the contraction-relaxation cycle, i.e., pressure dissipation occurred earlier without diastolic tetanization. Finally, to assess any link between rate of relaxation and upward arrow DCS, hearts were exposed to 10 mmol/l calcium. Calcium doubled contractility and accelerated relaxation velocity, but without affecting upward arrow DCS. Thus upward arrow DCS developed during ischemia despite severely reduced contractility via a rigor (and not calcium mediated) mechanism. Calcium resequestration capacity was preserved, and reduced relaxation velocity was not linked to upward arrow DCS.
MeSH term(s)	Ammonium Chloride/pharmacology ; Animals ; Blood Pressure/drug effects ; Calcium/pharmacology ; Diacetyl/analogs & derivatives ; Diacetyl/pharmacology ; Diastole ; Enzyme Inhibitors/pharmacology ; Erythrocytes ; Heart/drug effects ; Heart/physiopathology ; In Vitro Techniques ; Myocardial Contraction/drug effects ; Myocardial Ischemia/physiopathology ; Perfusion ; Rabbits ; Ventricular Dysfunction, Left/physiopathology
Chemical Substances	Enzyme Inhibitors ; Ammonium Chloride (01Q9PC255D) ; diacetylmonoxime (19SQ93LM6H) ; Diacetyl (K324J5K4HM) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2002-10-31
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	603838-4
ISSN	1522-1539 ; 0363-6135
ISSN (online)	1522-1539
ISSN	0363-6135
DOI	10.1152/ajpheart.00286.2002
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Book: Congestive heart failure

Ohlbaum, Karen / Apstein, Carl S

assessment and treatment

1989

Author's details	editor, Karen Ohlbaum ; commentary by Carl S. Apstein ... [et al.]
MeSH term(s)	Heart Failure/diagnosis ; Heart Failure/drug therapy
Language	English
Size	25 p.
Publisher	American Health Consultants
Publishing place	Boston
Document type	Book
Note	"Compiled from the pages of Clinical cardiology alert with supplements from the medical literature."
Database	Catalogue of the US National Library of Medicine (NLM)

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Article: Unveiling gender differences in demand ischemia: a study in a rat model of genetic hypertension.

Podesser, Bruno K / Jain, Mohit / Ngoy, Soeun / Apstein, Carl S / Eberli, Franz R

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2007 Volume 31, Issue 2, Page(s) 298–304

Abstract: Objective: Female gender is associated with reduced tolerance against acute ischemic events and a higher degree of left ventricular hypertrophy under chronic pressure overload. We tested whether female and male rats with left ventricular hypertrophy ... ...

Abstract	Objective: Female gender is associated with reduced tolerance against acute ischemic events and a higher degree of left ventricular hypertrophy under chronic pressure overload. We tested whether female and male rats with left ventricular hypertrophy present the same susceptibility to demand ischemia. Methods: Hearts from hypertrophied female and male salt-resistant and salt-sensitive Dahl rats (n=8 per group) underwent 30min of demand ischemia induced by rapid pacing (7Hz) and an 85% reduction of basal coronary blood flow, followed by 30min of reperfusion on an isovolumic red cell perfused Langendorff model. Results: In female hearts, high-salt diet induced a pronounced hypertrophy of the septum (2.38+/-0.09 vs 2.17+/-0.08mm; p<0.01), whereas male hearts showed the greatest increase in the anterior/posterior wall of the left ventricle (LV) (3.19+/-0.22 vs 2.01+/-0.16mm; p<0.05) compared with salt-resistant controls. At baseline, LV-developed pressure/g LV was significantly higher in female than male hearts (200+/-13 and 196+/-14 vs 161+/-10 and 152+/-15mmHgg(-1); p<0.01), independent of hypertrophy, indicating greater contractility in females. During ischemia, LV-developed pressure decreased in all groups; at the end of reperfusion, hypertrophied female and male hearts showed higher developed pressures independent of gender (148+/-3 and 130+/-8 vs 100+/-7 and 85+/-6mmHg; p<0.01). In contrast, diastolic pressure was more pronounced in female than in male hypertrophied hearts during ischemia and reperfusion (24+/-3 vs 12+/-2mmHg; p<0.01). Conclusions: In the pressure overload model of the Dahl salt-sensitive rat, female gender is associated with a more pronounced concentric hypertrophy, whereas male hearts develop a more eccentric type of remodeling. Although present at baseline, after ischemia/reperfusion systolic function is gender-independent but more determined by hypertrophy. In contrast, diastolic function is gender-dependent and aggravated by hypertrophy, leading to pronounced diastolic dysfunction. We can conclude that in the malignant setting of demand ischemia/reperfusion gender differences in hypertrophied hearts are unmasked: female hypertrophied hearts are more susceptible to ischemia/reperfusion than males. To determine whether in female hypertensive patients with acute coronary syndromes, diastolic dysfunction could contribute to the worse clinical course, further experimental and clinical studies are needed.
MeSH term(s)	Animals ; Coronary Circulation ; Diastole ; Disease Models, Animal ; Disease Susceptibility ; Female ; Hypertension/complications ; Hypertension/genetics ; Hypertension/physiopathology ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/metabolism ; Hypertrophy, Left Ventricular/physiopathology ; Lactic Acid/biosynthesis ; Male ; Myocardial Reperfusion Injury/etiology ; Myocardial Reperfusion Injury/physiopathology ; Rats ; Rats, Sprague-Dawley ; Sex Characteristics ; Systole
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2007-02
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1016/j.ejcts.2006.10.041
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Zs.A 2303: Show issues

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Article: Effects of AT1 receptor block begun late in life on normal cardiac aging in rats.

Saupe, Kurt W / Sobol, Sophie C / Koh, Stanley G / Apstein, Carl S

Journal of cardiovascular pharmacology

2003 Volume 42, Issue 4, Page(s) 573–580

Abstract: The goal of this study was to determine how short-term (12 weeks) angiotensin type I (AT1) block begun late in life affects aspects of myocardial biology and physiologic function altered by normal aging. Exercise capacity, myocardial morphology, ... ...

Abstract	The goal of this study was to determine how short-term (12 weeks) angiotensin type I (AT1) block begun late in life affects aspects of myocardial biology and physiologic function altered by normal aging. Exercise capacity, myocardial morphology, histopathology, and coronary vascular function (degree of coronary vasodilation in response to adenosine) were evaluated in 53 Fischer 344 rats. Adult (6 months of age) and old (21 months of age) rats were studied after 12 weeks of either control drinking water, a low dose of candesartan that did not significantly lower blood pressure (1 mg/kg/d), or a high dose of candesartan (10 mg/kg/d). Significant age-associated changes in exercise capacity (38% decrease), coronary dilation in response to adenosine (41% decrease), and histopathology occurred but were not affected by candesartan treatment. Age-associated myocardial hypertrophy occurred as indicated by an increase in heart weight-to-tibia length ratio from 0.27 g/cm +/- 0.01 in the adult controls to 0.34 g/cm +/- 0.02 in the old controls (P < 0.05). This hypertrophy in the aged hearts was significantly attenuated by both low-dose (0.30 g/cm +/- 0.01) and high-dose (0.29 g/cm +/- 0.01) candesartan (P < 0.05). Echocardiographic measurements indicate that the candesartan-induced decrease in hypertrophy occurred concomitantly with slight decreases in septal wall thickness and left ventricular (LV) chamber diameter. It is concluded that short-term AT1 block, even when initiated late in life, can decrease age-associated LV hypertrophy independent of blood pressure-lowering effects.
MeSH term(s)	Adenosine/administration & dosage ; Adenosine/pharmacokinetics ; Aging/drug effects ; Angiotensin II Type 1 Receptor Blockers ; Animals ; Benzimidazoles/administration & dosage ; Benzimidazoles/pharmacokinetics ; Biphenyl Compounds/administration & dosage ; Biphenyl Compounds/pharmacokinetics ; Blood Pressure/drug effects ; Blood Pressure/physiology ; Body Weight/drug effects ; Coronary Vessels/drug effects ; Coronary Vessels/physiology ; Exercise Tolerance/drug effects ; Heart/anatomy & histology ; Heart/drug effects ; Heart/physiology ; Hypertrophy, Left Ventricular/drug therapy ; Hypertrophy, Left Ventricular/pathology ; Muscle, Smooth, Vascular/drug effects ; Myocardium/pathology ; Organ Size/drug effects ; Rats ; Rats, Inbred F344 ; Receptor, Angiotensin, Type 1/drug effects ; Tetrazoles ; Tibia/anatomy & histology ; Vascular Resistance/drug effects ; Vascular Resistance/physiology ; Vasodilation/drug effects
Chemical Substances	Angiotensin II Type 1 Receptor Blockers ; Benzimidazoles ; Biphenyl Compounds ; Receptor, Angiotensin, Type 1 ; Tetrazoles ; Adenosine (K72T3FS567) ; candesartan cilexetil (R85M2X0D68)
Language	English
Publishing date	2003-10
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	391970-5
ISSN	1533-4023 ; 0160-2446
ISSN (online)	1533-4023
ISSN	0160-2446
DOI	10.1097/00005344-200310000-00017
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Zs.A 1471: Show issues

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Book: New ischemic syndromes

Yellon, Derek M / Rahimtoola, Shahbudin H / Apstein, Carl S

beyond angina and infarction

1997

Author's details	editors, Derek M. Yellon, Shahbudin H. Rahimtoola, Lionel H. Opie ; with contributions by Carl S. Apstein ... [et al.]
MeSH term(s)	Myocardial Ischemia ; Ischemic Preconditioning, Myocardial ; Myocardial Stunning
Language	English
Size	xiv, 237 p. :, ill.
Publisher	Authors' Publishing House, Lippincott-Raven Publishers ; Lippincott-Raven Publishers
Publishing place	New York ; Philadelphia
Document type	Book
ISBN	9781881063063 ; 1881063062
Database	Catalogue of the US National Library of Medicine (NLM)

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Article ; Online: Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events.

Lazar, Harold L / Chipkin, Stuart R / Fitzgerald, Carmel A / Bao, Yusheng / Cabral, Howard / Apstein, Carl S

Circulation

2004 Volume 109, Issue 12, Page(s) 1497–1502

Abstract: Background: This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes.: Methods and results: ... ...

Abstract	Background: This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes. Methods and results: One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138+/-4 versus 260+/-6 mg/dL; P<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; P=0.0017), and a shorter postoperative length of stay (6.5+/-0.1 versus 9.2+/-0.3 days; P=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (P=0.04) and decreased episodes of recurrent ischemia (5% versus 19%; P=0.01) and developed fewer recurrent wound infections (1% versus 10%, P=0.03). Conclusions: Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.
MeSH term(s)	Atrial Fibrillation/prevention & control ; Blood Glucose/analysis ; Cardioplegic Solutions/administration & dosage ; Cardioplegic Solutions/therapeutic use ; Cardiotonic Agents/administration & dosage ; Cardiotonic Agents/therapeutic use ; Coronary Artery Bypass ; Coronary Stenosis/complications ; Coronary Stenosis/surgery ; Diabetes Complications ; Diabetes Mellitus/blood ; Diabetes Mellitus/drug therapy ; Fatty Acids, Nonesterified/blood ; Female ; Glucose/administration & dosage ; Glucose/therapeutic use ; Humans ; Insulin/administration & dosage ; Insulin/therapeutic use ; Lactates/blood ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Potassium/administration & dosage ; Potassium/therapeutic use ; Recurrence ; Surgical Wound Infection/epidemiology ; Treatment Outcome
Chemical Substances	Blood Glucose ; Cardioplegic Solutions ; Cardiotonic Agents ; Fatty Acids, Nonesterified ; Insulin ; Lactates ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2004-03-30
Publishing country	United States
Document type	Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/01.CIR.0000121747.71054.79
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