Effects of glucagon-like peptide-1 in patients with acute myocardial infarction and left ventricular dysfunction after successful reperfusion

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 +/- 0.08 --> 2.02 +/- 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.