Ischaemic preconditioning reduces troponin T release in patients undergoing coronary artery bypass surgery.

D. P. Jenkins, W. B. Pugsley, A. M. Alkhulaifi, M. Kemp, J. Hooper, D. M. Yellon

University College London Hospital, University College Hospital, United Kingdom.

OBJECTIVE: To investigate whether ischaemic preconditioning could reduce myocardial injury, as manifest by troponin T release, in patients undergoing elective coronary artery bypass surgery. DESIGN: Randomised controlled trial. SETTING: Cardiothoracic unit of a tertiary care centre. PATIENTS: Patients with three vessel coronary artery disease and stable angina admitted for first time elective coronary artery bypass surgery were invited to take part in the study; 33 patients were randomised into control or preconditioning groups. INTERVENTION: Patients in the preconditioning group were exposed to two additional three minute periods of myocardial ischaemia at the beginning of the revascularisation operation, before the ischaemic period used for the first coronary artery bypass graft distal anastomosis. MAIN OUTCOME MEASURE: Serum troponin T concentration at 72 hours after cardiopulmonary bypass. RESULTS: The troponin T assays were performed by blinded observers at a different hospital. All patients had undetectable serum troponin T (< 0.1 microgram/l) before cardiopulmonary bypass, and troponin T was raised postoperatively in all patients. At 72 hours, serum troponin T was lower (P = 0.05) in the preconditioned group (median 0.3 microgram/l) than in the control group (median 1.4 micrograms/l). CONCLUSIONS: The direct application of a preconditioning stimulus in clinical practice has been shown, for the first time, to protect patients against irreversible myocyte injury.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Rahman, I., Bonser, R. S (2009). Remote ischaemic preconditioning: the current best hope for improved myocardial protection in cardiac surgery?. Heart 95: 1553-1555 [Full Text]  
• Boengler, K., Schulz, R., Heusch, G. (2009). Loss of cardioprotection with ageing. Cardiovasc Res 83: 247-261 [Abstract] [Full Text]  
• Venugopal, V., Ludman, A., Yellon, D. M., Hausenloy, D. J. (2009). 'Conditioning' the heart during surgery. Eur. J. Cardiothorac. Surg. 35: 977-987 [Abstract] [Full Text]  
• Peart, J. N., Headrick, J. P. (2009). Clinical cardioprotection and the value of conditioning responses. Am. J. Physiol. Heart Circ. Physiol. 296: H1705-H1720 [Abstract] [Full Text]  
• Walsh, S. R., Tang, T. Y., Kullar, P., Jenkins, D. P., Dutka, D. P., Gaunt, M. E. (2008). Ischaemic preconditioning during cardiac surgery: systematic review and meta-analysis of perioperative outcomes in randomised clinical trials. Eur. J. Cardiothorac. Surg. 34: 985-994 [Abstract] [Full Text]  
• Wang, L., Oka, N., Tropak, M., Callahan, J., Lee, J., Wilson, G., Redington, A., Caldarone, C. A. (2008). Remote ischemic preconditioning elaborates a transferable blood-borne effector that protects mitochondrial structure and function and preserves myocardial performance after neonatal cardioplegic arrest.. J. Thorac. Cardiovasc. Surg. 136: 335-342 [Abstract] [Full Text]  
• Cohen, M. V., Downey, J. M. (2008). Oestrogen plays a permissive role in cardioprotection. Cardiovasc Res 79: 353-354 [Full Text]  
• Mentzer, R. M. Jr, Jahania, M. S., Lasley, R. D. (2008). Myocardial Protection. Card Surg Adult 3: 443-464 [Full Text]  
• Walsh, S. R., Tang, T., Sadat, U., Dutka, D. P., Gaunt, M. E. (2007). Cardioprotection by remote ischaemic preconditioning. Br J Anaesth 99: 611-616 [Abstract] [Full Text]  
• Vinten-Johansen, J., Zhao, Z.-Q., Jiang, R., Zatta, A. J., Dobson, G. P. (2007). Preconditioning and postconditioning: innate cardioprotection from ischemia-reperfusion injury. J. Appl. Physiol. 103: 1441-1448 [Abstract] [Full Text]  
• Hausenloy, D. J, Yellon, D. M (2007). The evolving story of "conditioning" to protect against acute myocardial ischaemia-reperfusion injury. Heart 93: 649-651 [Abstract] [Full Text]  
• Martou, G., O'Blenes, C. A., Huang, N., McAllister, S. E., Neligan, P. C., Ashrafpour, H., Pang, C. Y., Lipa, J. E. (2006). Development of an in vitro model for study of the efficacy of ischemic preconditioning in human skeletal muscle against ischemia-reperfusion injury. J. Appl. Physiol. 101: 1335-1342 [Abstract] [Full Text]  
• Codispoti, M., Sundaramoorthi, T., A. Saad, R., Reid, A., Sinclair, C., Mankad, P. (2006). Optimal myocardial protection strategy for coronary artery bypass grafting without cardioplegia: prospective randomised trial. ICVTS 5: 217-221 [Abstract] [Full Text]  
• Ramzy, D., Rao, V., Weisel, R. D. (2006). Clinical applicability of preconditioning and postconditioning: The cardiothoracic surgeons's view. Cardiovasc Res 70: 174-180 [Full Text]  
• Domenech, R. J. (2006). Preconditioning: A New Concept About the Benefit of Exercise. Circulation 113: e1-e3 [Full Text]  
• Fujii, M., Chambers, D. J. (2005). Myocardial protection with intermittent cross-clamp fibrillation: does preconditioning play a role?. Eur. J. Cardiothorac. Surg. 28: 821-831 [Abstract] [Full Text]  
• De Hert, S. G., Turani, F., Mathur, S., Stowe, D. F. (2005). Cardioprotection with Volatile Anesthetics: Mechanisms and Clinical Implications. Anesth. Analg. 100: 1584-1593 [Abstract] [Full Text]  
• Pasupathy, S., Homer-Vanniasinkam, S. (2005). Surgical Implications of Ischemic Preconditioning. Arch Surg 140: 405-409 [Abstract] [Full Text]  
• IONA Study Group, (2004). Impact of nicorandil in angina: subgroup analyses. Heart 90: 1427-1430 [Abstract] [Full Text]  
• Khoynezhad, A., Jalali, Z., Tortolani, A. J. (2004). Apoptosis: Pathophysiology and therapeutic implications for the cardiac surgeon. Ann. Thorac. Surg. 78: 1109-1118 [Abstract] [Full Text]  
• Zaugg, M., Schaub, M. C., Foex, P. (2004). Myocardial injury and its prevention in the perioperative setting. Br J Anaesth 93: 21-33 [Abstract] [Full Text]  
• Solomon, S. D., Anavekar, N. S., Greaves, S., Rouleau, J. L., Hennekens, C., Pfeffer, M. A., HEART Investigators, (2004). Angina pectoris prior to myocardial infarction protects against subsequent left ventricular remodeling. J Am Coll Cardiol 43: 1511-1514 [Abstract] [Full Text]  
• Carr-White, G., Koh, T., DeSouza, A., Haxby, E., Kemp, M., Hooper, J., Gibson, D., Pepper, J. (2004). Chronic stable ischaemia protects against myocyte damage during beating heart coronary surgery. Eur. J. Cardiothorac. Surg. 25: 772-778 [Abstract] [Full Text]  
• Fujii, M., Avkiran, M., Chambers, D. J (2004). Experimental studies on myocardial protection with intermittent cross-clamp fibrillation: additive effect of the sodium-hydrogen exchanger inhibitor, cariporide. Ann. Thorac. Surg. 77: 1398-1407 [Abstract] [Full Text]  
• Zaugg, M., Lucchinetti, E., Garcia, C., Pasch, T., Spahn, D. R., Schaub, M. C. (2003). Anaesthetics and cardiac preconditioning. Part II. Clinical implications. Br J Anaesth 91: 566-576 [Abstract] [Full Text]  
• YELLON, D. M., DOWNEY, J. M. (2003). Preconditioning the Myocardium: From Cellular Physiology to Clinical Cardiology. Physiol. Rev. 83: 1113-1151 [Abstract] [Full Text]  
• Wu, Z.-K., Laurikka, J., Saraste, A., Kyto, V., Pehkonen, E. J., Savunen, T., Tarkka, M. R. (2003). Cardiomyocyte apoptosis and ischemic preconditioning in open heart operations. Ann. Thorac. Surg. 76: 528-534 [Abstract] [Full Text]  
• Wu, Z.-K., Iivainen, T., Pehkonen, E., Laurikka, J., Tarkka, M. R. (2003). Perioperative and postoperative arrhythmia in three-vessel coronary artery disease patients and antiarrhythmic effects of ischemic preconditioning. Eur. J. Cardiothorac. Surg. 23: 578-584 [Abstract] [Full Text]  
• Vaage, J., Valen, G. (2003). Preconditioning and cardiac surgery. Ann. Thorac. Surg. 75: S709-714 [Abstract] [Full Text]  
• Mentzer, R. M. Jr., Jahania, M. S., Lasley, R. D. (2003). Myocardial Protection. Card Surg Adult 2: 413-438 [Full Text]  
• Taggart, P., Yellon, D. M. (2002). Preconditioning and Arrhythmias. Circulation 106: 2999-3001 [Full Text]  
• Wu, Z.-K., Iivainen, T., Pehkonen, E., Laurikka, J., Tarkka, M. R. (2002). Ischemic Preconditioning Suppresses Ventricular Tachyarrhythmias After Myocardial Revascularization. Circulation 106: 3091-3096 [Abstract] [Full Text]  
• Kloner, R. A, Speakman, M. T, Przyklenk, K. (2002). Ischemic preconditioning: a plea for rationally targeted clinical trials. Cardiovasc Res 55: 526-533 [Full Text]  
• Teoh, L.K.K., Grant, R., Hulf, J.A., Pugsley, W.B., Yellon, D.M. (2002). The effect of preconditioning (ischemic and pharmacological) on myocardial necrosis following coronary artery bypass graft surgery. Cardiovasc Res 53: 175-180 [Abstract] [Full Text]  
• Wu, Z.-K., Pehkonen, E., Laurikka, J., Kaukinen, L., Honkonen, E. L., Kaukinen, S., Laippala, P., Tarkka, M. R. (2001). The protective effects of preconditioning decline in aged patients undergoing coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 122: 972-978 [Abstract] [Full Text]  
• Raeburn, C. D., Cleveland, J. C. Jr, Zimmerman, M. A., Harken, A. H. (2001). Organ Preconditioning. Arch Surg 136: 1263-1266 [Abstract] [Full Text]  
• Heusch, G. (2001). Nitroglycerin and Delayed Preconditioning in Humans : Yet Another New Mechanism for an Old Drug?. Circulation 103: 2876-2878 [Full Text]  
• Efstathiou, A., Seraskeris, S., Papakonstantinou, C., Aidonopoulos, A., Lazou, A. (2001). Differential effect of preconditioning on post-ischaemic myocardial performance in the absence of substantial infarction and in extensively infarcted rat hearts. Eur. J. Cardiothorac. Surg. 19: 493-499 [Abstract] [Full Text]  
• Mackay, K., Mochly-Rosen, D. (2001). Arachidonic acid protects neonatal rat cardiac myocytes from ischaemic injury through {epsilon} protein kinase C. Cardiovasc Res 50: 65-74 [Abstract] [Full Text]  
• Wu, Z.-K., Tarkka, M. R., Pehkonen, E., Kaukinen, L., Honkonen, E. L., Kaukinen, S. (2000). Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting. Ann. Thorac. Surg. 70: 1551-1557 [Abstract] [Full Text]  
• Tang, W., Weil, M. H., Sun, S., Pernat, A., Mason, E. (2000). KATP channel activation reduces the severity of postresuscitation myocardial dysfunction. Am. J. Physiol. Heart Circ. Physiol. 279: H1609-H1615 [Abstract] [Full Text]  
• Yellon, D. M., Dana, A. (2000). The Preconditioning Phenomenon : A Tool for the Scientist or a Clinical Reality?. Circ. Res. 87: 543-550 [Abstract] [Full Text]  
• Noda, T., Minatoguchi, S., Fujii, K., Hori, M., Ito, T., Kanmatsuse, K., Matsuzaki, M., Miura, T., Nonogi, H., Tada, M., Tanaka, M., Fujiwara, H. (1999). Evidence for the delayed effect in human ischemic preconditioning: Prospective multicenter study for preconditioning in acute myocardial infarction. J Am Coll Cardiol 34: 1966-1974 [Abstract] [Full Text]  
• Tomai, F., Crea, F., Chiariello, L., Gioffre, P. A. (1999). Ischemic Preconditioning in Humans : Models, Mediators, and Clinical Relevance. Circulation 100: 559-563 [Abstract] [Full Text]  
• Chen, H.-S. V., Body, S. C., Shernan, S. K. (1999). Myocardial Preconditioning: Characteristics, Mechanisms, and Clinical Applications. SEMIN CARDIOTHORAC VASC ANESTH 3: 85-97 [Abstract]  
• Koh, T W, Carr-White, G S, DeSouza, A C, Ferdinand, F D, Hooper, J, Kemp, M, Gibson, D G, Pepper, J R (1999). Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass. Heart 81: 495-500 [Abstract] [Full Text]  
• Laskey, W. K. (1999). Beneficial Impact of Preconditioning During PTCA on Creatine Kinase Release. Circulation 99: 2085-2089 [Abstract] [Full Text]  
• Billinger, M., Fleisch, M., Eberli, F. R., Garachemani, A., Meier, B., Seiler, C. (1999). Is the development of myocardial tolerance to repeated ischemia in humans due to preconditioning or to collateral recruitment?. J Am Coll Cardiol 33: 1027-1035 [Abstract] [Full Text]  
• GALIÑANES, M (1998). In search of a reliable marker of tissue injury during heart surgery. Heart 80: 317-318 [Full Text]  
• Koh, T W, Hooper, J, Kemp, M, Ferdinand, F D, Gibson, D G, Pepper, J R (1998). Intraoperative release of troponin T in coronary venous and arterial blood and its relation to recovery of left ventricular function and oxidative metabolism following coronary artery surgery. Heart 80: 341-348 [Abstract] [Full Text]  
• Kloner, R. A., Bolli, R., Marban, E., Reinlib, L., Braunwald, E. (1998). Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning : An NHLBI Workshop. Circulation 97: 1848-1867 [Full Text]  
• Yellon, D. M, Baxter, G. F, Garcia-Dorado, D., Heusch, G., Sumeray, M. S (1998). Ischaemic preconditioning: present position and future directions. Cardiovasc Res 37: 21-33 [Abstract] [Full Text]  
• Perrault, L. P., Menasche, P., Ylitalo, K. V., Peuhkurinen, K. J. (1997). Ischemic Preconditioning Before Normothermic Retrograde Cardioplegia. Ann. Thorac. Surg. 64: 1874-1876 [Full Text]  

eLetters:

Read all eLetters

Preconditioning: might it reverse ATP synthase?

Richard G Fiddian-Green

Online, 1 Jul 2004 [Full text]

Preconditioning: priming of the protonmotive force by ATP synthase reversal?

Richard G Fiddian-Green

Online, 13 Jul 2004 [Full text]