Enhanced coronary arteriolar contraction to vasopressin in patients with diabetes after cardiac surgery

Sellke, Nicholas; Kuczmarski, Alex; Lawandy, Isabella; Cole, Victoria; Ehsan, Afshin; Singh, Arun K.; Liu, Yuhong; Sellke, Frank W.; Feng, Jun

doi:10.1016/j.jtcvs.2018.05.090

Cited by 19 publications

(25 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[17][18][19][20] Marked alterations in vasomotor regulation have been documented after cardiac surgery utilizing cardiopulmonary bypass both in vivo 21 and in vitro. [17][18][19][20]22,23 These changes in vasomotor regulation and other cellular signaling are exacerbated or different in patients with poorly controlled diabetes compared to patients without diabetes or well controlled diabetes. [22][23][24][25] While hyperglycemia is often seen as an inflammatory state and therefore theorized to be associated with inflammatory markers penetrating the blood-brain barrier and causing decreased neurocognitive function, we did not observe that in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19][20]22,23 These changes in vasomotor regulation and other cellular signaling are exacerbated or different in patients with poorly controlled diabetes compared to patients without diabetes or well controlled diabetes. [22][23][24][25] While hyperglycemia is often seen as an inflammatory state and therefore theorized to be associated with inflammatory markers penetrating the blood-brain barrier and causing decreased neurocognitive function, we did not observe that in this study. Neither did pre-existing diabetes, as determined by an elevated preoperative HbA1c level, nor elevations of glucose levels the morning of or intra-operatively have any effect on early neurocognitive function.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Inflammation but not Glycemic Control is Associated with Neurocognitive Decline After Cardiac Surgery

Scrimgeour

Ikeda

Sellke

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Whether perioperative glycemic control or markers of inflammation is associated with neurocognitive decline (NCD) after cardiac surgery was examined. Methods: Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on post-operative day four (POD4). Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. Results: A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p=0.03). Patients with elevated IL-8 levels at 6 hours postoperatively had a significant decline in NCD at POD4 (p=0.04). Surprisingly, TNF-α, IL-1β, IL-2, or IL-6 levels were not associated with NCD (p>0.3 for all). There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p=0.973) or elevated fasting blood glucose levels the morning of surgery (>126mg/dL, p=0.910), or a higher maximum blood glucose levels during CPB (>180mg/dL, p=0.252), or higher average glucose levels during CPB (>160mg/dL, p=0.639). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. Conclusions: Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. Postoperative leukocytosis and elevated IL-8 levels are associated with neurocognitive decline. The profile of gene expression was altered in patients with NCD with or without diabetes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inflammation but not Glycemic Control is Associated with Neurocognitive Decline After Cardiac Surgery

Scrimgeour

Ikeda

Sellke

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The vasoconstrictor response was further amplified in diabetic patients, mediated by an increased expression of the vasopressin V1 receptor in vascular smooth muscle. 11 This study adds to the seminal contributions on the topic of vascular reactivity in diabetic patients by the authors. The authors previously demonstrated that the contractile responses of skeletal muscle arterioles to phenylephrine and vasopressin were decreased after CPB in humans, while mesenteric vessels showed an increased response to norepinephrine and vasoconstriction with vasopressin remained unchanged.…”

mentioning

confidence: 87%

“…In the current issue of the Journal, Sellke and colleagues 11 explore the in vitro response of human atrial arterioles to vasopressin obtained before and after CPB in patients with poorly controlled diabetes and in nondiabetic controls. 11 The in vitro vasoconstrictor response to vasopressin was increased in both diabetic and nondiabetic patients after CPB. The vasoconstrictor response was further amplified in diabetic patients, mediated by an increased expression of the vasopressin V1 receptor in vascular smooth muscle.…”

mentioning

confidence: 99%

Vasopressin atrial coronary constriction in humans: The unknown clinical significance of a laboratory finding

Crestanello

2018

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Vasodilatory shock occurs in 5% to 25% of patients after cardiac surgery and results in poor outcomes. 1 It is treated with vasopressor that leads to vasoconstriction of the splanchnic and skeletal circulation, resulting in end-organ hypoperfusion. 2 Although catecholamine vasopressor therapy, its duration, and number of vasopressors used are associated with an increased risk of adverse cardiac and noncardiac events, vasopressin appears to have a more effective and safer profile in the treatment of vasodilatory shock after cardiac surgery. 1,2 Vasopressin, a naturally occurring peptide, produces vasoconstriction by activating V1a receptor, blocking the opening of potassium adenosine triphosphate channels in vascular smooth muscle, and reducing nitric oxide production. 3,4 Vasopressin depletion and decreased circulating levels of vasopressin are fundamental mechanisms responsible for vasodilatory shock after cardiac surgery. 3,5,6 As such, vasopressin is commonly used to treat and prevent vasodilatory shock after cardiac surgery. In a prospective randomized controlled trial, Hajjar and colleagues 1 showed that the use of vasopressin after cardiac surgery is associated with a reduction in 30-day mortality, postoperative renal failure, and postoperative atrial fibrillation compared with norepinephrine. Other investigators previously demonstrated that vasopressin is effective in treating vasodilatory shock after cardiac surgery, sepsis, and other vasodilatory conditions, decreasing catecholamine use with no increase in adverse events. [7][8][9] Low ejection fraction, prolonged cardiopulmonary bypass (CPB), left ventricular assist device insertion, and preoperative use of angiotensin-converting enzyme inhibitors and beta-blockers are predictors of vasodilatory shock after cardiac surgery. 3,6 Despite the profound microvascular dysfunction seen in diabetes, diabetes has not been identified clinically as a risk factor for vasoplegia. However, diabetes is associated with poor outcomes after cardiac surgery. Some of those adverse outcomes can be explained by the microvascular and macrovascular dysfunction seen in diabetic patients, which are exacerbated by CPB. 10

show abstract

“…These clinical and experimental studies suggest that major coronary vasodilatation occurring in the early period following CP/CPB when these modalities are used. In another study by De Backer et al [2] , hemodynamic and microcirculatory variables were examined before and after cardiac surgery with or without CPB. Vascular function was also examined in a non-cardiac surgical control group.…”

Section: Introductionmentioning

confidence: 99%

Microvascular dysfunction following cardioplegic arrest and cardiopulmonary bypass

Feng¹,

Kant²,

Sellke³

2021

Self Cite

View full text Add to dashboard Cite

Cardioplegia and cardiopulmonary bypass (CP/CPB) during cardiac surgery may cause systemic microvascular dysfunction. CP/CPB is associated with significant alterations in myogenic tone, agonist-induced vasomotor response, and endothelial function in various organs and vascular beds. These alterations can result in vessel spasm, organ malperfusion, and tissue damage. This review summarizes the current state of research in this field.

show abstract

Enhanced coronary arteriolar contraction to vasopressin in patients with diabetes after cardiac surgery

Cited by 19 publications

References 36 publications

Inflammation but not Glycemic Control is Associated with Neurocognitive Decline After Cardiac Surgery

Inflammation but not Glycemic Control is Associated with Neurocognitive Decline After Cardiac Surgery

Vasopressin atrial coronary constriction in humans: The unknown clinical significance of a laboratory finding

Microvascular dysfunction following cardioplegic arrest and cardiopulmonary bypass

Contact Info

Product

Resources

About