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Yuan R, Xu M, Hu C, Ma H, Meng F, Ren J, Wen J. Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients. Front Med (Lausanne) 2024; 11:1352918. [PMID: 38765256 PMCID: PMC11100417 DOI: 10.3389/fmed.2024.1352918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/26/2024] [Indexed: 05/21/2024] Open
Abstract
Introduction The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown. Methods In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60-79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision. Results There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 μg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 μg·kg-1·min-1) and Group A (0.06 ± 0.02 μg·kg-1·min-1) (p = 0.004). Conclusion Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.
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Affiliation(s)
- Ruimei Yuan
- Department of Anesthesiology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Min Xu
- Department of Endocrinology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chunhai Hu
- Department of Urology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Huailing Ma
- Department of Anesthesiology, Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Fanjun Meng
- Department of Anesthesiology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jie Ren
- Department of Anesthesiology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing Wen
- Department of Urology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Guilleminot P, Andrei S, Nguyen M, Abou-Arab O, Besnier E, Bouhemad B, Guinot PG. Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis. Front Pharmacol 2024; 15:1343647. [PMID: 38783960 PMCID: PMC11112351 DOI: 10.3389/fphar.2024.1343647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
Objective: We investigated the effects of the maintenance of angiotensin-converting enzyme inhibitors (ACE inhibitors) the day of the surgery on the incidence of postoperative acute kidney injury (AKI) and cardiac events in patients undergoing cardiac surgery. Methods: We performed a multicentric observational study with propensity matching on 1,072 patients treated with ACE inhibitors. We collected their baseline demographic data, comorbidities, and operative and postoperative outcomes. AKI was defined by KDIGO (Kidney Disease: Improving Global Outcome). Results: Maintenance of an ACE inhibitor was not associated with an increased risk of AKI (OR: 1.215 (CI95%:0.657-2.24), p = 0.843, 71 patients (25.1%) vs. 68 patients (24%)). Multivariate logistic regression and sensitive analysis did not demonstrate any association between ACE inhibitor maintenance and AKI, following cardiac surgery (OR: 1.03 (CI95%:0.81-1.3)). No statistically significant difference occurs in terms of incidence of cardiogenic shock (OR: 1.315 (CI95%:0.620-2.786)), stroke (OR: 3.313 (CI95%:0.356-27.523)), vasoplegia (OR: 0.741 (CI95%:0.419-1.319)), postoperative atrial fibrillation (OR: 1.710 (CI95%:0.936-3.122)), or mortality (OR: 2.989 (CI95%:0.343-26.034)). ICU and hospital length of stays did not differ (3 [2; 5] vs. 3 [2; 5] days, p = 0.963 and 9.5 [8; 12] vs. 10 [8; 14] days, p = 0.638). Conclusion: Our study revealed that maintenance of ACE inhibitors on the day of the surgery was not associated with increased postoperative AKI. ACE inhibitor maintenance was also not associated with an increased rate of postoperative major cardiovascular events (arterial hypotension, cardiogenic shock, vasopressors use, stroke and death).
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Affiliation(s)
- Pierre Guilleminot
- Department of Cardiology, Dijon University Medical Centre, Dijon, France
| | - Stefan Andrei
- Department of Anaesthesiology and Critical Care Medicine, Hopital Bichat Claude Bernard, Paris, France
| | - Maxime Nguyen
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
- University of Burgundy and Franche-Comté, LNC UMR1231, F-21000, Dijon, France
| | - Osama Abou-Arab
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Medical Centre, Amiens, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care Medicine, Rouen University Medical Centre, Rouen, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
- University of Burgundy and Franche-Comté, LNC UMR1231, F-21000, Dijon, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
- University of Burgundy and Franche-Comté, LNC UMR1231, F-21000, Dijon, France
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Huang M, Huiskes FG, de Groot NMS, Brundel BJJM. The Role of Immune Cells Driving Electropathology and Atrial Fibrillation. Cells 2024; 13:311. [PMID: 38391924 PMCID: PMC10886649 DOI: 10.3390/cells13040311] [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: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Atrial fibrillation (AF) is the most common progressive cardiac arrhythmia worldwide and entails serious complications including stroke and heart failure. Despite decades of clinical research, the current treatment of AF is suboptimal. This is due to a lack of knowledge on the mechanistic root causes of AF. Prevailing theories indicate a key role for molecular and structural changes in driving electrical conduction abnormalities in the atria and as such triggering AF. Emerging evidence indicates the role of the altered atrial and systemic immune landscape in driving this so-called electropathology. Immune cells and immune markers play a central role in immune remodeling by exhibiting dual facets. While the activation and recruitment of immune cells contribute to maintaining atrial stability, the excessive activation and pronounced expression of immune markers can foster AF. This review delineates shifts in cardiac composition and the distribution of immune cells in the context of cardiac health and disease, especially AF. A comprehensive exploration of the functions of diverse immune cell types in AF and other cardiac diseases is essential to unravel the intricacies of immune remodeling. Usltimately, we delve into clinical evidence showcasing immune modifications in both the atrial and systemic domains among AF patients, aiming to elucidate immune markers for therapy and diagnostics.
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Affiliation(s)
- Mingxin Huang
- Department of Physiology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, 1081 HZ Amsterdam, The Netherlands; (M.H.); (F.G.H.)
- Department of Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Fabries G. Huiskes
- Department of Physiology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, 1081 HZ Amsterdam, The Netherlands; (M.H.); (F.G.H.)
| | | | - Bianca J. J. M. Brundel
- Department of Physiology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, 1081 HZ Amsterdam, The Netherlands; (M.H.); (F.G.H.)
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Zhang YQ, Liu XG, Ding Q, Berguson M, Morris RJ, Liu H, Goldhammer JE. Perioperative Renin-Angiotensin System Inhibitors Improve Major Outcomes of Heart Failure Patients Undergoing Cardiac Surgery: A Propensity-Adjusted Cohort Study. Ann Surg 2023; 277:e948-e954. [PMID: 35166263 DOI: 10.1097/sla.0000000000005408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to study the association of perioperative administration of renin angiotensin system inhibitors (RASi) and clinical outcomes of patients with heart failure (HF) undergoing cardiac surgery. SUMMARY BACKGROUND DATA It is controversial whether the perioperative RASi should be administered in HF patients undergoing cardiac surgery. METHODS A total of 2338 patients with HF and undergoing CABG and/or valve surgeries at multiple hospitals from 2001 to 2015 were identified from STS database. After adjustment using propensity score and instrumental variable, logistic regression was conducted to analyze the influence of preoperative continuation of RASi (PreRASi) on short-term in-hospital outcomes. Independent risk factors of 30-day mortality, major adverse cardiovascular events (MACE), and renal failure were analyzed by use of stepwise logistic regression. The effects of pre- and postoperative use of RASi (PostRASi) on long-term mortality were analyzed using survival analyses. Stepwise Cox regression was conducted to analyze the independent risk factors of 6-year mortality. The relationships of HF status and surgery type with perioperative RASi, as well as PreRASi-PostRASi, were also evaluated by subgroup analyses. RESULTS PreRASi was associated with lower incidences of 30-day mortality [ P < 0.0001, odds ratio (OR): 0.556, 95% confidence interval (CI) 0.405-0.763], stroke ( P =0.035, OR: 0.585, 95% CI: 0.355-0.962), renal failure ( P =0.007, OR: 0.663, 95% CI: 0.493-0.894). Both PreRASi ( P =0.0137) and PostRASi ( P =0.007) reduced 6-year mortality compared with the No-RASi groups. CONCLUSIONS Pre- and postoperative use of RASi was associated with better outcomes for the patients who have HF and undergo CABG and/or valve surgeries. Preoperative continuation and postoperative restoration are warranted in these patients.
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Affiliation(s)
- Yan-Qing Zhang
- Department of Anesthesiology, School of Anesthesiology, The First Hospital, Shanxi Medical University, Taiyuan, China
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Xiao-Gang Liu
- The Key Laboratory of Biomedical information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Ding
- Department of Anesthesiology, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Mark Berguson
- Department of Anesthesiology, Lankenau Medical Center, Wynnewood, PA
| | - Rohinton J Morris
- Division of Cardiothoracic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Hong Liu
- Department of Anesthesiology, University of California Davis Medical Center, Sacramento, CA
| | - Jordan E Goldhammer
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Noubiap JJ, Nouthe B, Sia YT, Spaziano M. Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery: A systematic review with meta-analysis. World J Cardiol 2022; 14:250-259. [PMID: 35582469 PMCID: PMC9048276 DOI: 10.4330/wjc.v14.i4.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/09/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vasoplegia is a common complication of cardiac surgery but its causal relationship with preoperative use of renin angiotensin system (RAS) blockers [angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB)] is still debated.
AIM To update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia.
METHODS All published studies from MEDLINE, EMBASE, and Web of Science providing relevant data through January 13, 2021 were identified. A random-effects meta-analysis method was used to pool estimates, and post-cardiac surgery shock was differentiated from vasoplegia.
RESULTS Ten studies reporting on a pooled population of 15672 patients (none looking at ARBs exclusively) were included in the meta-analysis. All were case-control studies. Use of ACEIs was associated with an increased risk of vasoplegia [pooled adjusted odds ratio (Aor) of 2.06, 95%CI: 1.45-2.93] and increased inotropic/vasopressor support requirement (pooled aOR 1.19, 95%CI: 1.10-1.29). Post-cardiac surgery shock was increased in the presence of left ventricular dysfunction (pooled aOR 2.32, 95%CI: 1.60-3.36; I2 49%) but not increased by the use of beta blockers (pooled aOR 0.78, 95%CI: 0.36-1.69; I2 77%). Two randomized control trials (RCTs), not eligible for the meta-analysis, did not show an association between continuation of RAS blockers and vasoplegia.
CONCLUSION Preoperative continuation of ACEIs is associated with an increased need for inotropic support postoperatively and with an increased risk of vasoplegia in observational studies but not in RCTs. The absence of a consensus definition of vasoplegia should lead to the use of perioperative cardiovascular monitoring when designing RCTs to better understand this discrepancy.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Brice Nouthe
- Department of Medicine, University of British Columbia, Vancouver V6T 1W5, Canada
| | - Ying Tung Sia
- Department of Medicine, Regional Trois-Rivières Hospital (CIUSSS-MCQ), Trois-Rivières 5000, Canada
| | - Marco Spaziano
- Department of Cardiology, McGill University Health Centre, Montréal QC H4A 3J1, Canada
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Balcı E, Demir ZA, Bahçecitapar M. Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure. Anesth Pain Med (Seoul) 2022; 17:112-119. [PMID: 34991190 PMCID: PMC8841255 DOI: 10.17085/apm.21050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Blood pressure fluctuations appear more significant in patients with poorly controlled hypertension and are known to be associated with adverse perioperative morbidity. In the present study, we aimed to determine the effects of antihypertensive drug treatment strategies on preanesthetic operating room blood pressure measurements. Methods A total of 717 patients participated in our study; 383 patients who were normotensive based on baseline measurements and not under antihypertensive therapy were excluded from the analysis. The remaining 334 patients were divided into six groups according to the antihypertensive drug treatment. These six groups were examined in terms of preoperative baseline and pre-anesthesia blood pressure measurements. Results As a result of the study, it was observed that 24% of patients had high blood pressure precluding surgery, and patients using renin-angiotensin-aldosterone system inhibitors (RAASI) had higher pre-anesthesia systolic blood pressure than patients using other antihypertensive drugs. Patients who received beta-blockers were also observed to have the lowest pre-anesthesia systolic blood pressure, diastolic blood pressure, and mean blood pressure, compared to others. Conclusions Recently, whether RAASI should be continued preoperatively remains controversial. Our study shows that RAASI cannot provide optimal pre-anesthesia blood pressure and lead to an increase in the number of postponed surgeries, probably due to withdrawal of medication before the operation. Therefore, the preoperative discontinuation of RAASI should be reevaluated in future studies.
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Affiliation(s)
- Eda Balcı
- Department of Anesthesiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Zeliha Aslı Demir
- Department of Anesthesiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
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Antoniak DT, Walters RW, Alla VM. Impact of Renin-Angiotensin System Blockers on Mortality in Veterans Undergoing Cardiac Surgery. J Am Heart Assoc 2021; 10:e019731. [PMID: 33969701 PMCID: PMC8200704 DOI: 10.1161/jaha.120.019731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Renin‐angiotensin system blockers (RASBs) have well‐validated benefit in patients with hypertension, coronary artery disease, and left ventricular systolic dysfunction. Their use in the perioperative period, however, has been controversial, including in patients undergoing cardiac surgery, who often have a strong indication for their use. In the current study, we explore the impact of RASB use with 30‐day and 1‐year mortality after cardiac surgery. Methods and Results The Veterans Affairs Surgical Quality Improvement Program and Corporate Data Warehouse were data sources for this retrospective cohort study. A total of 37 197 veterans undergoing elective coronary artery bypass grafting and or valve repair or replacement over a 10‐year period met inclusion criteria and were stratified into 4 groups by preoperative exposure (preoperative exposure versus no preoperative exposure) and postoperative continuing exposure (current exposure versus no current exposure) to RASBs. After adjusting for all baseline covariates, the preoperative exposure/current exposure group had lower 30‐day and 1‐year mortality than the preoperative exposure/no current exposure (30‐day hazard ratio [HR], 0.25; 95% CI, 0.19–0.33 [P<0.001] and 1‐year HR, 0.40; 95% CI, 0.33–0.48 [P<0.001] or no preoperative exposure/no current exposure (30‐day HR, 0.44; 95% CI, 0.32–0.60 [P<0.001] and 1‐year HR, 0.72; 95% CI, 0.62–0.84 [P<0.001] groups. The no preoperative exposure/current exposure group had significantly lower 30‐day (HR, 0.31; 95% CI, 0.14–0.71 [P=0.006]) and 1‐year (HR, 0.64; 95% CI, 0.53–0.77 [P<0.001]) mortality than the no preoperative exposure/no current exposure group. Conclusions Continuation of preoperative RASBs and initiation before discharge is associated with decreased mortality in veterans undergoing cardiac surgery. Given these findings, continuation of preoperative RASBs or initiation in the early postoperative period should be considered in patients undergoing cardiac surgery.
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Affiliation(s)
- Derrick T Antoniak
- Veterans Affairs Nebraska-Western Iowa Health Care System Omaha NE.,Division of General Internal Medicine Department of Medicine University of Nebraska Medical Center Omaha NE
| | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences Department of Medicine Creighton University Omaha NE
| | - Venkata M Alla
- Division of Cardiology Department of Medicine Creighton University Omaha NE
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Roberts DJ, Smith SA, Tan Z, Dixon E, Datta I, Devrome A, Hemmelgarn BR, Tonelli M, Pannu N, James MT. Angiotensin-Converting Enzyme Inhibitor/Receptor Blocker, Diuretic, or Nonsteroidal Anti-inflammatory Drug Use After Major Surgery and Acute Kidney Injury: A Case-Control Study. J Surg Res 2021; 263:34-43. [PMID: 33631376 DOI: 10.1016/j.jss.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is common after surgery and associated with increased mortality, costs, and lengths of hospitalization. We examined associations between angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), diuretic, or nonsteroidal anti-inflammatory drug (NSAID) use after major surgery and AKI. MATERIALS AND METHODS We conducted a nested case-control study of patients who underwent major cardiac, thoracic, general, or vascular surgery in Calgary, Alberta, Canada. Cases with AKI were matched on age, gender, and surgery type with up to five controls without AKI within 30-d after surgery. Adjusted odds ratios (ORs) for AKI were determined based on postoperative administration of ACEIs/ARBs, diuretics, or NSAIDs. RESULTS Among 33,648 patients in the cohort, 2911 cases with AKI were matched to 9309 controls without AKI. Postoperative diuretic [OR = 1.96; 95% confidence interval (CI) = 1.68-2.29], but not ACEI/ARB (OR = 0.83; 95% CI = 0.72-0.95) or NSAID (OR = 1.12; 95% CI = 0.96-1.31), use was independently associated with higher odds of AKI (including stages 1 and 2/3 AKI) after all types of major surgery. There were increased adjusted odds of AKI 1 to 5 d after first exposure to diuretics and 1 d after first exposure to NSAIDs (but not after later exposures). Relationships between ACEI/ARB use and AKI varied by surgery type (p-interaction = 0.004), with lower odds of AKI observed among ACEI/ARB use after cardiac surgery (OR = 0.70; 95% CI = 0.57-0.81), but no difference after other major surgeries. CONCLUSIONS Postoperative administration of diuretics and NSAIDs was associated with increased odds of AKI after major surgery. These findings characterize potentially modifiable medication exposures associated with AKI after surgery.
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Affiliation(s)
- Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Stephen A Smith
- Division of General Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Zhi Tan
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elijah Dixon
- Department of Surgery, Section of Vascular Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Indraneel Datta
- Department of Surgery, Section of General Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Devrome
- Department of Surgery, Section of Vascular Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Neesh Pannu
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Zhou H, Xie J, Zheng Z, Ooi OC, Luo H. Effect of Renin-Angiotensin System Inhibitors on Acute Kidney Injury Among Patients Undergoing Cardiac Surgery: A Review and Meta-Analysis. Semin Thorac Cardiovasc Surg 2020; 33:1014-1022. [DOI: 10.1053/j.semtcvs.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
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10
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De Bono JA, Conte SM, Newcomb AE. Effects of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy on Postoperative Renal Function in Cardiac Surgery. Heart Lung Circ 2020; 29:1656-1667. [PMID: 32732124 DOI: 10.1016/j.hlc.2020.06.003] [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: 12/23/2019] [Revised: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
A Best Evidence Topic in cardiac surgery was written according to a structured protocol. The question addressed was-"In patients who undergo cardiac surgery, is preoperative angiotensin-converting enzyme inhibitor therapy associated with postoperative renal dysfunction?" Altogether, 339 papers were found using the reported search. Ten (10) were chosen which best answered the clinical question. The papers were evaluated for bias and heterogeneity using validated tools and the collected results analysed qualitatively. Evidence in the current literature is inconclusive that preoperative administration of angiotensin-converting enzyme inhibitor therapy affects postoperative renal dysfunction in patients undergoing cardiac surgery.
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Affiliation(s)
- Joshua A De Bono
- Cardiothoracic Unit, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
| | - Sean M Conte
- Cardiology Unit, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Andrew E Newcomb
- Cardiothoracic Unit, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
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Tempe DK, Hasija S. Con: Does Preoperative Discontinuation of Angiotensin-Converting Enzyme Inhibitors/Angiotensin II Receptor Blockers Reduce Postoperative Acute Kidney Injury? J Cardiothorac Vasc Anesth 2020; 34:2836-2838. [PMID: 32444301 DOI: 10.1053/j.jvca.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/12/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak K Tempe
- Professor of Excellence and Former Dean, Maulana Azad Medical College, New Delhi.
| | - Suruchi Hasija
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
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12
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Zhou X, Dudley SC. Evidence for Inflammation as a Driver of Atrial Fibrillation. Front Cardiovasc Med 2020; 7:62. [PMID: 32411723 PMCID: PMC7201086 DOI: 10.3389/fcvm.2020.00062] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/26/2020] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most common types of arrhythmias and increases cardiovascular morbidity and mortality. Current therapeutic approaches to AF that focus on rhythm control have high recurrence rates and no life prolongation value. While possible explanations include toxicity of current therapies, another likely explanation may be that current therapies do not address fundamental mechanisms of AF initiation and maintenance. Inflammation has been shown to affect signaling pathways that lead to the development of AF. This paper reviews the roles of inflammation in the occurrence, development, and mechanisms of AF and reviews the therapeutic implications of the correlation of inflammation and AF.
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Affiliation(s)
- Xiaoxu Zhou
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN, United States
| | - Samuel C Dudley
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN, United States
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Milne B, Gilbey T, Ostermann M, Kunst G. Pro: We Should Stop ACE Inhibitors Early Before Cardiac Surgery to Prevent Postoperative Acute Kidney Injury. J Cardiothorac Vasc Anesth 2020; 34:2832-2835. [PMID: 32418831 DOI: 10.1053/j.jvca.2020.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Gilbey
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St. Thomas' Hospital, London, UK
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, Faculty of Life Sciences and Medicine, London, UK.
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14
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Shah R, Wenger RK, Patel PA, Davis S, Ha B, Feinman JW, Patel S, Pulton D, Weiss SJ, Restrepo-Cardenas J, Aljure OD, Vasquez CR, Augoustides JG. Severe Vasoplegic Shock During Coronary Artery Bypass Surgery: Therapeutic challenges and Dilemmas in Hemodynamic Rescue. J Cardiothorac Vasc Anesth 2020; 34:1341-1347. [PMID: 32146101 DOI: 10.1053/j.jvca.2020.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ronak Shah
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert K Wenger
- Department of Surgery, Division of Cardiac Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott Davis
- Department of Anesthesiology, Chester County Hospital, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Oscar D Aljure
- Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Charles R Vasquez
- Department of Surgery, Division of Cardiac Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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15
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Seese L, Sultan I, Wang Y, Gleason T, Thoma F, Kilic A. The effect of angiotensin‐converting enzyme inhibitor exposure on coronary artery bypass grafting. J Card Surg 2019; 35:58-65. [DOI: 10.1111/jocs.14385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Seese
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Yisi Wang
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Thomas Gleason
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Floyd Thoma
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
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16
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van Diepen S, Norris CM, Zheng Y, Nagendran J, Graham MM, Gaete Ortega D, Townsend DR, Ezekowitz JA, Bagshaw SM. Comparison of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial. J Am Heart Assoc 2019; 7:e009917. [PMID: 30371293 PMCID: PMC6474971 DOI: 10.1161/jaha.118.009917] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Postoperative clinical outcomes associated with the preoperative continuation or discontinuation of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) before cardiac surgery remain unclear. Methods and Results In a single‐center, open‐label, randomized, registry‐based clinical trial, patients undergoing nonemergent cardiac surgery were assigned to ACEI/ARB continuation or discontinuation 2 days before surgery. Among the 584 patients screened, 261 met study criteria and 126 (48.3%) patients were enrolled. In total,121 patients (96% adherence; 60 to continuation and 61 to ACEI/ARB discontinuation) underwent surgery and completed the study protocol, and follow‐up was 100% complete. Postoperative intravenous vasopressor use (78.3% versus 75.4%, P=0.703), vasodilator use (71.7% versus 80.3%, P=0.265), vasoplegic shock (31.7% versus 27.9%, P=0.648), median duration of vasopressor (10 versus 5 hours, P=0.494), and vasodilator requirements (10 versus 9 hours, P=0.469) were not significantly different between the continuation and discontinuation arms. No differences were observed in the incidence of acute kidney injury (1.7% versus 1.6%, P=0.991), stroke (no events, mortality (1.7% versus 1.6%, P=0.991), median duration of mechanical ventilation (6 versus 6 hours, P=0.680), and median intensive care unit length of stay (43 versus 27 hours, P=0.420) between the treatment arms. Conclusions A randomized study evaluating the routine continuation or discontinuation of ACEIs or ARBs before cardiac surgery was feasible, and treatment assignment was not associated with differences in postoperative physiological or clinical outcomes. These preliminary findings suggest that preoperative ACEI/ARB management strategies did not affect the postoperative course of patients undergoing cardiac surgery. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02096406.
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Affiliation(s)
- Sean van Diepen
- 1 Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada.,2 Division of Cardiology Department of Medicine University of Alberta Edmonton Alberta Canada.,3 Canadian VIGOUR Center University of Alberta Edmonton Alberta Canada
| | - Colleen M Norris
- 1 Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada.,4 Division of Cardiac Surgery University of Alberta Hospital Edmonton Alberta Canada.,5 Faculty of Nursing University of Alberta Edmonton Alberta Canada
| | - Yinggan Zheng
- 3 Canadian VIGOUR Center University of Alberta Edmonton Alberta Canada
| | - Jayan Nagendran
- 4 Division of Cardiac Surgery University of Alberta Hospital Edmonton Alberta Canada
| | - Michelle M Graham
- 2 Division of Cardiology Department of Medicine University of Alberta Edmonton Alberta Canada
| | - Damaris Gaete Ortega
- 1 Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
| | - Derek R Townsend
- 1 Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
| | - Justin A Ezekowitz
- 2 Division of Cardiology Department of Medicine University of Alberta Edmonton Alberta Canada.,3 Canadian VIGOUR Center University of Alberta Edmonton Alberta Canada
| | - Sean M Bagshaw
- 1 Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
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17
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Perioperative use of renin-angiotensin system inhibitors and outcomes in patients undergoing cardiac surgery. Nat Commun 2019; 10:4202. [PMID: 31519895 PMCID: PMC6744557 DOI: 10.1038/s41467-019-11678-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/24/2019] [Indexed: 12/28/2022] Open
Abstract
It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one (3.41% vs. 5.02%); PostRASi is associated with reduced long-term mortality rate compared with without one (6.62% vs. 7.70% at 2-year; 17.09% vs. 19.95% at 6-year). The results suggest that perioperative use of RASi has a significant benefit for the postoperative and long-term survival among patients undergoing cardiac surgery. Renin-angiotensin system inhibitors (RASi) are beneficial in several classes of cardiovascular patients. However, whether their perioperative use is beneficial and/or safe in cardiac surgery is unclear. Here the authors perform a multicenter retrospective cohort study showing that preoperative and postoperative use of RASi is associated with reduction of mortality in patients undergoing cardiac surgery.
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18
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Han J, Pinsino A, Sanchez J, Takayama H, Garan AR, Topkara VK, Naka Y, Demmer RT, Kurlansky PA, Colombo PC, Takeda K, Yuzefpolskaya M. Prognostic value of vasoactive-inotropic score following continuous flow left ventricular assist device implantation. J Heart Lung Transplant 2019; 38:930-938. [PMID: 31201088 PMCID: PMC9891263 DOI: 10.1016/j.healun.2019.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/06/2019] [Accepted: 05/17/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the utility of vasoactive-inotropic score (VIS) in predicting outcomes after left ventricular assist device (LVAD) implantation and explore possible mechanisms of post-operative hemodynamic instability. METHODS Retrospective review was performed in 418 consecutive patients with LVAD implantation. VIS was calculated as dopamine + dobutamine + 10 × milrinone + 100 × epinephrine + 100 × norepinephrine (all μg/kg/min) + 10000 × vasopressin (U/kg/min) after initial stabilization in the operating room and upon arrival at the intensive care unit. The primary outcome was in-hospital mortality. The secondary outcomes were a composite of in-hospital mortality, delayed right ventricular assist device (RVAD) implantation, and continuous renal replacement therapy. The pre-operative biomarkers of inflammation, oxidative stress, endotoxemia and gut-derived metabolite trimethylamine-N-oxide (TMAO) were measured in a subset of 61 patients. RESULTS Median VIS was 20.0 (interquartile range 13.3-27.9). VIS was an independent predictor of in-hospital mortality (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09, p < 0.001) and composite outcome (OR 1.03, 95% CI 1.01-1.06, p = 0.008). In-hospital mortality increased for each VIS quartile (0% vs 3.9% vs 7.6% vs 12.3%, p = 0.002). VIS was superior to other established LVAD risk models as a predictor of in-hospital mortality (area under the curve 0.73, 95% CI 0.64-0.82). The optimal cut-off point for VIS as a predictor of in-hospital mortality was 20. Pre-operative hemoglobin level was the only independent predictor of VIS ≥ 20 (p = 0.003). Patients with a high VIS were more likely to have elevated TMAO pre-operatively (53.6% vs 25.8%, p = 0.03). CONCLUSIONS A high post-operative VIS is associated with adverse in-hospital outcomes and is a better predictor of in-hospital mortality compared with existing LVAD risk models. Whether early hemodynamic stabilization using RVAD may benefit patients with a high VIS remains to be investigated.
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Affiliation(s)
- Jiho Han
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Alberto Pinsino
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joseph Sanchez
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
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19
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Chen S, Acou WJ, Kiuchi MG, Meyer C, Sommer P, Martinek M, Schratter A, Andrea BR, Ling Z, Liu S, Yin Y, Hindricks G, Pürerfellner H, Krucoff MW, Schmidt B, Chun KRJ. Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e194934. [PMID: 31150082 PMCID: PMC6547087 DOI: 10.1001/jamanetworkopen.2019.4934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Postoperative atrial fibrillation (POAF) is a well-known complication after cardiac surgery. Renin-angiotensin system inhibitors (RASIs) have been suggested as an upstream therapy for selected patients with AF; however, evidence in the surgical setting is limited. OBJECTIVE To evaluate the role of preoperative RASIs in prevention of POAF and adverse events for patients undergoing cardiac surgery. DATA SOURCES The PubMed database and the Cochrane Library from inception until December 31, 2018, were searched by using the keywords renin-angiotensin system inhibitors OR angiotensin-converting enzyme inhibitors OR angiotensin receptor blocker OR aldosterone antagonist AND cardiac surgery. ClinicalTrials.gov was searched from inception until December 31, 2018, by using the keywords postoperative atrial fibrillation. STUDY SELECTION Randomized clinical trials (RCTs) and observational studies comparing the association between preoperative RASI treatment vs no preoperative RASI treatment (control group) and the incidence of POAF were identified. Eleven unique studies met the selection criteria. DATA EXTRACTION AND SYNTHESIS Pooled analysis was performed using a random-effects model. Sensitivity and subgroup analyses of RCTs were performed to test the stability of the overall effect. Metaregression was conducted to explore potential risk of bias. MAIN OUTCOMES AND MEASURES The primary outcome was POAF, and the secondary outcomes included rates of stroke and mortality and duration of hospitalization. RESULTS Eleven unique studies involving 27 885 unique patients (74.4% male; median age, 65 years [range, 58.5-74.5 years]) were included. Compared with the control group, the RASI group did not have a significantly reduced risk of POAF (odds ratio [OR], 1.04; 95% CI, 0.91-1.19; P = .55; z = 0.60), stroke (OR, 0.86; 95% CI, 0.62-1.19; P = .37; z = 0.90; without significant heterogeneity, P = .11), death (OR, 1.07; 95% CI, 0.85-1.35; P = .56; z = 0.59; without significant heterogeneity, P = .12), composite adverse cardiac events (OR, 1.04; 95% CI, 0.91-1.18; P = .58; z = 0.56), or a reduced hospital stay (weighted mean difference, -0.04; 95% CI, -1.05 to 0.98; P = .94; z = 0.07) using a random-effects model. Pooled analysis focusing on RCTs showed consistent results. The primary overall effect was maintained in sensitivity and subgroup analyses. Metaregression showed that male sex was significantly associated with POAF (τ2 = 0.0065; z = 3.47; Q = 12.047; P < .001) and that use of β-blockers was associated with a significantly reduced risk in developing POAF (τ2 = 0.018; z = -2.24; Q = 5.0091; P = .03). CONCLUSIONS AND RELEVANCE The findings from this study suggest that preoperative RASI treatment does not offer additional benefit in reducing the risk of POAF, stroke, death, and hospitalization in the setting of cardiac surgery. The results provide no support for conventional use of RASIs for the possible prevention of POAF and adverse events in patients undergoing cardiac surgery; further randomized data, particularly among those patients with heart failure, are needed.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Marcio G. Kiuchi
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth
| | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Abteilung der Elektrophysiologie, Herzzentrum Universität Leipzig, Leipzig, Germany
| | - Martin Martinek
- Abteilung der Kardiologie, Akademisches Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Alexandra Schratter
- Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria
| | - Bruno R. Andrea
- Department of Cardiology, Sul Fluminense University Hospital, Vassouras, Brazil
| | - Zhiyu Ling
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing, China
| | - Gerhard Hindricks
- Abteilung der Elektrophysiologie, Herzzentrum Universität Leipzig, Leipzig, Germany
| | - Helmut Pürerfellner
- Abteilung der Kardiologie, Akademisches Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Mitchell W. Krucoff
- Department of Medicine and Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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20
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Orozco Vinasco DM, Triana Schoonewolff CA, Orozco Vinasco AC. Vasoplegic syndrome in cardiac surgery: Definitions, pathophysiology, diagnostic approach and management. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:277-287. [PMID: 30736984 DOI: 10.1016/j.redar.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
Vasoplegic syndrome is a state of vasopressor resistant systemic vasodilation in the presence of a normal cardiac output. Its definition, pathophysiology, risk factors, diagnosis and therapeutic approach will be reviewed in this paper. It occurs frequently during cardiac surgery and is associated with high morbidity and mortality. A search in the LILACS, MEDLINE, and GOOGLE SCHOLAR databases was conducted to find the most relevant papers during the last 18 years. Prompt identification and diagnosis of patients at risk must be undertaken in order to implement an optimal therapeutic approach. This latter includes early treatment with vasopressors with different mechanisms of action.
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Affiliation(s)
- D M Orozco Vinasco
- Departamento de Anestesia cardiovascular, Clínica Colsubsidio Calle 100, Instituto del Corazón de Bucaramanga sede Bogotá, Bogotá, Colombia.
| | - C A Triana Schoonewolff
- Departamento de Anestesia cardiovascular, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - A C Orozco Vinasco
- Departamento de Anestesia, Hospital Universitario Severo Ochoa, Leganés Madrid, España
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21
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Zacharia E, Papageorgiou N, Ioannou A, Siasos G, Papaioannou S, Vavuranakis M, Latsios G, Vlachopoulos C, Toutouzas K, Deftereos S, Providência R, Tousoulis D. Inflammatory Biomarkers in Atrial Fibrillation. Curr Med Chem 2019; 26:837-854. [DOI: 10.2174/0929867324666170727103357] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022]
Abstract
During the last few years, a significant number of studies have attempted to clarify
the underlying mechanisms that lead to the presentation of atrial fibrillation (AF). Inflammation
is a key component of the pathophysiological processes that lead to the development
of AF; the amplification of inflammatory pathways triggers AF, and, in tandem, AF
increases the inflammatory state. Indeed, the plasma levels of several inflammatory biomarkers
are elevated in patients with AF. In addition, the levels of specific inflammatory
biomarkers may provide information regarding to the AF duration. Several small studies
have assessed the role of anti-inflammatory treatment in atrial fibrillation but the results
have been contradictory. Large-scale studies are needed to evaluate the role of inflammation
in AF and whether anti-inflammatory medications should be routinely administered to
patients with AF.
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Affiliation(s)
- Effimia Zacharia
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | | | | | - Gerasimos Siasos
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Spyridon Papaioannou
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Manolis Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - George Latsios
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | | | - Konstantinos Toutouzas
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | | | - Rui Providência
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
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22
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Lomivorotov VV, Efremov SM, Abubakirov MN, Belletti A, Karaskov AM. Perioperative Management of Cardiovascular Medications. J Cardiothorac Vasc Anesth 2018; 32:2289-2302. [DOI: 10.1053/j.jvca.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Indexed: 12/28/2022]
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23
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Abstract
New-onset atrial fibrillation (NOAF) is the most common perioperative complication of heart surgery, typically occurring in the perioperative period. NOAF commonly occurs in patients who are elderly, or have left atrial enlargement, or left ventricular hypertrophy. Various factors have been identified as being involved in the development of NOAF, and numerous approaches have been proposed for its prevention and treatment. Risk factors include diabetes, obesity, and metabolic syndrome. For prevention of NOAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. NOAF can be treated by rhythm/rate control, and antithrombotic therapy. Treatment is required in patients with decreased cardiac function, a heart rate exceeding 130 beats/min, or persistent NOAF lasting for ≥ 48 h. It is anticipated that anticoagulant therapies, as well as hemodynamic management, will also play a major role in the management of NOAF. When using warfarin as an anticoagulant, its dose should be adjusted based on PT-INR. PT-INR should be controlled between 2.0 and 3.0 in patients aged < 70 years and between 1.6 and 2.6 in those aged ≥ 70 years. Rate control combined with antithrombotic therapies for NOAF is expected to contribute to further advances in treatment and improvement of survival.
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Affiliation(s)
- Takeshi Omae
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan. .,Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan.
| | - Eiichi Inada
- Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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24
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Magne J, Guinot B, Le Guyader A, Bégot E, Marsaud JP, Mohty D, Aboyans V. Relation Between Renin-Angiotensin System Blockers and Survival Following Isolated Aortic Valve Replacement for Aortic Stenosis. Am J Cardiol 2018; 121:455-460. [PMID: 29254679 DOI: 10.1016/j.amjcard.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
Abstract
Renin-angiotensin system blockers (RASb) improve cardiac remodeling, but their clinical utility after surgical aortic valve replacement (SAVR) for aortic stenosis (AS) is unclear. We aimed to assess the impact of RASb on short- and long-term survival following isolated SAVR for severe AS. From January 2005 to January 2014, 508 consecutive patients had isolated SAVR for severe AS. Patients with RASb (n = 286; 53%) were more often female (p = 0.039), hypertensive (p < 0.0001), and diabetic (p = 0.004), with higher body mass index (p < 0.0001) and EuroSCORE II (p = 0.025), and lower mean aortic pressure gradient (p = 0.011). The 30-day mortality was similar in both groups (RASb: 3% vs no RASb: 5.8%, p = 0.13), but lower under angiotensin receptor blockers (ARB) than angiotensin-converting enzyme inhibitors (ACEi; 0.7% vs 5.6%, p = 0.017). Patients under RASb had a better 8-year survival than those without RASb (83 ± 3% vs 52 ± 5%, p < 0.0001), confirmed in a propensity score-matched pairs analysis (82 ± 4% vs 50 ± 7%, p < 0.0001). Regarding different types of RASb, patients under ARB had lower mortality than those under ACEi (87 ± 3% vs 79 ± 4%, p = 0.028). In multivariate analysis, the use of RASb was associated with improved survival (hazard ratio = 0.31, 95% confidence interval 0.20 to 0.47, p < 0.0001), with lower mortality under ARB than under ACEi (hazard ratio = 0.39, 95% confidence interval 0.18 to 0.85, p = 0.018). In this observational study, the use of RASb was associated with improved long-term outcome after isolated SAVR for severe AS. A randomized clinical trial is mandatory.
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Affiliation(s)
- Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France
| | - Barthélémy Guinot
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
| | | | - Emmanuelle Bégot
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
| | | | - Dania Mohty
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France
| | - Victor Aboyans
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France.
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Quality of medical therapy in heart failure patients undergoing elective revascularisation: A protective effect of disease modifying therapy at discharge. Sci Rep 2017; 7:14909. [PMID: 29097746 PMCID: PMC5668379 DOI: 10.1038/s41598-017-15004-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/20/2017] [Indexed: 12/28/2022] Open
Abstract
The STICH(-ES) trial showed that coronary artery bypass grafting was superior to medical therapy alone in treating ischemic heart failure. However, dosages of disease modifying drugs were not reported. We included 128 (84% male, mean age 66 ± 11 years) consecutive patients with ischemic heart failure and an ejection fraction ≤35% undergoing isolated elective coronary artery bypass grafting. We defined optimal medical therapy (OMT) as prescription of ≥50% dosages of guideline recommended medications (i.e. beta-blocker (BB) and renin angiotensin system (RAS) antagonist) plus prescription of a mineralocorticoid receptor antagonist (MRA). The mean logistic EuroSCORE was 12.3 ± 13.8%. The five year survival was 74%. At discharge, 111 patients (87%) were on a BB and 106 (83%) were on a RAS antagonist. Forty-nine patients (38%) received an MRA. Only 8 patients (6%) received OMT. A Cox regression analysis revealed EuroSCORE (p < 0.001) and the use of MRA (p = 0.003) and BB (p = 0.037) at discharge as significant predictors of 5 year survival. Prescription rates of heart failure medication are comparable to those reported in the STICH trial, but rates of OMT are very low at admission and discharge. Prescription of BB and MRA was associated with improved survival, highlighting the need for disease management programs and rigorous discharge management.
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Sahu MK, Das A, Hote MP, Rajashekar P, Sreenivas V, Airan B. Predictors of intra-aortic balloon pump insertion in different spectrum of patients undergoing elective coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Manning MW, Cooter M, Mathew J, Alexander J, Peterson E, Ferguson TB, Lopes R, Podgoreanu M. Angiotensin Receptor Blockade Improves Cardiac Surgical Outcomes in Patients With Metabolic Syndrome. Ann Thorac Surg 2017; 104:98-105. [PMID: 28131423 PMCID: PMC5479726 DOI: 10.1016/j.athoracsur.2016.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/25/2016] [Accepted: 10/10/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative use of angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEis) in patients undergoing cardiac operations remains controversial. The current practice of discontinuing renin-angiotensin-system inhibitors preoperatively may negate their beneficial effects in vulnerable populations, including patients with metabolic syndrome, who exhibit elevated renin-angiotensin system activity. We hypothesized that preoperative ARB use is associated with reduced incidence of postoperative complications, compared with ACEi or no drug, in patients with metabolic syndrome undergoing coronary artery bypass grafting. METHODS We used propensity matching to derive a cohort of 1,351 patients from 2,998 who underwent coronary artery bypass grafting based on preoperative use of ARBs, ACEis, or no renin-angiotensin-system inhibitors. Our primary end point was a composite of adverse events occurring within 30 days after the operation: new-onset atrial fibrillation/flutter, arrhythmia requiring cardioversion, perioperative myocardial infarction, acute renal failure, need for dialysis, cerebrovascular accidents, acute respiratory failure, or perioperative death. RESULTS At least one adverse event occurred in 524 (38.8%) of matched cohort patients (1,184 [39.6% of all patients]). Adjusting for European System for Cardiac Operative Risk Evaluation and metabolic syndrome in the matched cohort, preoperative use of ARBs was associated with a lower incidence of adverse events in patients with metabolic syndrome compared with preoperative use of no renin-angiotensin-system inhibitors (odds ratio, 0.43; 95% confidence interval, 0.19 to 0.99) or ACEis (odds ratio, 0.38; 95% confidence interval, 0.16 to 0.88). CONCLUSIONS Preoperative use of ARBs, but not ACEis, confers a benefit within 30 days after cardiac operations in patients with metabolic syndrome, suggesting potential efficacy differences of these drug classes in reducing cardiovascular morbidity and death in ambulatory vs surgical patients.
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Affiliation(s)
- Michael W Manning
- Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North California.
| | - Mary Cooter
- Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North California
| | - Joseph Mathew
- Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North California
| | - John Alexander
- Division of Cardiology, Duke University Medical Center, Durham, North California; Duke Clinical Research Institute, Duke University Medical Center, Durham, North California
| | - Eric Peterson
- Division of Cardiology, Duke University Medical Center, Durham, North California; Duke Clinical Research Institute, Duke University Medical Center, Durham, North California
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, North California
| | - Renato Lopes
- Division of Cardiology, Duke University Medical Center, Durham, North California; Duke Clinical Research Institute, Duke University Medical Center, Durham, North California
| | - Mihai Podgoreanu
- Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North California; Duke Clinical Research Institute, Duke University Medical Center, Durham, North California
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Kumar V, Arya VK, Sondekoppam RV, Arora S, Minz M, Garg R, Gupta N. Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study. Indian J Anaesth 2017; 61:150-156. [PMID: 28250484 PMCID: PMC5330072 DOI: 10.4103/0019-5049.199853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Antihypertensive drugs are continued until the day of renal transplant surgery. These are associated with increased incidence of hypotension and bradycardia. Hence, this study was designed to evaluate perioperative haemodynamic and early graft functioning in renal recipients with discontinuation of antihypertensive drugs on the morning of surgery. METHODS This prospective, randomised, double-blind study recruited 120 patients. Group 1 patients received placebo tablet while Group 2 patients received usual antihypertensive drugs on the day of surgery. Perioperative haemodynamics and time for reinstitution of antihypertensives were the primary outcome measures. The secondary outcome measures were need for inotropic support and graft function. Perioperative haemodynamics were analysed using ANOVA and Student's t-tests with Bonferroni correction. Fischer's exact test was used for analysis. RESULTS Systolic blood pressure (SBP) declined, which was more in Group 2. Forty-one patients developed significant hypotension; a correlation was found between the maximum observed hypotension and number of antihypertensive medications (P = 0.003). Four cases had slow graft function (one in Group 1 and three in Group 2). Twenty-eight patients in Group 2 required mephentermine boluses to maintain their SBP compared to 13 patients in Group 1 (P < 0.001). Two patients in Group 2 required dopamine to maintain SBP above 90 mmHg after the establishment of reperfusion as compared to none in Group 1. CONCLUSION Single dose of long-acting antihypertensive drugs can be omitted on the morning of surgery without any haemodynamic fluctuations and graft function in controlled hypertensive end-stage renal disease renal transplant patients receiving a combined epidural and general anaesthesia.
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Affiliation(s)
- Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India
- Address for correspondence: Dr. Vinod Kumar, Room No. 139, Dr. BRA IRCH, AIIMS, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | | | | | - Suman Arora
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Mukut Minz
- Professor and Head, Transplant Surgery Unit, PGIMER, Chandigarh, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India
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Pichette M, Liszkowski M, Ducharme A. Preoperative Optimization of the Heart Failure Patient Undergoing Cardiac Surgery. Can J Cardiol 2017; 33:72-79. [DOI: 10.1016/j.cjca.2016.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 02/02/2023] Open
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Bokeriya LA, Aronov DM. Russian clinical guidelines Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. ACTA ACUST UNITED AC 2016. [DOI: 10.26442/cs45210] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mazzone AL, Baker RA, Gleadle JM. Mending a broken heart but breaking the kidney. Nephrology (Carlton) 2016; 21:812-20. [DOI: 10.1111/nep.12799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/05/2016] [Accepted: 04/09/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Annette L Mazzone
- Department of Cardiac Surgery Research and Perfusion, Cardiac and Thoracic Surgical Unit; Flinders Medical Centre; Adelaide South Australia Australia
- School of Medicine; Flinders University; Adelaide South Australia Australia
| | - Robert A Baker
- Department of Cardiac Surgery Research and Perfusion, Cardiac and Thoracic Surgical Unit; Flinders Medical Centre; Adelaide South Australia Australia
- School of Medicine; Flinders University; Adelaide South Australia Australia
| | - Jonathan M Gleadle
- School of Medicine; Flinders University; Adelaide South Australia Australia
- Department of Renal Medicine; Flinders Medical Centre; Adelaide South Australia Australia
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Coleman AE, Shepard MK, Schmiedt CW, Hofmeister EH, Brown SA. Effects of orally administered enalapril on blood pressure and hemodynamic response to vasopressors during isoflurane anesthesia in healthy dogs. Vet Anaesth Analg 2016; 43:482-94. [DOI: 10.1111/vaa.12338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022]
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Yang L, Wang X, Nie H, Shao L, Wang G, Liu Y. Residual levels of rare earth elements in freshwater and marine fish and their health risk assessment from Shandong, China. MARINE POLLUTION BULLETIN 2016; 107:393-397. [PMID: 27016961 DOI: 10.1016/j.marpolbul.2016.03.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
The total concentrations of rare earth elements (ΣREE) were quantified in 251 samples from 10 common species of freshwater and marine fish in seventeen cities of Shandong, China. ΣREE obtained from the freshwater fish ranged from 34.0 to 37.9ngg(-1) (wet weight) and marine fish from 12.7 to 37.6ngg(-1). The ratio of LREE to HREE was 13.7:1 and 10:1 for freshwater and marine fish, respectively. This suggests that freshwater fish exhibit greater REE concentrations than marine fish and the biological effects of LREE are higher than HREE. Results revealed a similar REE distribution pattern between those fish and coastal sediments, abiding the "abundance law". The health risk assessment demonstrated the EDIs of REEs in fish were significantly lower than the ADI, indicating that the consumption of these fish presents little risk to human health.
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Affiliation(s)
- Luping Yang
- Shandong Center for Food Safety Risk Assessment, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China; Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Xining Wang
- Shandong Center for Food Safety Risk Assessment, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China; Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Hongqian Nie
- Shandong Center for Food Safety Risk Assessment, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China; Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Lijun Shao
- Shandong Center for Food Safety Risk Assessment, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China; Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Guoling Wang
- Shandong Center for Food Safety Risk Assessment, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China; Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Yongjun Liu
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
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Disque A, Neelankavil J. Con: ACE Inhibitors Should Be Stopped Prior to Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2016; 30:820-2. [DOI: 10.1053/j.jvca.2016.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Indexed: 01/14/2023]
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Bhatia M, Arora H, Kumar PA. Pro: ACE Inhibitors Should Be Continued Perioperatively and Prior to Cardiovascular Operations. J Cardiothorac Vasc Anesth 2016; 30:816-9. [DOI: 10.1053/j.jvca.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Indexed: 11/11/2022]
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Vijay A, Grover A, Coulson TG, Myles PS. Perioperative Management of Patients Treated with Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Quality Improvement Audit. Anaesth Intensive Care 2016; 44:346-52. [DOI: 10.1177/0310057x1604400305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have shown that patients continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on the day of surgery are more likely to have significant intraoperative hypotension, higher rates of postoperative acute kidney injury and lower incidences of postoperative atrial fibrillation. However, many of these studies were prone to bias and confounding, and questions remain over the validity of these outcomes. This observational, before-and-after quality mprovement audit aimed to assess the effect of withholding these medications on the morning of surgery. We recruited 323 participants, with 83 (26%) having their preoperative angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) withheld on the day of surgery. There were only very small Spearman rank-order correlations between time since last dose of these medications (rho −0.12, P=0.057) and intraoperative and recovery room intravenous fluid administration (rho −0.11, P=0.042). There was no statistically significant difference between the continued or withheld groups in vasopressor (metaraminol use 3.5 [1.5–8.3] mg versus 3.5 [1.5–8.5] mg, P=0.67) or intravenous fluid administration (1000 ml [800–1500] ml versus 1000 [800–1500] ml, P=0.096), nor rates of postoperative acute kidney injury (13% vs 18%, P=0.25) or atrial fibrillation (15% versus 18%, P=0.71). This audit found no significant differences in measured outcomes between the continued or withheld ACEi/ARB groups. This finding should be interpreted with caution due to the possibility of confounding and an insufficient sample size. However, as the finding is in contrast to many previous studies, future prospective randomised clinical trials are required to answer this important question.
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Affiliation(s)
- A. Vijay
- Alfred Hospital, Melbourne, Victoria
| | - A. Grover
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria
| | - T. G. Coulson
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria
| | - P. S. Myles
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria
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Raiten JM, Ghadimi K, Augoustides JGT, Ramakrishna H, Patel PA, Weiss SJ, Gutsche JT. Atrial fibrillation after cardiac surgery: clinical update on mechanisms and prophylactic strategies. J Cardiothorac Vasc Anesth 2016; 29:806-16. [PMID: 26009291 DOI: 10.1053/j.jvca.2015.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Jesse M Raiten
- Cardiovascular Critical Care Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Division of CT Anesthesiology and Critical Care Medicine, Department of Anesthesiology, School of Medicine, Duke University, Durham, NC
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Prakash A Patel
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Zou Z, Yuan HB, Yang B, Xu F, Chen XY, Liu GJ, Shi XY. Perioperative angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers for preventing mortality and morbidity in adults. Cochrane Database Syst Rev 2016; 2016:CD009210. [PMID: 26816003 PMCID: PMC6478100 DOI: 10.1002/14651858.cd009210.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perioperative hypertension requires careful management. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) have shown efficacy in treating hypertension associated with surgery. However, there is lack of consensus about whether they can prevent mortality and morbidity. OBJECTIVES To systematically assess the benefits and harms of administration of ACEIs or ARBs perioperatively for the prevention of mortality and morbidity in adults (aged 18 years and above) undergoing any type of surgery under general anaesthesia. SEARCH METHODS We searched the current issue of the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), Ovid MEDLINE (1966 to 8 December 2014), EMBASE (1980 to 8 December 2014), and references of the retrieved randomized trials, meta-analyses, and systematic reviews. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing perioperative administration of ACEIs or ARBs with placebo in adults (aged 18 years and above) undergoing any type of surgery under general anaesthesia. We excluded studies in which participants underwent procedures that required local anaesthesia only, or participants who had already been on ACEIs or ARBs. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, assessed the risk of bias, and extracted data. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included seven RCTs with a total of 571 participants in the review. Two of the seven trials involved 36 participants undergoing non-cardiac vascular surgery (infrarenal aortic surgery), and five involved 535 participants undergoing cardiac surgery, including valvular surgery, coronary artery bypass surgery, and cardiopulmonary bypass surgery. The intervention was started from 11 days to 25 minutes before surgery in six trials and during surgery in one trial. We considered all seven RCTs to carry a high risk of bias. The effects of ACEIs or ARBs on perioperative mortality and acute myocardial infarction were uncertain because the quality of the evidence was very low. The risk of death was 2.7% in the ACEIs or ARBs group and 1.6% in the placebo group (risk ratio (RR) 1.61; 95% confidence interval (CI) 0.44 to 5.85). The risk of acute myocardial infarction was 1.7% in the ACEIs or ARBs group and 3.0% in the placebo group (RR 0.55; 95% CI 0.14 to 2.26). ACEIs or ARBs may improve congestive heart failure (cardiac index) perioperatively (mean difference (MD) -0.60; 95% CI -0.70 to -0.50, very low-quality evidence). In terms of rate of complications, there was no difference in perioperative cerebrovascular complications (RR 0.48; 95% CI 0.18 to 1.28, very low-quality evidence) and hypotension (RR 1.95; 95% CI 0.86 to 4.41, very low-quality evidence). Cardiac surgery-related renal failure was not reported. ACEIs or ARBs were associated with shortened length of hospital stay (MD -0.54; 95% CI -0.93 to -0.16, P value = 0.005, very low-quality evidence). These findings should be interpreted cautiously due to likely confounding by the clinical backgrounds of the participants. ACEIs or ARBs may shorten the length of hospital stay, (MD -0.54; 95% CI -0.93 to -0.16, very low-quality evidence) Two studies reported adverse events, and there was no evidence of a difference between the ACEIs or ARBs and control groups. AUTHORS' CONCLUSIONS Overall, this review did not find evidence to support that perioperative ACEIs or ARBs can prevent mortality, morbidity, and complications (hypotension, perioperative cerebrovascular complications, and cardiac surgery-related renal failure). We found no evidence showing that the use of these drugs may reduce the rate of acute myocardial infarction. However, ACEIs or ARBs may increase cardiac output perioperatively. Due to the low and very low methodology quality, high risk of bias, and lack of power of the included studies, the true effect may be substantially different from the observed estimates. Perioperative (mainly elective cardiac surgery, according to included studies) initiation of ACEIs or ARBs therapy should be individualized.
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Affiliation(s)
- Zui Zou
- Changzheng Hospital, The Second Military Medical UniversityDepartment of AnaesthesiologyNo 415, Feng Yang RoadShanghaiChina200003
| | - Hong B Yuan
- Changzheng Hospital, The Second Military Medical UniversityDepartment of AnaesthesiologyNo 415, Feng Yang RoadShanghaiChina200003
| | - Bo Yang
- Changzheng Hospital, Second Military Medical UniversityKidney Institute of CPLA, Division of Nephrology415 Fengyang RoadShanghaiChina200003
| | - Fengying Xu
- Changzheng Hospital, The Second Military Medical UniversityDepartment of AnaesthesiologyNo 415, Feng Yang RoadShanghaiChina200003
| | - Xiao Y Chen
- The General Hospital of the People's Liberation Army (PLAGH) (also Hospital 301)Department of NeurologyNo. 28, Fuxing RoadBeijingChina100853
| | - Guan J Liu
- West China Hospital, Sichuan UniversityCochrane ChinaNo. 37, Guo Xue XiangChengduChina610041
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Turagam MK, Downey FX, Kress DC, Sra J, Tajik AJ, Jahangir A. Pharmacological strategies for prevention of postoperative atrial fibrillation. Expert Rev Clin Pharmacol 2015; 8:233-50. [PMID: 25697411 DOI: 10.1586/17512433.2015.1018182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation (AF) complicating cardiac surgery continues to be a major problem that increases the postoperative risk of stroke, myocardial infarction, heart failure and costs and can affect long-term survival. The incidence of AF after surgery has not significantly changed over the last two decades, despite improvement in medical and surgical techniques. The mechanism and pathophysiology underlying postoperative AF (PoAF) is incompletely understood and results from a combination of acute and chronic factors, superimposed on an underlying abnormal atrial substrate with increased interstitial fibrosis. Several anti-arrhythmic and non-anti-arrhythmic medications have been used for the prevention of PoAF, but the effectiveness of these strategies has been limited due to a poor understanding of the basis for the increased susceptibility of the atria to AF in the postoperative setting. In this review, we summarize the pathophysiology underlying the development of PoAF and evidence behind pharmacological approaches used for its prevention in the postoperative setting.
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Affiliation(s)
- Mohit K Turagam
- University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
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Renin-angiotensin system blockers in cardiac surgery. J Crit Care 2015; 30:613-8. [DOI: 10.1016/j.jcrc.2015.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/13/2015] [Accepted: 02/23/2015] [Indexed: 11/22/2022]
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Abstract
Open-heart surgery has become a common procedure. Postcardiac surgery management is a critical issue and represents a crucial period in terms of physical recovery. Cardiac rehabilitation is increasingly considered as an integral component of the continuum of care for patients with cardiovascular disease. Its usefulness is now widely accepted, and therefore, it is recommended in most contemporary cardiovascular clinical practice guidelines. Similarly, early pharmacological management can modulate the pathophysiological alterations after cardiac surgery, leading to an improvement in the early and long-term outcome. In this review, we will present recent advances in postcardiac surgery management, focusing on the pathophysiology of the perioperative period and on recent evidences in pharmacological and rehabilitative strategies.
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Cheungpasitporn W, Thongprayoon C, Srivali N, O'Corragain OA, Edmonds PJ, Ungprasert P, Kittanamongkolchai W, Erickson SB. Preoperative renin-angiotensin system inhibitors use linked to reduced acute kidney injury: a systematic review and meta-analysis. Nephrol Dial Transplant 2015; 30:978-88. [PMID: 25800881 DOI: 10.1093/ndt/gfv023] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/08/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous trials of interventions to prevent acute kidney injury (AKI) have been unsuccessful and additional interventions are needed. Existing reviews of preoperative renin-angiotensin system (RAS) inhibitors have suggested harm. We included more recent studies and conducted this meta-analysis to evaluate the risk of postoperative AKI in patients who received preoperative RAS inhibitors. METHODS A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through October, 2014. Studies that reported relative risks, odds ratios or hazard ratios comparing the AKI risk in patients who received preoperative RAS inhibitors versus those who did not were included. We performed the prespecified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS Twenty-four studies (1 randomized controlled trial and 23 cohort studies) with 102 675 patients were included in the analysis to assess the risk of postoperative AKI and preoperative RAS inhibitors use. The pooled RR of AKI in patients receiving RAS inhibitors was 1.05 (95% CI: 0.92-1.20). The meta-analysis of the RCT and 11 studies with propensity score analysis demonstrated the pooled RR of AKI in patients receiving RAS inhibitors of 0.92 (95% CI: 0.85-0.99). Within the selected studies, preoperative RAS inhibitor therapy was not associated with a significant increase or decrease in mortality (RR: 0.93; 95% CI: 0.80-1.09). CONCLUSIONS Our meta-analysis demonstrates an association between preoperative RAS inhibitor treatment and lower incidence of AKI.
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Affiliation(s)
| | | | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine,Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Stephen B Erickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Cheng X, Tong J, Hu Q, Chen S, Yin Y, Liu Z. Meta-analysis of the effects of preoperative renin-angiotensin system inhibitor therapy on major adverse cardiac events in patients undergoing cardiac surgery. Eur J Cardiothorac Surg 2014; 47:958-66. [PMID: 25301954 DOI: 10.1093/ejcts/ezu330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/21/2014] [Indexed: 02/06/2023] Open
Abstract
The purpose of this meta-analysis was to assess the role of preoperative renin-angiotensin system inhibitor (RASI) therapy on major adverse cardiac events (MACE) in patients undergoing cardiac surgery. The Medline, Cochrane Library and Embase databases were searched for clinical studies published up to May 2014. Studies that evaluated the effects of preoperative RASI therapy in cardiac surgery were included. Odds ratio (OR) estimates were generated under a random-effects model. After a literature search in the major databases, 18 studies were identified [three randomized prospective clinical trials (RCTs) and 15 observational trials] that reported outcomes of 54 528 cardiac surgery patients with (n = 22 661; 42%) or without (n = 31 867; 58%) preoperative RASI therapy. Pool analysis indicated that preoperative RASI therapy was not associated with a significant reduction of early all-cause mortality [OR: 1.01; 95% confidence interval (CI) 0.88-1.15, P = 0.93; I(2) = 25%], myocardial infarction (OR: 1.04; 95% CI 0.91-1.19, P = 0.60; I(2) = 16%), or stroke (OR: 0.93; 95% CI 0.75-1.14, P = 0.46; I(2) = 38%). Meta-regression analysis confirmed that there was a strong negative correlation between the percentage of diabetics and early all-cause mortality (P = 0.03). Furthermore, preoperative RASI therapy significantly reduced mortality in studies containing a high proportion of diabetic patients (OR: 0.84; 95% CI 0.71-0.99, P = 0.04; I(2) = 0%). In conclusion, our meta-analysis indicated that although preoperative RASI therapy was not associated with a lower risk of MACE in cardiac surgery patients, it might provide benefits for diabetic patients.
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Affiliation(s)
- Xiaocheng Cheng
- Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China
| | - Jin Tong
- Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China Department of Respirology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China
| | - Qiongwen Hu
- Department of Clinical Laboratory, The Third People's Hospital of Chongqing, Chongqing, China
| | - Shaojie Chen
- Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China Cardiology/Medicine, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China
| | - Zengzhang Liu
- Department of Cardiology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China
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Wang J, Xia W, Xiao Y, Ying C, Long J, Zhang H, Chen X, Mao C, Li X, Wang L, Xu S. Assessment of estrogen disrupting potency in animal foodstuffs of China by combined biological and chemical analyses. J Environ Sci (China) 2014; 26:2131-2137. [PMID: 25288558 DOI: 10.1016/j.jes.2014.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/06/2014] [Accepted: 02/12/2014] [Indexed: 06/03/2023]
Abstract
Food has been documented as one of major routes for human exposure to environmental estrogens (EEs), but information on the occurrence of EEs in animal foodstuffs is still scarce. This study analyzed estrogenic activity in 16 types of animal foodstuffs (n=142) collected from four cities (Wuhan, Guangzhou, Wenzhou and Yantai) of China by combined yeast estrogen screen (YES) bioassay and chemical analysis. By bioassay, all samples' extracts were found to induce estrogenic activities and the bioassay-derived 17β-estradiol equivalent (EEQbio) ranged from 8.29 to 118.32ng/g. In addition, the samples were analyzed by liquid chromatography coupled to tandem mass spectrometry for further chemical analysis. 17β-Estradiol was found in all samples in this survey at levels of 0.44 to 15.04ng/g. All samples had 33.1% detection rate of 17α-ethinylestradiol (EE2), and the maximum concentration was 2.80ng/g. Bisphenol A and 4-nonylphenols were detected in 83.8% and 83.1% of samples, with concentrations up to 12.56ng/g and 35.76ng/g, respectively. However, the concentrations of estrone, diethylstilbestrol and 4-t-octylphenol were found to be below the limit of detection. A comparison of EEQbio measured from the YES assay and EEQchem calculated from chemical analysis showed good correlation (R(2)=0.84). Based on the results, the YES assay can be used as a rapid pre-screening method for monitoring the levels of estrogenic activity in large numbers of animal foodstuffs, and chemical analysis used in combination can be used for the identification of specific EEs.
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Affiliation(s)
- Jun Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; The Clinical Laboratory Department of Jiaozhou Central Hospital of Qingdao, Qingdao 266300, China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yonghua Xiao
- Wuhan City Center for Disease Prevention and Control, Wuhan 430015, China
| | - Chenjiang Ying
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia Long
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui Zhang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xi Chen
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Congda Mao
- The Clinical Laboratory Department of Jiaozhou Central Hospital of Qingdao, Qingdao 266300, China
| | - Xiumin Li
- The Clinical Laboratory Department of Jiaozhou Central Hospital of Qingdao, Qingdao 266300, China
| | - Lin Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Hemodynamic effects of angiotensin inhibitors in elderly hypertensives undergoing total knee arthroplasty under regional anesthesia. ACTA ACUST UNITED AC 2014; 8:644-51. [DOI: 10.1016/j.jash.2014.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/17/2022]
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Zhang Y, Ma L. Effect of preoperative angiotensin-converting enzyme inhibitor on the outcome of coronary artery bypass graft surgery. Eur J Cardiothorac Surg 2014; 47:788-95. [DOI: 10.1093/ejcts/ezu298] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/24/2014] [Indexed: 12/22/2022] Open
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Alassar A, Bazerbashi S, Easto R, Unsworth-White J. Which patients should be on renin-angiotensin system blockers after coronary surgery? Interact Cardiovasc Thorac Surg 2014; 19:667-72. [PMID: 24997188 DOI: 10.1093/icvts/ivu211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'which patients should be on renin-angiotensin system blockers after coronary surgery?' Using the reported search, 12 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The 12 studies included 5 prospective randomized controlled trials (RCTs) and 1 meta-analysis. One RCT of 2553 stable patients post-coronary artery bypass surgery (CABG) with left ventricular (LV) ejection fraction ≤40% showed that angiotensin-converting enzyme inhibition (ACEI) therapy can and probably should be delayed beyond 7 days due to increased cardiovascular morbidity and mortality associated with immediate postoperative initiation of ACEI treatment. Another study showed that the cardioprotective benefits of ACEI following CABG are persistent with respect to an LV ejection fraction below or above 40% and whether percutaneous coronary intervention (PCI) or CABG was performed. A large multicentre international study of 4224 patients undergoing CABG looking at a composite outcome of rates of cardiac, cerebral and renal events and in-hospital mortality showed that continuous treatment with ACEI compared with no ACEI was associated with reductions of risks of non-fatal events (P = 0.009, odds ratio 0.69, 95% confidence interval 0.52-0.91). Addition of ACEI de novo following surgery was also associated with significant reduction in the risk of the composite outcome (P = 0.004) and of a cardiovascular event (P = 0.04). We conclude that angiotensin-converting enzyme inhibitor treatment plays an important role in minimizing ischaemic events after CABG even in low-risk patients. The cardioprotective benefits of these drugs are persistent at mid- and long-term follow-up, with respect to LV ejection fraction below or above 40% and whether PCI or CABG was performed. Not only continuation of angiotensin-converting enzyme inhibition early after surgery but also adding ACEI de novo postoperatively can be associated with better cardiovascular and renal outcomes.
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Affiliation(s)
- Aiman Alassar
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK
| | - Samer Bazerbashi
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK
| | - Rachel Easto
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK
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Affiliation(s)
- R. D. Sanders
- Surgical Outcomes Research Centre; University College London Hospital; London UK
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Bandeali SJ, Kayani WT, Lee VV, Elayda M, Alam M, Huang HD, Wilson JM, Jneid H, Birnbaum Y, Deswal A, Farmer J, Ballantyne CM, Virani SS. Association between preoperative diuretic use and in-hospital outcomes after cardiac surgery. Cardiovasc Ther 2014; 31:291-7. [PMID: 23517524 DOI: 10.1111/1755-5922.12024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a paucity of evidence on the association between preoperative diuretics use and outcomes following cardiac surgery. We hypothesized that diuretic use prior to cardiac surgery will be associated with adverse in-hospital clinical outcomes. METHODS We evaluated patients undergoing cardiac surgery at a single institution between January 1, 2000, and December 31, 2011. Patients were grouped as follows: isolated coronary artery bypass grafting (CABG) (n = 8759), CABG plus valve surgery (n = 1188), and valve surgery only (n = 2646). A fourth group "All cardiac surgery" is comprised of patients from all three groups. Preoperative diuretic use was defined as patient on any diuretic till the day of surgery. Primary outcome was the incidence of major adverse events (MAEs) defined as the composite of mortality, postoperative renal dysfunction, myocardial infarction, stroke, and new-onset atrial fibrillation (AF). Logistic regression analysis and propensity score matching were performed. RESULTS We included 12,593 patients [3546 on diuretic (28%)]. After logistic regression analyses, preoperative diuretic use was associated with an increased risk of the following: (1) MAE among all groups except the concomitant CABG and valve surgery group, (2) AF in "All cardiac surgery" and isolated CABG groups, (3) postoperative renal dysfunction in all groups. After propensity score matching (n = 3050 in each group), preoperative diuretic use was significantly associated with MAE (48% vs. 43%; P < 0.0001), postoperative renal dysfunction (19% vs. 14%; P < 0.0001), and AF (34% vs. 32%; P = 0.03) in the "All cardiac surgery" group. CONCLUSION Preoperative diuretics use is associated with an increased incidence of MAEs after cardiac surgery.
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Affiliation(s)
- Salman J Bandeali
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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