Abstract 17497: Pre-treatment With Glucagon-like Peptide-1 Protects Against Supply Ischemic Left Ventricular Dysfunction - Insights From Conductance Catheter Assessment During Elective PCI
Background: The incretin hormone, glucagon-like peptide-1 (GLP-1), has emerged as a potential cardioprotective agent, although the mechanisms for benefit remain unclear. Human studies have predominantly assessed the effects of GLP-1 when administered after an initial ischemic insult, at a time when reperfusion injury pathways have been activated. There is however, limited data investigating the impact of GLP-1 on supply ischemia when given before percutaneous coronary intervention (PCI).
METHODS: 30 patients (age 62.4 years, 87% male) with normal left ventricular (LV) function were studied during elective PCI to the left anterior descending coronary artery. Pressure-volume loops were recorded using a LV conductance catheter at baseline, during 1-minute low-pressure balloon occlusion (BO1), after 30 minutes recovery, and during a second 1 minute balloon occlusion (BO2). Patients were randomized to receive either intravenous saline (control) or GLP-1 (7-36) (1.2 pmol/kg/min) given before BO1. Data were analyzed offline by a blinded reviewer using PVAN software (Millar instruments) for measures of systolic (dP/dTmax - maximum rate of isovolumic pressure increase) and diastolic (dP/dTmin - maximum rate of isovolumic pressure decline) function.
RESULTS: Coronary balloon occlusion caused LV stunning in the control group with cumulative LV dysfunction on subsequent occlusion. In contrast, pre-treatment with GLP-1, which achieved a 14-fold increase in the plasma concentration of GLP-1 (p<0.001 versus control), protected against LV dysfunction during BO1 (Δ dP/dTmax from baseline -5.66% vs -15.26%, P=0.04; Δ dP/dTmin from baseline -10.39% vs - 21.8%, P=0.04), improved recovery of systolic function at 30 minutes (Δ dP/dTmax from baseline +4.83% vs -12.16%, P=0.03) and reduced LV dysfunction after BO2 (Δ dP/dTmax from baseline -7.7% vs -25.32%, P=0.02; Δ dP/dTmin from baseline -15.29% vs - 30.27%, P=0.05).
CONCLUSION: Pre-treatment with GLP-1 protects against supply ischemic LV dysfunction caused by coronary balloon occlusion, and attenuates stunning.
- Coronary artery disease
- Percutaneous coronary intervention
- Pressure – volume relation
- Ischemia reperfusion
- © 2013 by American Heart Association, Inc.