Glutamate for Metabolic Intervention in Coronary Surgery II

Summary

The aim of GLUTAMICS II is to evaluate whether intravenous glutamate infusion surgery reduces the risk of postoperative heart failure as measured by plasma NT-proBNP in patients undergoing moderate to high-risk coronary artery bypass graft surgery. Patients accepted for coronary artery bypass surgery of at least two vessel disease or left main stenosis with or without concomitant procedure and considered to be at moderate to high surgical risk preoperatively with regard to postoperative heart failure will be studied. The primary endpoint is postoperative increase of NT-proBNP from the day before surgery to the third postoperative day.

Timeline

Start

2015-11-15

Primary completion

2020-10-30

Completion

2020-10-30

Publications

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• Background Vanky FB, Hakanson E, Svedjeholm R. Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgery. Ann Thorac Surg. 2007 Jun;83(6):2036-43. doi: 10.1016/j.athoracsur.2007.01.031.
• Background Dahlin LG, Olin C, Svedjeholm R. Perioperative myocardial infarction in cardiac surgery--risk factors and consequences. A case control study. Scand Cardiovasc J. 2000 Oct;34(5):522-7. doi: 10.1080/140174300750064710.
• Background Khoynezhad A, Jalali Z, Tortolani AJ. Apoptosis: pathophysiology and therapeutic implications for the cardiac surgeon. Ann Thorac Surg. 2004 Sep;78(3):1109-18. doi: 10.1016/j.athoracsur.2003.06.034.
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• Background Aya HD, Cecconi M, Hamilton M, Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2013 Apr;110(4):510-7. doi: 10.1093/bja/aet020. Epub 2013 Feb 27.
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• Background Shahin J, DeVarennes B, Tse CW, Amarica DA, Dial S. The relationship between inotrope exposure, six-hour postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery. Crit Care. 2011 Jul 7;15(4):R162. doi: 10.1186/cc10302.
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• Background Safer B. The Metabolic Significance of the Malate-Aspartate Cycle in Heart. Circ Res. 1975 Nov;37(5):527-33. doi: 10.1161/01.res.37.5.527. No abstract available.
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• Background Pisarenko OI, Novikova EB, Serebryakova LI, Tskitishvili OV, Ivanov VE, Studneva IM. Function and metabolism of dog heart in ischemia and in subsequent reperfusion: effect of exogenous glutamic acid. Pflugers Arch. 1985 Dec;405(4):377-83. doi: 10.1007/BF00595691.
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• Background Pisarenko OI, Lepilin MG, Ivanov VE. Cardiac metabolism and performance during L-glutamic acid infusion in postoperative cardiac failure. Clin Sci (Lond). 1986 Jan;70(1):7-12. doi: 10.1042/cs0700007.
• Background Svedjeholm R, Vanhanen I, Hakanson E, Joachimsson PO, Jorfeldt L, Nilsson L. Metabolic and hemodynamic effects of intravenous glutamate infusion early after coronary operations. J Thorac Cardiovasc Surg. 1996 Dec;112(6):1468-77. doi: 10.1016/S0022-5223(96)70005-3.
• Background Svedjeholm R, Huljebrant I, Hakanson E, Vanhanen I. Glutamate and high-dose glucose-insulin-potassium (GIK) in the treatment of severe cardiac failure after cardiac operations. Ann Thorac Surg. 1995 Feb;59(2 Suppl):S23-30. doi: 10.1016/0003-4975(94)00918-w.
• Background Svedjeholm R, Vidlund M, Vanhanen I, Hakanson E. A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG. Scand Cardiovasc J. 2010 Feb;44(1):45-58. doi: 10.3109/14017430903531008.
• Background Vidlund M, Hakanson E, Friberg O, Juhl-Andersen S, Holm J, Vanky F, Sunnermalm L, Borg JO, Sharma R, Svedjeholm R. GLUTAMICS--a randomized clinical trial on glutamate infusion in 861 patients undergoing surgery for acute coronary syndrome. J Thorac Cardiovasc Surg. 2012 Oct;144(4):922-930.e7. doi: 10.1016/j.jtcvs.2012.05.066. Epub 2012 Jun 19.
• Background de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet. 2003 Jul 26;362(9380):316-22. doi: 10.1016/S0140-6736(03)13976-1.
• Background Karlstrom P, Alehagen U, Boman K, Dahlstrom U; UPSTEP-study group. Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: responders to treatment have a significantly better outcome. Eur J Heart Fail. 2011 Oct;13(10):1096-103. doi: 10.1093/eurjhf/hfr078. Epub 2011 Jun 29.
• Background Reyes G, Fores G, Rodriguez-Abella RH, Cuerpo G, Vallejo JL, Romero C, Pinto A. NT-proBNP in cardiac surgery: a new tool for the management of our patients? Interact Cardiovasc Thorac Surg. 2005 Jun;4(3):242-7. doi: 10.1510/icvts.2004.101576. Epub 2005 Mar 30.
• Background Nozohoor S, Nilsson J, Algotsson L, Sjogren J. Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2011 Jun;25(3):469-75. doi: 10.1053/j.jvca.2010.07.002. Epub 2010 Sep 9.
• Background Fox AA, Nascimben L, Body SC, Collard CD, Mitani AA, Liu KY, Muehlschlegel JD, Shernan SK, Marcantonio ER. Increased perioperative b-type natriuretic peptide associates with heart failure hospitalization or heart failure death after coronary artery bypass graft surgery. Anesthesiology. 2013 Aug;119(2):284-94. doi: 10.1097/ALN.0b013e318299969c.
• Holm J, Vanky F, Svedjeholm R. Association of Glutamate Infusion With Risk of Acute Kidney Injury After Coronary Artery Bypass Surgery: A Pooled Analysis of 2 Randomized Clinical Trials. JAMA Netw Open. 2024 Jan 2;7(1):e2351743. doi: 10.1001/jamanetworkopen.2023.51743.
• Holm J, Vanky F, Svedjeholm R. Glutamate Infusion Reduces Myocardial Dysfunction after Coronary Artery Bypass Grafting According to NT-proBNP: Summary of 2 Randomized Controlled Trials (GLUTAmate for Metabolic Intervention in Coronary Surgery [GLUTAMICS I-II]). Am J Clin Nutr. 2023 Nov;118(5):930-937. doi: 10.1016/j.ajcnut.2023.08.012. Epub 2023 Aug 30.
• Holm J, Ferrari G, Holmgren A, Vanky F, Friberg O, Vidlund M, Svedjeholm R. Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial. PLoS Med. 2022 May 9;19(5):e1003997. doi: 10.1371/journal.pmed.1003997. eCollection 2022 May.

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