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The S-100B substudy of the GLUTAMICS-trial: glutamate infusion not associated with sustained elevation of plasma S-100B after coronary surgery
Örebro University, School of Health and Medical Sciences.
Linköping Heart Ctr, Dept Cardiothorac Surgery, Linköping Univ Hosp, Linköping, Sweden.
Linköping Heart Ctr, Dept Cardiothorac Anesthesia, Linköping Univ Hosp, Linköping, Sweden.
Dept Cardiothorac Surg & Anesthesia, Univ Hosp Örebro, Örebro, Sweden.
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2010 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 29, no 3, p. 358-364Article in journal (Refereed) Published
Abstract [en]

Background & aimsConcerns have been raised about potential neurological injury related to exogenous glutamate. In cardiac surgery glutamate has been administered as a putative cardioprotective agent by cardioplegia or intravenous infusion. In the GLUTAMICS trial, in addition to surveillance of clinical neurological injuries, a prespecified subgroup was analyzed with regard to postoperative S-100B levels to detect potential subclinical neurological injury related to glutamate infusion.MethodsSixty-nine patients operated on for unstable coronary syndrome were randomized to intravenous infusion of glutamate (n=35) or saline (n=34) perioperatively. Plasma levels of S-100B were obtained on the third postoperative day.ResultsS-100B in the glutamate group and the control group were 0.079±0.034μg/L and 0.090±0.042μg/L respectively (p=0.245). There were no patients with stroke or mortality. Three patients in the control group and two in the glutamate group had postoperative confusion. These patients had significantly elevated S-100B compared with those without confusion (0.132±0.047vs 0.081±0.036μg/L; p=0.003). Overall, 21 patients had S-100B above reference level (≥0.10μg/L) and these patients had significantly more calcifications in the ascending aorta on epiaortic scanning.ConclusionsIntravenous glutamate infusion during surgery for unstable coronary artery disease did not initiate a sustained elevation of plasma S-100B. Thus, no evidence for subclinical neurological injury related to glutamate infusion was found. In contrast, postoperative elevation of plasma S-100B was linked to calcification of the ascending aorta and postoperative confusion.

Place, publisher, year, edition, pages
2010. Vol. 29, no 3, p. 358-364
Keywords [en]
Glutamate, Neurological injury, Nutrition, Coronary artery bypass surgery, Myocardial protection, Stroke
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-20138DOI: 10.1016/j.clnu.2009.09.007ISI: 000279413100013OAI: oai:DiVA.org:oru-20138DiVA, id: diva2:450601
Note

Mårten Vidlund is also affiliated to Univ Hosp Orebro, Dept Cardiothorac Surg & Anesthesia, Orebro, Sweden.

Available from: 2011-10-21 Created: 2011-10-21 Last updated: 2018-04-24Bibliographically approved
In thesis
1. Glutamate for metabolic intervention in coronary surgery: with special reference to the GLUTAMICS-trial
Open this publication in new window or tab >>Glutamate for metabolic intervention in coronary surgery: with special reference to the GLUTAMICS-trial
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Myocardial ischemia is a major cause of postoperative heart failure and adverse outcome in coronary artery bypass graft surgery (CABG). Conventional treatment of postoperative heart failure with inotropic drugs may aggravate underlying ischemic injury. Glutamate has been claimed to increase myocardial tolerance to ischemia and promote metabolic and hemodynamic recovery after ischemia. The aim of this work was to investigate if intravenous glutamate infusion given in association with CABG for acute coronary syndrome can reduce mortality and prevent or mitigate myocardial injury and postoperative heart failure. We also wanted to assess neurological safety issues, as a concern with the use of glutamate is that it may act as an excitotoxin under certain conditions.A metabolic strategy for perioperative care was assessed in an observational study on 104 consecutive patients with severe left ventricular dysfunction undergoing CABG. Based on encouraging clinical results, unsurpassed in the literature, the GLUTAMICS-trial was initiated. 861 patients undergoing CABG for acute coronary syndrome were randomly allocated to blinded intravenous infusion of L-glutamicacid solution or saline. The primary endpoint was a composite of postoperative mortality (≤30 days), perioperative myocardial infarction and left ventric ular heart failure in association with weaning from cardiopulmonary bypass. Secondary endpoints included neurological safety issues, degree of myocardial injury,postoperative hemodynamic state, use of circulatory support and cardiac mortality.The event rate was lower than anticipated and the primary endpoint did not differ significantly between the groups. Regarding secondary endpoints there were significant differences compatible with a beneficial effect of glutamate on post-ischemic myocardial recovery. The putative effect of glutamate infusion was seen in more ischemic patients (CCS class IV) and in patients with evident or anticipated LV-failure on weaning from CPB. No evidence for increased incidence of clinical or subclinical neurological injury was found. In conclusion, intravenous glutamate infusion is safe in the dosages employed and could provide a novel and important way of promoting myocardial recovery after ischemic injury.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 87
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 58
Keywords
myocardial ischemia, coronary artery bypass, cardiac surgery, acute coronary syndrome, glutamate, metabolic intervention, postoperative heart failure, myocardial recovery
National Category
Medical and Health Sciences Clinical Medicine Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-19757 (URN)978-91-7668-824-3 (ISBN)
Public defence
2011-11-11, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
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Supervisors
Available from: 2011-10-07 Created: 2011-10-07 Last updated: 2017-10-17Bibliographically approved

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