Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery
Purpose: Myocardial injury due to on-pump coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF) is associated with poor outcomes. This study determines whether intravenous glutamine could protect the myocardium during on-pump CABG in patients with low EF. Materials and M...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press Ltd
2022
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| Online Access: | https://repository.ugm.ac.id/283186/1/24.pdf |
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| author | Parmana, I Made Adi Boom, Cindy Elfira Rachmadi, Lisnawati Hanafy, Dudy Arman Widyastuti, Yunita Mansyur, Muchtaruddin Siswanto, Bambang Budi |
| author_facet | Parmana, I Made Adi Boom, Cindy Elfira Rachmadi, Lisnawati Hanafy, Dudy Arman Widyastuti, Yunita Mansyur, Muchtaruddin Siswanto, Bambang Budi |
| author_sort | Parmana, I Made Adi |
| collection | UGM |
| description | Purpose: Myocardial injury due to on-pump coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF) is associated with poor outcomes. This study determines whether intravenous glutamine could protect the myocardium during on-pump CABG in patients with low EF. Materials and Methods: This was a double-blind, randomized controlled trial to assess glutamine as a myocardial protector during on-pump CABG in patients with left ventricle EF of 31–50, conducted from January to October 2021. Patients in the glutamine group (n = 30) received 0.5 g/kg of 20 glutamine solution diluted with 0.9 NaCl up to 500 mL in total volume over a period of 24 hours. Patients in the control group (n = 30) received 0.9 NaCl over the same period. The primary outcomes were plasma troponin I and plasma glutamine levels. Secondary outcomes included α-ketoglutarate (α-KG) levels and histopathology scoring of the right atrial appendage tissue, plasma lactate levels, hemodynamic measurement, and morbidity. Results: Twenty-nine patients from each group (58 in total) were included in the analysis. Plasma troponin I levels at 6 and 24 hours after cardiopulmonary bypass (CPB) were significantly lower in the glutamine than the control group (mean 3.43 ± 1.51 ng/mL vs mean 4.41 ± 1.89 ng/mL; p = 0.034; median 3.08 ng/mL min–max: 1.30–6.59 vs median 3.77 ng/mL min–max: 0.00–36.53; p = 0.038, respectively). Plasma glutamine levels at 24 hours after CPB were significantly higher in the glutamine than the control group (mean 935.42 ± 319.10 μmol/L vs mean 634.79 ± 243.89 μmol/L, p = 0.001). Plasma lactate levels at 6 and 24 hours after CPB were significantly lower in the glutamine than the control group (median 5.30 mmol/L min-max: 1.20–9.50 vs median 5.70 mmol/L min-max: 2.80–11.30, p = 0.042; mean 2.08 ± 0.67 mmol/L vs mean 2.46 ± 0.69 mmol/L, p = 0.044, respectively). Myocardial injury score was significantly lower in the glutamine than the control group (mean 1.30 ± 0.24 vs mean 1.48 ± 0.26, p = 0.011). Conclusion: Perioperative administration of 0.5 g/kg intravenous glutamine solution over the period of 24 hours has myocardial protection effect in patients with low EF who undergo elective on-pump CABG. © 2022 Parmana et al. |
| first_indexed | 2024-03-14T00:06:58Z |
| format | Article |
| id | oai:generic.eprints.org:283186 |
| institution | Universiti Gadjah Mada |
| language | English |
| last_indexed | 2024-03-14T00:06:58Z |
| publishDate | 2022 |
| publisher | Dove Medical Press Ltd |
| record_format | dspace |
| spelling | oai:generic.eprints.org:2831862023-11-20T02:44:14Z https://repository.ugm.ac.id/283186/ Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery Parmana, I Made Adi Boom, Cindy Elfira Rachmadi, Lisnawati Hanafy, Dudy Arman Widyastuti, Yunita Mansyur, Muchtaruddin Siswanto, Bambang Budi Cardiology (incl. Cardiovascular Diseases) Purpose: Myocardial injury due to on-pump coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF) is associated with poor outcomes. This study determines whether intravenous glutamine could protect the myocardium during on-pump CABG in patients with low EF. Materials and Methods: This was a double-blind, randomized controlled trial to assess glutamine as a myocardial protector during on-pump CABG in patients with left ventricle EF of 31–50, conducted from January to October 2021. Patients in the glutamine group (n = 30) received 0.5 g/kg of 20 glutamine solution diluted with 0.9 NaCl up to 500 mL in total volume over a period of 24 hours. Patients in the control group (n = 30) received 0.9 NaCl over the same period. The primary outcomes were plasma troponin I and plasma glutamine levels. Secondary outcomes included α-ketoglutarate (α-KG) levels and histopathology scoring of the right atrial appendage tissue, plasma lactate levels, hemodynamic measurement, and morbidity. Results: Twenty-nine patients from each group (58 in total) were included in the analysis. Plasma troponin I levels at 6 and 24 hours after cardiopulmonary bypass (CPB) were significantly lower in the glutamine than the control group (mean 3.43 ± 1.51 ng/mL vs mean 4.41 ± 1.89 ng/mL; p = 0.034; median 3.08 ng/mL min–max: 1.30–6.59 vs median 3.77 ng/mL min–max: 0.00–36.53; p = 0.038, respectively). Plasma glutamine levels at 24 hours after CPB were significantly higher in the glutamine than the control group (mean 935.42 ± 319.10 μmol/L vs mean 634.79 ± 243.89 μmol/L, p = 0.001). Plasma lactate levels at 6 and 24 hours after CPB were significantly lower in the glutamine than the control group (median 5.30 mmol/L min-max: 1.20–9.50 vs median 5.70 mmol/L min-max: 2.80–11.30, p = 0.042; mean 2.08 ± 0.67 mmol/L vs mean 2.46 ± 0.69 mmol/L, p = 0.044, respectively). Myocardial injury score was significantly lower in the glutamine than the control group (mean 1.30 ± 0.24 vs mean 1.48 ± 0.26, p = 0.011). Conclusion: Perioperative administration of 0.5 g/kg intravenous glutamine solution over the period of 24 hours has myocardial protection effect in patients with low EF who undergo elective on-pump CABG. © 2022 Parmana et al. Dove Medical Press Ltd 2022 Article PeerReviewed application/pdf en https://repository.ugm.ac.id/283186/1/24.pdf Parmana, I Made Adi and Boom, Cindy Elfira and Rachmadi, Lisnawati and Hanafy, Dudy Arman and Widyastuti, Yunita and Mansyur, Muchtaruddin and Siswanto, Bambang Budi (2022) Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery. Vascular Health and Risk Management, 18. 219 -231. ISSN 8104688X8 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85128092985&doi=10.2147%2fVHRM.S361298&partnerID=40&md5=dd2832e9179dcb4234db9adaaf969dcf 10.2147/VHRM.S361298 |
| spellingShingle | Cardiology (incl. Cardiovascular Diseases) Parmana, I Made Adi Boom, Cindy Elfira Rachmadi, Lisnawati Hanafy, Dudy Arman Widyastuti, Yunita Mansyur, Muchtaruddin Siswanto, Bambang Budi Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery |
| title | Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery |
| title_full | Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery |
| title_fullStr | Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery |
| title_full_unstemmed | Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery |
| title_short | Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery |
| title_sort | myocardial protecting role of glutamine in patients with low ejection fraction undergoing elective on pump coronary artery bypass graft surgery |
| topic | Cardiology (incl. Cardiovascular Diseases) |
| url | https://repository.ugm.ac.id/283186/1/24.pdf |
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