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Curran J, Ross-White A, Sibley S. Magnesium prophylaxis of new-onset atrial fibrillation: A systematic review and meta-analysis. PLoS One 2023; 18:e0292974. [PMID: 37883337 PMCID: PMC10602269 DOI: 10.1371/journal.pone.0292974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Atrial fibrillation (AF) is the most common cardiac arrhythmia in intensive care units (ICU) and is associated with increased morbidity and mortality. Magnesium prophylaxis has been shown to reduce incidence of AF in cardiac surgery patients, however, evidence outside this population is limited. The objective of this study is to summarize studies examining magnesium versus placebo in the prevention of NOAF outside the setting of cardiac surgery. SOURCE We performed a comprehensive search of MEDLINE, EMBASE, and Cochrane Library (CENTRAL) from inception until January 3rd, 2023. We included all interventional research studies that compared magnesium to placebo and excluded case reports and post cardiac surgery patients. We conducted meta-analysis using the inverse variance method with random effects modelling. PRINCIPAL FINDINGS Of the 1493 studies imported for screening, 87 full texts were assessed for eligibility and six citations, representing five randomized controlled trials (n = 4713), were included in the review, with four studies (n = 4654) included in the pooled analysis. Administration of magnesium did not significantly reduce the incidence of NOAF compared to placebo (OR 0.72, [95% CI 0.48 to 1.09]). CONCLUSION Use of magnesium did not reduce the incidence of NOAF, however these studies represent diverse groups and are hindered by significant bias. Further studies are necessary to determine if there is benefit to magnesium prophylaxis for NOAF in non-cardiac surgery patients.
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Affiliation(s)
- Jeffrey Curran
- Department of Critical Care Medicine, Queen’s University, Kingston, Canada
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen’s University, Kingston, Canada
| | - Stephanie Sibley
- Department of Critical Care Medicine, Queen’s University, Kingston, Canada
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Deyell MW, AbdelWahab A, Angaran P, Essebag V, Glover B, Gula LJ, Khoo C, Lane C, Nault I, Nery PB, Rivard L, Slawnych MP, Tulloch HL, Sapp JL. 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Position Statement on the Management of Ventricular Tachycardia and Fibrillation in Patients With Structural Heart Disease. Can J Cardiol 2020; 36:822-836. [DOI: 10.1016/j.cjca.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022] Open
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Salaminia S, Sayehmiri F, Angha P, Sayehmiri K, Motedayen M. Evaluating the effect of magnesium supplementation and cardiac arrhythmias after acute coronary syndrome: a systematic review and meta-analysis. BMC Cardiovasc Disord 2018; 18:129. [PMID: 29954320 PMCID: PMC6025730 DOI: 10.1186/s12872-018-0857-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/07/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial and ventricular cardiac arrhythmias are one of the most common early complications after cardiac surgery and these serve as a major cause of mortality and morbidity after cardiac revascularization. We want to evaluate the effect of magnesium sulfate administration on the incidence of cardiac arrhythmias after cardiac revascularization by doing this systematic review and meta-analysis. METHODS The search performed in several databases (SID, Magiran, IranDoc, IranMedex, MedLib, PubMed, EmBase, Web of Science, Scopus, the Cochrane Library and Google Scholar) for published Randomized controlled trials before December 2017 that have reported the association between Magnesium consumption and the incidence of cardiac arrhythmias. This relationship measured using odds ratios (ORs) with a confidence interval of 95% (CIs). Funnel plots and Egger test used to examine publication bias. STATA (version 11.1) used for all analyses. RESULTS Twenty-two studies selected as eligible for this research and included in the final analysis. The total rate of ventricular arrhythmia was lower in the group receiving magnesium sulfate than placebo (11.88% versus 24.24%). The same trend obtained for the total incidence of supraventricular arrhythmia (10.36% in the magnesium versus 23.91% in the placebo group). In general the present meta-analysis showed that magnesium could decrease ventricular and supraventricular arrhythmias compared with placebo (OR = 0.32, 95% CI 0.16-0.49; p < 0.001 and OR = 0.42, 95% CI 0.22-0.65; p < 0.001, respectively). Subgroup analysis showed that the effect of magnesium on the incidence of cardiac arrhythmias was not affected by clinical settings and dosage of magnesium. Meta-regression analysis also showed that there was no significant association between the reduction of ventricular arrhythmias and sample size. CONCLUSION The results of this meta-analysis study suggest that magnesium sulfate can be used safely and effectively and is a cost-effective way in the prevention of many of ventricular and supraventricular arrhythmias.
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Affiliation(s)
- Shirvan Salaminia
- Department of Cardiac Surgery, Yasuj University of Medical Science, Yasuj, Iran
| | - Fatemeh Sayehmiri
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Angha
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Koroush Sayehmiri
- Department of Social Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Morteza Motedayen
- Department of Cardiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
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Abstract
BACKGROUND Mortality and morbidity from acute myocardial infarction (AMI) remain high. Intravenous magnesium started early after the onset of AMI is thought to be a promising adjuvant treatment. Conflicting results from earlier trials and meta-analyses warrant a systematic review of available evidence. OBJECTIVES To examine the effect of intravenous magnesium versus placebo on early mortality and morbidity. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library Issue 3, 2006), MEDLINE (January 1966 to June 2006) and EMBASE (January 1980 to June 2006), and the Chinese Biomedical Disk (CBM disk) (January 1978 to June 2006). Some core Chinese medical journals relevant to the cardiovascular field were hand searched from their starting date to the first-half year of 2006. SELECTION CRITERIA All randomized controlled trials that compared intravenous magnesium with placebo in the presence or absence of fibrinolytic therapy in addition to routine treatment were eligible if they reported mortality and morbidity within 35 days of AMI onset. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the trial quality and extracted data using a standard form. Odds ratio (OR) were used to pool the effect if appropriate. Where heterogeneity of effects was found, clinical and methodological sources of this were explored. MAIN RESULTS For early mortality where there was evidence of heterogeneity, a fixed-effect meta-analysis showed no difference between magnesium and placebo groups (OR 0.99, 95%CI 0.94 to 1.04), while a random-effects meta-analysis showed a significant reduction comparing magnesium with placebo (OR 0.66, 95% CI 0.53 to 0.82). Stratification by timing of treatment (< 6 hrs, 6+ hrs) reduced heterogeneity, and in both fixed-effect and random-effects models no significant effect of magnesium was found. In stratified analyses, early mortality was reduced for patients not treated with thrombolysis (OR=0.73, 95% CI 0.56 to 0.94 by random-effects model) and for those treated with less than 75 mmol of magnesium (OR=0.59, 95% CI 0.49 to 0.70) in the magnesium compared with placebo groups.Meta-analysis for the secondary outcomes where there was no evidence of heterogeneity showed reductions in the odds of ventricular fibrillation (OR=0.88, 95% CI 0.81 to 0.96), but increases in the odds of profound hypotension (OR=1.13, 95% CI 1.09 to 1.19) and bradycardia (OR=1.49, 95% CI 1.26 to 1.77) comparing magnesium with placebo. No difference was observed for heart block (OR=1.05, 95% CI 0.97-1.14). For those outcomes where there was evidence of heterogeneity, meta-analysis with both fixed-effect and random-effects models showed that magnesium could decrease ventricular tachycardia (OR=0.45, 95% CI 0.31 to 0.66 by fixed-effect model; OR=0.40, 95% CI 0.19 to 0.84 by random-effects model) and severe arrhythmia needing treatment or Lown 2-5 (OR=0.72, 95% CI 0.60 to 0.85 by fixed-effect model; OR=0.51, 95% CI 0.33 to 0.79 by random-effects model) compared with placebo. There was no difference on the effect of cardiogenic shock between the two groups. AUTHORS' CONCLUSIONS Owing to the likelihood of publication bias and marked heterogeneity of treatment effects, it is essential that the findings are interpreted cautiously. From the evidence reviewed here, we consider that: (1) it is unlikely that magnesium is beneficial in reducing mortality both in patients treated early and in patients treated late, and in patients already receiving thrombolytic therapy; (2) it is unlikely that magnesium will reduce mortality when used at high dose (>=75 mmol); (3) magnesium treatment may reduce the incidence of ventricular fibrillation, ventricular tachycardia, severe arrhythmia needing treatment or Lown 2-5, but it may increase the incidence of profound hypotension, bradycardia and flushing; and (4) the areas of uncertainty regarding the effect of magnesium on mortality remain the effect of low dose treatment (< 75 mmol) and in patients not treated with thrombolysis.
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Affiliation(s)
- J Li
- West China Hospital,Sichuan University, Chinese Cochrane Centre, Chengdu, Sichuan, China, 610041.
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Sade E, Aytemir K, Oto A, Nazli N, Ozmen F, Ozkutlu H, Tokgözoglu L, Aksöyek S, Ovünç K, Kabakçi G, Ozer N, Kes S. Assessment of heart rate turbulence in the acute phase of myocardial infarction for long-term prognosis. Pacing Clin Electrophysiol 2003; 26:544-50. [PMID: 12710312 DOI: 10.1046/j.1460-9592.2003.00092.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study is designed to assess the value of heart rate turbulence (HRT) in the acute phase of MI for prediction of long-term mortality risk. The study included 128 consecutive acute MI patients with 24-hour Holter recordings to evaluate HRT (turbulence onset and slope), SDNN, mean RR interval, and ventricular premature beat frequency. LVEF was evaluated by two-dimensional echocardiography. Data from 117 patients (mean age 58 +/- 11 years) were available for further analysis. Twelve patients died during follow-up (mean 312 +/- 78 days). Although SDNN < 70 ms was the most powerful predictor of mortality among all presumed risk factors (hazard ratio 20 [95% CI 2.6-158]; P = 0.004) in univariate Cox regression analysis, in multivariate analysis LVEF < or = 0.40 and turbulence slope < or = 2.5 ms/RR interval were the only independent predictors of mortality (hazard ratio 6.9 [95% CI 1.8-26]; P = 0.006, hazard ratio 7.3 [95% CI 1.4-37]; P = 0.016, respectively). Addition of HRT parameters for LVEF increased remarkably the positive predictive value (60%) without any decrease in the negative predictive value (92%). Blunted HRT reaction within the first 24 hours of acute MI is an independent predictor of long-term mortality. Furthermore, its predictive power is comparable and also additive to that of LVEF.
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Affiliation(s)
- Elif Sade
- Hacettepe University School of Medicine, Department of Cardiology, Ankara, Turkey.
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Woods KL, Abrams K. The importance of effect mechanism in the design and interpretation of clinical trials: the role of magnesium in acute myocardial infarction. Prog Cardiovasc Dis 2002; 44:267-74. [PMID: 12007082 DOI: 10.1053/pcad.2002.31595] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The design and interpretation of randomized clinical trials and of meta-analyses of trials should be informed by a biologically plausible hypothesis of treatment effect. Without some insight on likely mechanism, trial conditions may not be optimum to allow a true treatment effect to be detected. Judgments on mechanism underpin decisions on the appropriateness of pooling studies in meta-analysis. Where statistical heterogeneity of trial results is found, the possibility of true biological effect modification can only be assessed by considering potential treatment mechanisms. These can then be tested in carefully designed laboratory models. Meta-analysis of 12 randomized controlled trials of intravenous Mg(2+) in acute myocardial infarction gives a null effect (odds ratio 1.02, 95% CI 0.96 to 1.08) with a fixed effects model, but with strong evidence of heterogeneity (P <.0001) due to a single large study in which Mg(2+) was generally given late and after fibrinolytic treatment. A random effects model gives a pooled odds ratio 0.61 (95% CI 0.43 to 0.87, P = 0.006). Laboratory models show that timing of Mg(2+) administration before or after reperfusion critically determines whether myocardial protection occurs.
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Affiliation(s)
- Kent L Woods
- Departments of Medicine and Epidemiology and Public Health, University of Leicester, Leicester, UK.
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Affiliation(s)
- A Baraka
- Department of Anesthesiology, American University of Beirut, Lebanon
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Thel MC, Armstrong AL, McNulty SE, Califf RM, O'Connor CM. Randomised trial of magnesium in in-hospital cardiac arrest. Duke Internal Medicine Housestaff. Lancet 1997; 350:1272-6. [PMID: 9357406 DOI: 10.1016/s0140-6736(97)05048-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The apparent benefit of magnesium in acute myocardial infarction, and the persistently poor outcome after cardiac arrest, have led to use of magnesium in cardiopulmonary resuscitation. Because few data on its use in cardiac arrest were available, we undertook a randomised placebo-controlled trial (MAGIC trial). METHODS Patients treated for cardiac arrest by the Duke Hospital code team were randomly assigned intravenous magnesium (2 g [8 mmoles] bolus, followed by 8 g [32 mmoles] over 24 h; 76 patients) or placebo (80 patients). Only patients in intensive care or general wards were eligible; those whose cardiac arrest occurred in emergency, operating, or recovery rooms were excluded. The primary endpoint was return of spontaneous circulation, defined as attainment of any measurable blood pressure or palpable pulse for at least 1 h after cardiac arrest. The secondary endpoints were survival to 24 h, survival to hospital discharge, and neurological outcome. Analysis was by intention to treat. FINDINGS There were no significant differences between the magnesium and placebo groups in the proportion with return of spontaneous circulation (41 [54%] vs 48 [60%], p = 0.44), survival to 24 h (33 [43%] vs 40 [50%], p = 0.41), survival to hospital discharge (16 [21%] vs 17 [21%], p = 0.98), or Glasgow coma score (median 15 in both). INTERPRETATION Empirical magnesium supplementation did not improve the rate of successful resuscitation, survival to 24 h, or survival to hospital discharge overall or in any subpopulation of patients with in-hospital cardiac arrest.
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Affiliation(s)
- M C Thel
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA
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Zehender M, Meinertz T, Just H. [Magnesium deficiency and magnesium substitution. Effect on ventricular cardiac arrhythmias of various etiology]. Herz 1997; 22 Suppl 1:56-62. [PMID: 9333593 DOI: 10.1007/bf03042656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During recent years there has been an increasing but still controversial discussion on the antiarrhythmic effects and overall benefit of magnesium when directed to patients with various types of ventricular tachyarrhythmias. While magnesium is considered to be a simple, safe and cost-effective approach and many casuistic and empiric reports have indicated antiarrhythmic properties of magnesium in patients with suspected or manifest ventricular arrhythmias, controlled studies proving the antiarrhythmic and overall benefit and justifying a broader use of magnesium in treating various types of ventricular arrhythmias are missing or rare. At present, antiarrhythmic properties and clinical benefit of magnesium application has only been established in patients with torsade de pointes and digitalis-induced ventricular tachyarrhythmias. In perioperative patients at risk for ventricular tachyarrhythmias and in patients suffering from manifest heart failure, data may also indicate some antiarrhythmic properties of magnesium, however, in this case with a wide consensus that the prevention of magnesium deficit is more effective and preferred in most patients over the therapeutic application of magnesium. Another group of patients who may profit from such a therapeutic approach are patients with frequent ventricular arrhythmias and stable underlying heart disease, in whom a recently published double-blind, randomized study documented an antiarrhythmic effect of a 3 week treatment with potassium and magnesium. For all other types of ventricular tachyarrhythmias, the therapeutic use of magnesium can be considered as not harmful, but also as not proven to be effective.
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Affiliation(s)
- M Zehender
- Abteilung für Kardiologie, Universitätsklinik Freiburg
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10
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Seelig MS, Elin RJ. Is there a place for magnesium in the treatment of acute myocardial infarction? Am Heart J 1996; 132:471-7; discussion 496-502. [PMID: 8694006 DOI: 10.1016/s0002-8703(96)90338-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Infusions of solutions of magnesium sulfate for patients with acute myocardial infarction were shown by a meta-analysis of seven small studies and a larger study of 2316 patients (LIMIT-2) to have clinical efficacy. However, the ISIS-4 study of 58,050 patients found no improvement in short-term mortality rates with magnesium therapy in patients with acute myocardial infarction. In this article we explore the following four differences between the ISIS-4 study and the earlier studies: (1) Time of initiation of magnesium treatment after acute myocardial infarction and thrombolytic therapy; (2) dosage of magnesium in the first 24 hours after acute myocardial infarction; (3) duration of magnesium infusion after acute myocardial infarction; and (4) differences in patient risks in control and treatment groups. These four differences may explain the different outcomes among these studies and indicate the type of additional studies that are needed to define the clinical utility of magnesium infusion in the treatment of patients with acute myocardial infarction.
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Affiliation(s)
- M S Seelig
- School of Public Health, University of North Carolina, Chapel Hill, USA
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12
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Euler DE. Effect of magnesium on ischemic and reperfusion arrhythmias in a canine model with diminished collateral blood flow. Cardiovasc Drugs Ther 1995; 9:565-71. [PMID: 8547206 DOI: 10.1007/bf00878088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To assess the effects of elevated serum magnesium on ischemic and reperfusion arrhythmias, the left anterior descending coronary artery was cannulated and perfused by a shunt from a carotid artery in 20 open-chest anesthetized dogs. Ischemia was caused for 30 minutes by shunt occlusion and retrograde diversion of collateral blood flow. Dogs (10/group) were treated prior to occlusion with either saline or MgSO4 (100 mg/kg IV). Plasma magnesium rose from 0.72 +/- 0.05 mM to 3.89 +/- 0.29 mM before occlusion (p < 0.01) and fell to 3.28 +/- 0.21 mM just before reperfusion (p < 0.01). Compared to saline, magnesium significantly slowed heart rate (113 +/- 4 beats/min vs. 124 +/- 3 beats/min, p < 0.05), lowered arterial blood pressure (90 +/- 2 mmHg vs. 111 +/- 4 mmHg, p < 0.05), and reduced myocardial blood flow to the ischemic zone before the occlusion (59 +/- 7 ml/min/100 g vs. 83 +/- 5 ml/min/100 g, p < 0.01). The incidence of ventricular tachycardia during occlusion was 80% in the saline group and 70% in the magnesium group (p = 1.0). The time required for a monophasic complex to develop in an electrogram over the ischemic zone was 4.5 +/- 0.24 minutes in the saline group and was not altered by magnesium (4.6 +/- 0.18 minutes). The incidence of reperfusion-induced ventricular fibrillation was 100% in both groups. The results suggest that acute infusion of magnesium offers little protection against ventricular tachyarrhythmias evoked by occlusion or reperfusion in a canine model of myocardial ischemia with diminished collateral blood flow.
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Affiliation(s)
- D E Euler
- Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
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Schlack W, Bier F, Schäfer M, Uebing A, Schäfer S, Borchard U, Thämer V. Intracoronary magnesium is not protective against acute reperfusion injury in the regional ischaemic-reperfused dog heart. Eur J Clin Invest 1995; 25:501-9. [PMID: 7556368 DOI: 10.1111/j.1365-2362.1995.tb01736.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Intravenous magnesium lowers mortality in patients with suspected myocardial infarction. We tested the hypothesis that the protective effect may be due to a direct, local influence of magnesium on myocardial reperfusion injury in a dog model of ischaemia/reperfusion. Ten anaesthetized open chest dogs underwent 1 h of left anterior descending artery (LAD) occlusion and 6 h of reperfusion. The animals received intracoronary (i.c.) magnesium aspartate (Mg, n = 5) or vehicle infusion (n = 5) for the first hour of reperfusion. Mg infusion was adapted to actual LAD flow (ultrasonic flow probe) to increase regional plasma concentration by 4 mmol L-1. Regional myocardial function was measured as percent systolic wall thickening (sWTh, sonomicrometry). Intracoronary Mg increased LAD flow during application (at 15 min reperfusion; Mg, 194 +/- 44 (mean +/- SD); control, 116 +/- 41 mL min-1 100 g-1, P < 0.01). sWTh decreased during coronary occlusion from 14.3 +/- 7.1% to -4.7 +/- 2.7% in the control group and from 14.8 +/- 2.5% to -4.1 +/- 3.1% in the Mg group. Throughout the reperfusion period wall function remained depressed in both groups to a similar degree (control, -3.5 +/- 1.8%; Mg, -3.0 +/- 1.9% at 6 h reperfusion). Global haemodynamics were not different. Infarct size after 6 h reperfusion (TTC staining) was similar in both groups (Mg, 20.6 +/- 5.0; control, 24.4 +/- 8.7% of area at risk). Regional magnesium application (i.c.) to post-ischaemic reperfused myocardium had no influence on infarct size or post-ischaemic regional wall function in this model.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W Schlack
- Abt. für Herz- und Kreislaufphysiologie, Heinrich-Heine-Universität, Dusseldorf, Germany
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Leor J, Kloner RA. An experimental model examining the role of magnesium in the therapy of acute myocardial infarction. Am J Cardiol 1995; 75:1292-3. [PMID: 7778564 DOI: 10.1016/s0002-9149(99)80787-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In conclusion, considering the results from our model, magnesium infusion is effective as adjunct therapy to enhance myocardial salvage in the setting of acute myocardial infarction. However, its effectiveness may be limited to a subset of patients whose magnesium therapy can be started early and combined with early reperfusion therapy.
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Affiliation(s)
- J Leor
- Heart Institute, Good Samaritan Hospital, Los Angeles, California 90017, USA
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Woods KL, Fletcher S. Long-term outcome after intravenous magnesium sulphate in suspected acute myocardial infarction: the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1994; 343:816-9. [PMID: 7908076 DOI: 10.1016/s0140-6736(94)92024-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2) examined the effect of an intravenous regimen of magnesium sulphate in 2316 patients with suspected acute myocardial infarction. Treatment, according to a double-blind randomised protocol, was started with a loading injection, before any thrombolytic therapy, and continued with a maintenance infusion for a further 24 h. Cause-specific mortality of randomised patients has now been examined over 1.0-5.5 (mean 2.7) years of follow-up. Mortality rate from ischaemic heart disease was reduced by 21% (95% CI 5-35%, p = 0.01) and all-cause mortality rate reduced by 16% (2-29%, p = 0.03) in magnesium-treated patients. Magnesium protects the contractile function of the myocardium from reperfusion injury ("stunning") in experimental models; this observation accords with the 25% (7-39%, p = 0.009) reduction in early left ventricular failure in the magnesium group of LIMIT-2. For such protection to occur, magnesium must be raised by the time of reperfusion since the injury is immediate. In the clinical context the timing of magnesium treatment in relation to thrombolytic therapy or spontaneous reperfusion is likely to be critical. The early benefits of this simple and safe intervention are reflected in improved long-term survival.
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Affiliation(s)
- K L Woods
- Department of Medicine and Therapeutics, University of Leicester, UK
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