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L-arginine cardioplegia reduces oxidative stress and preserves diastolic function in patients with low ejection fraction undergoing coronary artery surgery.
MedLine Citation:
PMID:  22313068     Owner:  NLM     Status:  In-Data-Review    
PL-arginine cardioplegia decreases biochemical markers of myocardial damage and oxidative stress in patients with normal left ventricular function. We investigated the effects of L-arginine supplemented cardioplegic arrest in patients with reduced ejection fraction. Fifty-three adult patients with left ventricular ejection fraction <35% undergoing elective coronary artery bypass surgery were randomised to receive blood cardioplegia with or without L-arginine. Following cardiopulmonary bypass, measured endpoints were cardiac troponin-I concentration at 12 and 24 hours, coronary sinus concentrations of malondialdehyde and superoxide dismutase activity at five and 15 minutes, lactic acid flux at one, five and 15 minutes and left ventricular systolic and diastolic function after protamine administration. There were no differences in cardiac troponin-I between groups. Malondialdehyde was lower in the L-arginine group, 0.28±0.12 vs 0.48±0.32 (5 minutes) and 0.31±0.14 vs 0.38±0.15 (15 minutes) (P=0.0004). Superoxide dismutase activity was higher in L-arginine group, 229±87 vs 191.3±68 (5 minutes), 229±54 vs 198±15 nmol.minute(-1).m(l) (15 minutes) (P=0.005). Lactic acid flux was lower in L-arginine group, 0.15±0.23 vs 0.48±0.32 (1 minute), 0.08±0.19 vs 0.38±0.31 (5 minutes) and -0.15±0.13 vs 0.26±0.30 mmol.l(-1) (15 minutes), (P=0.0003). There was no difference in left ventricular systolic function. The mitral annular tissue Doppler inflow (e') velocity during early diastole improved in the L-arginine group following cardiopulmonary bypass (control 4.2±1.9 cm.s(-1) to 3.6±1.2 cm.s(-1) vs L-arginine 3.8±1.2 cm.s(-1) to 4.6±1.4 cm.s(-1)) (P=0.018). In patients with reduced ejection fraction, L-arginine supplemented cardioplegic arrest did not affect postoperative cardiac troponin-I levels, but attenuated cardiac cellular peroxidation and improved early left ventricular diastolic function.
David T Andrews; Joan Sutherland; Peter Dawson; Alistair G Royse; Colin Royse
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anaesthesia and intensive care     Volume:  40     ISSN:  0310-057X     ISO Abbreviation:  Anaesth Intensive Care     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-02-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0342017     Medline TA:  Anaesth Intensive Care     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  99-106     Citation Subset:  IM    
Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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