Improving Energy Metabolism in the Postischemic Heart-The Story of GIK

Abstract

Heart muscle is a metabolic omnivore. The normal heart derives its energy for contraction from the oxidation of longchain fatty acids. The stressed heart switches to carbohydrate substrates for greater efficiency of energy production. Here we review the evidence for glucose-insulin-potassium as an effective strategy to treat postischemic contractile dysfunction of the heart. There is a strong rationale for both glucose and insulin to restore efficient energy transfer in the metabolically depleted postischemic heart. In spite ofits long history and abundant opportunities for translational research, the field is still in its infancy. Further progress is tied to two broad areas of research: randomized, multicenter clinical trialsand systematic studies addressing cellular signaling mechanisms, including nutrient sensing of myocardial gene expression.