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DOI: 10.1097/AOG.0000000000003500 [3] Simon, J.A., Kingsberg, S.A., Portman, D., et al

Effects on myocardium Electrophysiologic effects GLP-1 infusions in murine models have been reported to cause a dose-dependent inotropic and chronotropic effect

This applies every single time you access the vial, not just the first time