| Preconditioning the human heart. | |
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MedLine Citation:
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PMID: 9038496 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The phenomenon of ischaemic preconditioning protects the myocardium by limiting infarct size in animal models of ischaemia and reperfusion. Ischaemic preconditioning may be induced by short periods of ischaemia and reperfusion. We investigated whether the human heart can be ischaemically preconditioned during coronary artery bypass grafting (CABG). Patients were enrolled into two separate studies. In the first study myocardial adenosine triphosphate (ATP) was used as the measured endpoint, assayed from myocardial biopsies taken at onset of cardiopulmonary bypass (CPB), at the end of the preconditioning stimulus, and at the end of a 10 min sustained ischaemic insult. In the second study the release of myocardial troponin T was used as the endpoint; taken at pre-CPB, and at 1, 6, 24, and 72 h after CPB. In both studies, patients were randomised into either the preconditioning group or the control group. Preconditioning was induced, after the onset of CPB, with two 3 min periods of crossclamping and an intervening 2 min of reperfusion, followed by 10 min sustained ischaemia. The control group only received 10 min of sustained ischaemia. Ischaemic preconditioning resulted in a slower rate of ATP (mumol/g dry weight) depletion in the preconditioned hearts at the end of the 10 min of sustained ischaemia (preconditioned: 11.5 +/- 0.8 vs control: 7.2 +/- 0.3; P < 0.005). Also, preconditioning resulted in a slower rate of troponin T release which was significantly different at 72 h after CPB in the preconditioned group (0.3 milligram) when compared with the control group (1.4 milligrams; P < 0.05). In addition, more patients in the preconditioned group had troponin T levels lower than 0.5 milligram at 72 h than in the control group (10 vs 3 patients). Both groups of patients received the same number of grafts, and underwent the same length of ischaemia during the procedure. We conclude that in patients undergoing CABG surgery, ischaemic preconditioning may reduce myocardial injury as shown by the favourable changes in myocardial ATP, and serum troponin T levels. |
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Authors:
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A M Alkhulaifi |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Annals of the Royal College of Surgeons of England Volume: 79 ISSN: 0035-8843 ISO Abbreviation: Ann R Coll Surg Engl Publication Date: 1997 Jan |
Date Detail:
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Created Date: 1997-03-12 Completed Date: 1997-03-12 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 7506860 Medline TA: Ann R Coll Surg Engl Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 49-54 Citation Subset: IM |
Affiliation:
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Harefield Hospital, Middlesex. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine Triphosphate
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metabolism Aged Biological Markers Coronary Artery Bypass* Creatine Kinase / blood Humans Ischemic Preconditioning, Myocardial* Lactic Acid / metabolism Middle Aged Myocardium / metabolism Phosphocreatine / metabolism Troponin / blood Troponin T |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Troponin; 0/Troponin T; 50-21-5/Lactic Acid; 56-65-5/Adenosine Triphosphate; 67-07-2/Phosphocreatine; EC 2.7.3.2/Creatine Kinase |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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