Acute-phase proteins and oxidative stress in patients undergoing coronary artery bypass graft: comparison of cardioplegia strategy

Evaluation of Vasodilatory Effect of Nitroglycerin in Cardioplegia Solution on Patients Undergoing Coronary Artery Bypass Graft Surgery

INTRODUCTION

This study aimed to evaluate the vasodilatory effect of nitroglycerin (NTG) in cardioplegia solution on changes in troponin I and creatine phosphokinase-MB (CPK-MB) levels during coronary artery bypass graft (CABG) surgery.

METHOD

A randomized controlled double-blind clinical trial was performed on 44 patients who were candidates for CABG surgery. These patients were divided into two groups. In the first group (NTG group), 3 mg/kg NTG was added to the cardioplegia solution, while 10 cc placebo (distilled water) was added to the cardioplegia solution in the second group (control group). Troponin I and CPK-MB levels were then assessed before and after the surgery.

RESULTS

In this study, 72.7% and 27.3% of patients in the NTG group and 68.2% and 31.8% of patients in the control group were male and female, respectively. In addition, 9.1% within the age range of 40-50 years, 27.3% within the age range of 50-60 years, and 63.6% within the age range of more than 60 years were present in the NTG group. Moreover, 18.2% within the age range of 40-50 years, 36.4% within the age range of 50-60 years, and 45.5% within the age range of more than 60 years were present in the control group. Although the mean cardiopulmonary bypass (CPB) and cross-clamp time was insignificantly higher in the NTG group compared to the control group. In addition, troponin I and CPK-MB levels after surgery in the NTG group with the mean of 2090.68 ± 1856.07 and 97.27 ± 38.17 were significantly lower than those of the control group with the mean of 2697.02 ± 5586.56 and 137.95 ± 227.99, respectively (P-value <0.05).

CONCLUSION

According to the results of this study, although troponin I and CPK-MB levels increased significantly after CABG surgery, this increase was significantly lower in the intervention group compared to the control group following the administration of NTG.

Alterations in the Properties of Red Blood Cells in Men with Coronary Artery Diseases after Comprehensive Cardiac Rehabilitation

Purpose

Comprehensive cardiac rehabilitation (CCR) is a complex program aimed at improving the health status of patients with coronary artery disease (CAD), especially those who have been subjected to cardiac interventions (PCI and CABG).The aim of this study was to measure the changes in the properties of red blood cells (RBCs) in men with CAD after cardiac intervention and after participation in CCR program.

Methods

In this study, we have investigated the influence of the physical training-based CCR program in 12 men with CAD, after PCI or CABG. The characteristics of RBCs including the basic morphology of RBCs, the conformational state of RBC membrane protein and hemoglobin, acetylcholinesterase activity, membrane fluidity, the osmotic fragility, and thiol concentration in membrane and in hemolysate were measured. Ascorbate concentration and reduced glutathione were also determined. The analysis was performed in men, before and after participation in CCR. The properties of RBCs were observed in connection with the exercise test, and parameters were evaluated before, immediately after, and 1 hour after the exercise test.

Results

After CCR, a decrease in the mobility of erythrocyte membrane proteins was observed, which was accompanied by a decrease in lipid fluidity. In addition, immediately after the exercise test and 1 hour later, we measured a decrease in thiol level in hemolysate, but not in the plasma membrane. Unexpectedly, an increase in reduced glutathione concentration one hour after the exercise test after completing comprehensive cardiac rehabilitation was observed.

Conclusion

CCR in men with CAD after cardiac intervention is connected with decreased membrane fluidity and decreased membrane protein mobility, which indicates that reduction of oxidative changes in these components occurs.