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Ott S, Lee ZY, Müller-Wirtz LM, Cangut B, Roessler J, Patterson W, Thomas CM, Bekele BM, Windpassinger M, Lobdell K, Grant MC, Arora RC, Engelman DT, Fremes S, Velten M, O'Brien B, Ruetzler K, Heyland DK, Stoppe C. The effect of a selenium-based anti-inflammatory strategy on postoperative functional recovery in high-risk cardiac surgery patients - A nested sub-study of the sustain CSX trial. Life Sci 2024; 351:122841. [PMID: 38897349 DOI: 10.1016/j.lfs.2024.122841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
AIM The cardiac surgery-related ischemia-reperfusion-related oxidative stress triggers the release of cytotoxic reactive oxygen and nitrogen species, contributing to organ failure and ultimately influencing patients' short- and long-term outcomes. Selenium is an essential co-factor for various antioxidant enzymes, thereby contributing to the patients' endogenous antioxidant and anti-inflammatory defense mechanisms. Given these selenium's pleiotropic functions, we investigated the effect of a high-dose selenium-based anti-inflammatory perioperative strategy on functional recovery after cardiac surgery. MATERIALS AND METHODS This prospective study constituted a nested sub-study of the SUSTAIN CSX trial, a double-blinded, randomized, placebo-controlled multicenter trial to investigate the impact of high-dose selenium supplementation on high-risk cardiac surgery patients' postoperative recovery. Functional recovery was assessed by 6-min walk distance, Short Form-36 (SF-36) and Barthel Index questionnaires. KEY FINDINGS 174 patients were included in this sub-study. The mean age (SD) was 67.3 (8.9) years, and 78.7 % of the patients were male. The mean (SD) predicted 30-day mortality by the European System for Cardiac Operative Risk Evaluation II score was 12.6 % (9.4 %). There was no difference at hospital discharge and after three months in the 6-min walk distance between the selenium and placebo groups (131 m [IQR: not performed - 269] vs. 160 m [IQR: not performed - 252], p = 0.80 and 400 m [IQR: 299-461] vs. 375 m [IQR: 65-441], p = 0.48). The SF-36 and Barthel Index assessments also revealed no clinically meaningful differences between the selenium and placebo groups. SIGNIFICANCE A perioperative anti-inflammatory strategy with high-dose selenium supplementation did not improve functional recovery in high-risk cardiac surgery patients.
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Affiliation(s)
- Sascha Ott
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Zheng-Yii Lee
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lukas M Müller-Wirtz
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66424 Homburg, Saarland, Germany; Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA.
| | - Busra Cangut
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Julian Roessler
- Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - William Patterson
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA.
| | - Christian M Thomas
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany.
| | - Biniam M Bekele
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marita Windpassinger
- Department of Anesthesia, Critical Care and Pain Medicine, Division of General Anesthesia and Intensive Care Medicine, Medical University Vienna, Vienna, Austria.
| | - Kevin Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC 28203, USA.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA; Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Rakesh C Arora
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health and University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Department of Surgery, University of Toronto, Toronto, Canada.
| | - Markus Velten
- Department of Anesthesiology and Pain Management, Division of Cardiovascular and Thoracic Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Benjamin O'Brien
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; St Bartholomew's Hospital and Barts Heart Centre, Department of Perioperative Medicine, London EC1A 7BE, UK.
| | - Kurt Ruetzler
- Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany; Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany.
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Steinmetz C, Krause L, Sulejmanovic S, Kaumkötter S, Mengden T, Grefe C, Knoglinger E, Reiss N, Brixius K, Bjarnason-Wehrens B, Schmidt T, von Haehling S, Sadlonova M, von Arnim CAF, Heinemann S. The prevalence and impact of sarcopenia in older cardiac patients undergoing inpatient cardiac rehabilitation - results from a prospective, observational cohort pre-study. BMC Geriatr 2024; 24:94. [PMID: 38267843 PMCID: PMC10809534 DOI: 10.1186/s12877-024-04694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The prevalence of sarcopenia and its impact in older patients undergoing inpatient cardiac rehabilitation (iCR) after cardiac procedure has been insufficiently studied. The main aim of this study was to evaluate the prevalence of sarcopenia and quantify the functional capacity of older sarcopenic and non-sarcopenic patients participating in iCR. METHODS Prospective, observational cohort study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". A sample of 122 patients ≥75 years undergoing iCR after cardiac procedure were recruited in four German iCR facilities and followed up 3 months later by telephone. At iCR (baseline), the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire was used to identify sarcopenic patients. In addition, Katz-Index, Clinical Frailty Scale (CFS), handgrip strength (HGS), Short Physical Performance Battery (SPPB) and 6-minute walk distance (6MWD) measured functional capacity and frailty at baseline. Outcomes were prevalence of sarcopenia and the correlation of sarcopenia to functional capacity and frailty at baseline as well as the SARC-F score at follow-up. The Wilcoxon test was applied for pre-post-test analysis. Correlation between sarcopenia and 6MWD, SPPB score and HGS was tested with the eta coefficient with one-way ANOVA. RESULTS Complete assessments were collected from 101 patients (79.9 ± 4.0 years; 63% male). At baseline, the mean SARC-F score was 2.7 ± 2.1; 35% with sarcopenia. Other baseline results were Katz-Index 5.7 ± 0.9, CFS 3.2 ± 1.4, HGS 24.9 ± 9.9 kg, SPPB score 7.5 ± 3.3 and 6MWD 288.8 ± 136.5 m. Compared to baseline, fewer patients were sarcopenic (23% versus 35%) at follow-up. In the subgroup of sarcopenic patients at baseline (n = 35), pre-post comparison resulted in a significant SARC-F improvement (p = 0.017). There was a significant correlation between sarcopenia measured by SARC-F and poor results in the assessments of functional capacity (p < 0.001; r > 0.546). CONCLUSIONS The prevalence of sarcopenia in older patients at iCR after cardiac procedure is high (35%) and remains high at follow-up (23%). Sarcopenia screening is important since the diagnosis of sarcopenia in these patients correlates significantly with poor functional capacity. The results indicate that these patients may benefit from prehabilitation aimed at improving perioperative outcomes, increasing functional capacity and mitigating adverse effects. TRIAL REGISTRATION German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00032256). Retrospectively registered on 13 July 2023.
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Affiliation(s)
- Carolin Steinmetz
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Laura Krause
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Samra Sulejmanovic
- Institute for Sports Science University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Sabrina Kaumkötter
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Heart Center, Ludwigstr. 41, 61231, Bad Nauheim, Germany
| | - Clemens Grefe
- Clinic and Rehabilitation Center Lippoldsberg, Birkenallee 1, 34399, Wesertal, Germany
| | - Ernst Knoglinger
- Kirchberg Clinic, Bad Lauterberg, Kirchberg 7-11, 37431, Bad Lauterberg, Germany
| | - Nils Reiss
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Klara Brixius
- Institute of Cardiology and Sports Medicine, Department of Molecular and Cellular Sports Medicine, German Sport University, Am Müngersdorfer Sportpark 6, 50933, Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Müngersdorfer Sportpark 6, 50933, Cologne, Germany
| | - Thomas Schmidt
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Müngersdorfer Sportpark 6, 50933, Cologne, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Robert-Koch-Str. 42a, 37075, Goettingen, Germany
| | - Monika Sadlonova
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Robert-Koch-Str. 42a, 37075, Goettingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Robert-Koch-Str. 42a, 37075, Goettingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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