Effects of inorganic nitrate on ischaemia-reperfusion injury after coronary artery bypass surgery: a randomised controlled trial.
Aged
Biomarkers
/ blood
Blood Loss, Surgical
Cardiopulmonary Bypass
/ methods
Coronary Artery Bypass
/ methods
Double-Blind Method
Female
Humans
Male
Middle Aged
Myocardial Reperfusion Injury
/ physiopathology
Nitrates
/ administration & dosage
Nitric Oxide
/ metabolism
Preoperative Care
/ methods
Troponin T
/ blood
bleeding
cardiac surgery
ischaemia-reperfusion injury
nitrate
nitric oxide
nitrite
perioperative
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
25
02
2021
revised:
18
06
2021
accepted:
21
06
2021
pubmed:
18
8
2021
medline:
16
11
2021
entrez:
17
8
2021
Statut:
ppublish
Résumé
Nitric oxide (NO) is an important signalling molecule in the cardiovascular system with protective properties in ischaemia-reperfusion injury. Inorganic nitrate, an oxidation product of endogenous NO production and a constituent in our diet, can be recycled back to bioactive NO. We investigated if preoperative administration of inorganic nitrate could reduce troponin T release and other plasma markers of injury to the heart, liver, kidney, and brain in patients undergoing cardiac surgery. This single-centre, randomised, double-blind, placebo-controlled trial included 82 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mg×2) or placebo (NaCl) were administered before surgery. Biomarkers of ischaemia-reperfusion injury and plasma nitrate and nitrite were collected before and up to 72 h after surgery. Troponin T release was our predefined primary endpoint and biomarkers of renal, liver, and brain injury were secondary endpoints. Plasma concentrations of nitrate and nitrite were elevated in nitrate-treated patients compared with placebo. The 72-h release of troponin T did not differ between groups. Other plasma biomarkers of organ injury were also similar between groups. Blood loss was not a predefined outcome parameter, but perioperative bleeding was 18% less in nitrate-treated patients compared with controls. Preoperative administration of inorganic nitrate did not influence troponin T release or other plasma biomarkers of organ injury in cardiac surgery. NCT01348971.
Sections du résumé
BACKGROUND
BACKGROUND
Nitric oxide (NO) is an important signalling molecule in the cardiovascular system with protective properties in ischaemia-reperfusion injury. Inorganic nitrate, an oxidation product of endogenous NO production and a constituent in our diet, can be recycled back to bioactive NO. We investigated if preoperative administration of inorganic nitrate could reduce troponin T release and other plasma markers of injury to the heart, liver, kidney, and brain in patients undergoing cardiac surgery.
METHODS
METHODS
This single-centre, randomised, double-blind, placebo-controlled trial included 82 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mg×2) or placebo (NaCl) were administered before surgery. Biomarkers of ischaemia-reperfusion injury and plasma nitrate and nitrite were collected before and up to 72 h after surgery. Troponin T release was our predefined primary endpoint and biomarkers of renal, liver, and brain injury were secondary endpoints.
RESULTS
RESULTS
Plasma concentrations of nitrate and nitrite were elevated in nitrate-treated patients compared with placebo. The 72-h release of troponin T did not differ between groups. Other plasma biomarkers of organ injury were also similar between groups. Blood loss was not a predefined outcome parameter, but perioperative bleeding was 18% less in nitrate-treated patients compared with controls.
CONCLUSION
CONCLUSIONS
Preoperative administration of inorganic nitrate did not influence troponin T release or other plasma biomarkers of organ injury in cardiac surgery.
CLINICAL TRIAL REGISTRATION
BACKGROUND
NCT01348971.
Identifiants
pubmed: 34399982
pii: S0007-0912(21)00452-9
doi: 10.1016/j.bja.2021.06.046
pmc: PMC8524391
pii:
doi:
Substances chimiques
Biomarkers
0
Nitrates
0
Troponin T
0
Nitric Oxide
31C4KY9ESH
sodium nitrate
8M4L3H2ZVZ
Banques de données
ClinicalTrials.gov
['NCT01348971']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
547-555Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
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