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Angeloni E, Melina G, Federici F, Pischedda F, Vignaroli W, Rocco M, Sinatra R. Preliminary results of the Multicenter Observational Study with Enoximone in Cardiac surgery (MOSEC). Int J Cardiol 2018; 269:51-55. [PMID: 30037630 DOI: 10.1016/j.ijcard.2018.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/04/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Perioperative administration of Enoximone has been shown to improve hemodynamics, organ function, and inflammatory response. Aim of the present study was to evaluate the effects of Enoximone after on-pump cardiac surgery. METHODS A protocol for a multicenter observational study was reviewed and approved by local ethic committee. This preliminary report involves the first 29 patients enrolled, in whom Enoximone was perioperatively administered in the context of on-pump cardiac surgery. All patients enrolled were propensity-matched 1:1 with controls not receiving Enoximone, renal function was evaluated in terms of estimated glomerular filtration rate (eGFR) with the CKD-EPI equation. RESULTS After propensity matching, the two cohorts of patients receiving Enoximone or not did not show any significant differences among baseline characteristics. Patients receiving Enoximone showed a progressive improvement of eGFR at each time-point of follow-up: roughly +4.3, +10.0, and +12.3 mL/min/1.73 m2 on postoperative days 2, 7, and 30; respectively. Consistently, maximum difference versus baseline was +12.6 mL/min/1.73 m2 (or +19.3%) among Enoximone patients vs +3.3 mL/min/1.73 m2 (or +4.4%) among controls (p = 0.02). Multivariable regression analysis (R2-adjusted 0.47) showed only age (β -0.53; p = 0.01), preoperative eGFR (β -0.39; p = 0.02), diabetes (β 2.1; p = 0.01), cardio-pulmonary bypass duration (β 0.08; p = 0.05), and Enoximone administration (β -0.74; p = 0.05) to be independently correlated with delta eGFR variation on day 30. CONCLUSION These preliminary results show that perioperative Enoximone administration improved renal function in patients undergoing on-pump cardiac surgery. Further studies are needed to confirm these findings.
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Affiliation(s)
- Emiliano Angeloni
- Department of Cardiac Surgery, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy.
| | - Giovanni Melina
- Department of Cardiac Surgery, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy
| | - Francesco Federici
- Department of Anaesthesiology, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy
| | - Francesca Pischedda
- Department of Anaesthesiology, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy
| | - Walter Vignaroli
- Department of Cardiac Surgery, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy
| | - Monica Rocco
- Department of Anaesthesiology, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy
| | - Riccardo Sinatra
- Department of Cardiac Surgery, Sapienza University of Rome, Policlinico Sant'Andrea, Roma, Italy
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Angeloni E, Melina G, Roscitano A, Refice S, Capuano F, Comito C, Benedetto U, Sinatra R. Perioperative administration of enoximone and renal function after cardiac surgery: a propensity-matched analysis. Int J Cardiol 2013; 167:1961-6. [PMID: 22633430 DOI: 10.1016/j.ijcard.2012.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perioperative administration of enoximone has been shown to improve hemodynamics, organ function, and inflammatory response. Aim of the present study is to evaluate the impact of enoximone on postoperative renal function after on-pump cardiac surgery. METHODS A total of 3727 patients undergoing cardiac surgery at one Institution between May 2004 and November 2010 were reviewed. A propensity score was built and a 1:1 perfect matching was performed, providing two fairly comparable cohorts of 712 patients each, receiving or not enoximone after surgery. Renal function was evaluated by lower glomerular filtration rate (GFR) value reached postoperatively. RESULTS Overall 30-day mortality rate was 4.3% (62/1424). Cumulative incidence of postoperative renal failure (RF) was 157/1424(11%), of which 99/1424(7%) needed renal replacement therapy. Mean lower postoperative GFR in patients who received or not enoximone was 63 ± 30.1 and 53.5 ± 26.1 ml/min/1.73 m(2) (p<0.0001), respectively. At multivariable analysis age (OR2.75, p=0.0004), diabetes (OR1.82, p=0.006), preoperative GFR (OR3.81, p<0.0001), preoperative cardiogenic shock (OR1.65, p=0.004), previous cardiac surgery (OR2.12, p=0.0002), type of intervention (OR1.96, p=0.005), and enoximone (OR0.38, p=0.001) were found to be independently associated with postoperative RF. Logistic regression analysis showed that the administration of enoximone (OR0.41, p=0.0001), and of no inotropes (OR0.27, p<0.0001) were protective vs. the occurrence of postoperative RF. CONCLUSION Patients perioperatively receiving enoximone showed a statistically significant better renal function after cardiac surgery.
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Affiliation(s)
- Emiliano Angeloni
- Sapienza, University of Rome, Policlinico Sant'Andrea, Department of Cardiac Surgery, Rome, Italy.
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Avni T, Paret G, Thaler A, Mishali D, Yishay S, Tal G, Dalal I. Delta chemokine (fractalkine)--a novel mediator of pulmonary arterial hypertension in children undergoing cardiac surgery. Cytokine 2011; 52:143-5. [PMID: 20869263 DOI: 10.1016/j.cyto.2010.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 05/26/2010] [Accepted: 08/20/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fractalkine (FKN), a unique chemokine associated with pulmonary hypertension, may be involved in the acute stress response that regulates inflammation after cardiopulmonary bypass (CPB) surgery. We characterized FKN levels and correlated them with clinical parameters in children undergoing cardiac surgery involving CPB. METHODS Twenty-seven consecutive patients, aged 30 days to 11.5 years, who underwent surgery for correction of congenital heart defects, were prospectively studied. Serial blood samples were collected preoperatively, upon termination of CPB, and at six points postoperatively. Plasma was recovered immediately, aliquoted, and frozen at -70° C until assayed. Clinical and laboratory data were collected. RESULTS Baseline FKN levels were skewed between patients. Patients with low FKN levels showed significantly higher levels of oxygen saturation in room air compared to patients with high FKN levels (p<0.05). Moreover, there was a positive correlation between preoperative pulmonary arterial hypertension and FKN levels (p<0.05). Surprisingly, FKN elevation from preoperative to postoperative levels displayed no discernible pattern. CONCLUSIONS FKN levels significantly correlate with preoperative hypoxemia and PAH, suggesting that FKN may be up-regulated during hypoxemia. CPB is not associated with acute changes in circulating FKN levels. The role of FKN in the postoperative course should be further investigated.
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Affiliation(s)
- Tomer Avni
- Department of Pediatric Critical Care, The Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Panagiotopoulos I, Palatianos G, Michalopoulos A, Chatzigeorgiou A, Prapas S, Kamper EF. Alterations in biomarkers of endothelial function following on-pump coronary artery revascularization. J Clin Lab Anal 2011; 24:389-98. [PMID: 21089169 DOI: 10.1002/jcla.20416] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) has been associated with activation and injury of endothelial cells, probably responsible for the systemic inflammatory response syndrome (SIRS) taking place in these patients. METHODS We measured plasma concentrations of soluble P-selectin (sP-s), E-selectin (sE-s), tetranectin (TN), vonWillebrand factor (vWF) levels, and angiotensin-converting enzyme (ACE) activity in 31 adult patients undergoing elective coronary artery bypass grafting, just before and up to three days after surgery, and in 25 healthy volunteers. RESULTS Patients showed higher plasma sP-s and sE-s and ACE concentrations, just before surgery, but significantly lower TN levels, compared with controls. During the first three postoperative days (PD), the concentration of each of the molecules followed a different and independent pattern, although in the third PD, the levels of sP-s, sE-s and ACE were higher and those of vWF and TN lower, compared with the preoperative ones. However, patients had higher sP-s (P=0.06), sE-s (P=0.07), and vWF (P=0.005), but lower TN concentrations (P=0.02) on the third PD compared with controls. CONCLUSIONS CPB is characterised by pronounced changes in plasma sP-s, sE-s, TN, vWF levels, and ACE activity, which are associated with significant alteration in the intra- and early postoperative endothelial function observed in open heart surgery.
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Liangos O, Addabbo F, Tighiouart H, Goligorsky M, Jaber BL. Exploration of disease mechanism in acute kidney injury using a multiplex bead array assay: a nested case-control pilot study. Biomarkers 2010; 15:436-45. [PMID: 20482449 DOI: 10.3109/1354750x.2010.485252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) causes increased morbidity and mortality. OBJECTIVE To evaluate the plasma profile of biomarkers potentially involved in AKI development following CPB. METHODS In a nested case-control study, plasma levels of 27 biomarkers in 11 AKI cases were compared with 25 controls. RESULTS Pre-CPB, plasma levels of epidermal growth factor and macrophage inflammatory protein-1beta, 2 h following CPB, soluble vascular cell adhesion molecule-1 (sVCAM-1), fractalkine and macrophage inflammatory protein-1alpha, and at later time points, sVCAM-1 and interleukin-6 were associated with AKI. CONCLUSION Biomarkers associated with AKI following CPB may merit further study.
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Affiliation(s)
- Orfeas Liangos
- Kidney & Dialysis Research Laboratory, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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Pontiroli AE, Pizzocri P, Paroni R, Folli F. Sympathetic overactivity, endothelial dysfunction, inflammation, and metabolic abnormalities cluster in grade III (World Health Organization) obesity: reversal through sustained weight loss obtained with laparoscopic adjustable gastric banding. Diabetes Care 2006; 29:2735-8. [PMID: 17130217 DOI: 10.2337/dc06-1417] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kozik DJ, Tweddell JS. Characterizing the Inflammatory Response to Cardiopulmonary Bypass in Children. Ann Thorac Surg 2006; 81:S2347-54. [PMID: 16731102 DOI: 10.1016/j.athoracsur.2006.02.073] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 01/07/2006] [Accepted: 02/04/2006] [Indexed: 11/29/2022]
Abstract
Cardiopulmonary bypass is known to trigger a global inflammatory response. Age-dependent differences in the inflammatory response, the increased susceptibility to injury of immature organ systems, and the larger extracorporeal circuit to patient size ratio results in greater susceptibility of younger and smaller patients to the damaging effects of cardiopulmonary bypass. In this review the components of the inflammatory response to cardiopulmonary bypass are reviewed with special reference to the pediatric age group, including the age-specific impact on organ systems. In addition the current and evolving strategies to prevent, limit, and treat the inflammatory response to cardiopulmonary bypass in children are examined.
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Affiliation(s)
- Deborah J Kozik
- The Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Chello M, Carassiti M, Agrò F, Mastroroberto P, Pugliese G, Colonna D, Covino E. Simvastatin blunts the increase of circulating adhesion molecules after coronary artery bypass surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2004; 18:605-9. [PMID: 15578471 DOI: 10.1053/j.jvca.2004.07.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Endothelial dysfunction has been shown to be a critical early component of organ injury after myocardial ischemia and reperfusion. Circulating levels of adhesion molecules have been regarded as a valid index of endothelial activation. Recent reports suggest that statins, widely used in the control of hypercholesterolemia, exert a protective effect on the endothelium reflected by a reduced level of circulating adhesion molecules. In this study, the effects of preoperative simvastatin treatment, at doses equivalent to those used orally for cholesterol control, were studied on plasma levels of VCAM-1, ICAM-1, and ELAM-1. DESIGN A case-control study. SETTING University hospital. PARTICIPANTS Fifteen patients taking simvastatin with good control of cholesterol levels, 15 patients not responsive to the simvastatin treatment, and 15 normocholesterolemic patients (control) undergoing elective coronary artery bypass surgery. MEASUREMENTS AND MAIN RESULTS The plasma levels of VACM-1, ICAM-1, and ELAM-1 were evaluated at baseline; during cardiopulmonary bypass; and 6 hours, 24 hours, and 48 hours postoperatively. In the late postoperative samples, the plasma levels of ICAM-1 and ELAM-1 were lower in both simvastatin-treated patients compared with the control patients. No significant difference was found between the patients responsive to statin and those not responsive. Finally, no significant difference was found for VCAM-1 plasma levels between the control group and the 2 treatment groups. CONCLUSIONS Pretreatment with simvastatin significantly reduces the increase of ICAM-1 and ELAM-1 after coronary artery bypass surgery, by a mechanism that seems not related to its efficacy in lowering cholesterol levels.
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Affiliation(s)
- Massimo Chello
- Department of Cardiovascular Sciences, University Campus BioMedico of Rome, Rome, Italy.
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Leone M, Garcin F, Chaabane W, Boutière-Albanèse B, Albanèse J, Dignat-Georges F, Martin C. Activation des molécules d’adhésion chez les patients en choc septique. ACTA ACUST UNITED AC 2003; 22:721-9. [PMID: 14522392 DOI: 10.1016/s0750-7658(03)00327-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To analyze the pattern of adhesion molecules in patients with septic shock. Data sources. - References obtained from Pubmed databank. DATA EXTRACTION Models of inflammation linking endothelial dysfunction, adhesion molecules and septic states were analyzed. DATA SYNTHESIS The endothelium has been identified as the central effector in the inflammatory response. Adhesion molecules are strongly involved in the inflammatory process by modulating the leukocyte trafficking. The most important adhesion molecules are the selectins (E-, L-, and P-selectins) and members of the immunoglobulin superfamily (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1). Plasma levels of these molecules are increased in septic shock patients, which may be related to a marked activation of the endothelium. However, a dichotomous profile is observed between plasma and tissue expression. The inhibition of adhesive molecule actions could make it possible to control the inflammatory response.
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Affiliation(s)
- M Leone
- Département d'anesthésie et de réanimation et centre de traumatologie, hôpital Nord, boulevard P.-Dramard, 13915 Marseille cedex 20, France.
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Pentoxifylline: A Useful Adjuvant in the Critically Ill? Intensive Care Med 2002. [DOI: 10.1007/978-1-4757-5551-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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