Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study

Montaigne, David; Maréchal, Xavier; Modine, Thomas; Coisne, Augustin; Mouton, S.; Fayad, Georges; Ninni, Sandro; Klein, Cédric; Ortmans, Staniel; Seunes, C.; Potelle, Charlotte; Berthier, Alexandre; Gheeraert, Céline; Piveteau, Catherine; Déprez, Rebecca; Eeckhoute, Jérôme; Duez, Hélène; Lacroix, Dominique; Déprez, Benoît; Jégou, B.; Koussa, Mohamed; Edmé, Jean-Louis; Lefèbvre, Philippe; Staels, Bart

doi:10.1016/s0140-6736(17)32132-3

Cited by 250 publications

(261 citation statements)

References 30 publications

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“…These findings extend and corroborate previous work assessing biorhythms in cardiovascular function, the tolerance of the cardiovascular system to external stressors, and cardiovascular disorders15–17 A recent pilot study observed a lower ischaemia/reperfusion tolerance and higher incidence of PMI among patients undergoing on-pump aortic valve replacement in the morning as compared with patients undergoing the same operation in the afternoon 6. This daytime variation in ischaemia/reperfusion tolerance achieved enormous attention, as it was associated with a difference in major cardiovascular events during follow-up.…”

Section: Discussionsupporting

confidence: 90%

“…Following this concept, a recent pilot study exclusively enrolling patients undergoing on-pump cardiac aortic valve replacement suggested the presence of a daytime variation for PMI occurring during cardiac surgery with a lower event rate triggered by operations that are performed in the afternoon 6. Such a daytime-dependent cardioprotective strategy based solely on the time of surgery could represent an inexpensive and easily implementable way to improve short-term and long-term outcome in patients at increased cardiovascular risk undergoing surgery 7.…”

Section: Introductionmentioning

confidence: 99%

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Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Lavallaz

Puelacher

Buse

et al. 2018

Heart

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ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registration NCT02573532;Results.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Lavallaz

Puelacher

Buse

et al. 2018

Heart

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“…Recently, the importance of time of day in clinical practice has been realized [6,[26][27][28][29][30][31][32][33][34][35] ( Table 1). The time of day at which our immune system is triggered, by for example sustaining a wound, undergoing surgery or having a vaccination, has a significant impact on how we respond.…”

Section: Clinical Translationmentioning

confidence: 99%

“…In 2017, the Nobel Prize in Physiology or Medicine was awarded jointly to Jeffrey C. Hall, Michael Rosbash, and Michael W. Young ''for their discoveries of molecular mechanisms controlling the circadian rhythm'' [1][2][3]. The circadian clock is crucial in regulating daily physiological processes and it is now realized that the time at which our immune system is triggered (by infection [4], vaccination [5], surgery [6]), appears to be critical to the way we respond to these insults. Several inflammatory diseases, such as asthma, display a marked time of day pattern in symptoms.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Body Clock in Asthma and COPD: Implication for Treatment

Krakowiak

Durrington

2018

Pulm Ther

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Asthma exhibits a marked time of day variation in symptoms, airway physiology, and airway inflammation. This is also seen in chronic obstructive pulmonary disease (COPD), but to a lesser extent. Our understanding of how physiological daily rhythms are regulated by the circadian clock is increasing, and there is growing evidence that the molecular clock is important in the pathogenesis of these two airway diseases. If time of day is important, then it follows that treatment of asthma and COPD should also be tailored to the most efficacious time of the day, a concept known as 'chronotherapy'. There have been a number of studies to determine the optimal time of day at which to take medications for asthma and COPD. Some of these agents are already used 'chronotherapeutically' in practice (often at night-time). However, several studies investigating systemic and inhaled corticosteroids have consistently shown that the best time of day to take these medications for treating asthma is in the afternoon or early evening and not in the morning, when these medications are often prescribed. Future, large, randomized, placebo-controlled studies of systemic and inhaled corticosteroids in asthma and COPD are needed to inform clinical practice.

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“…After all, haven't circadian rhythm been demonstrated to transcriptionally orchestrate perioperative myocardial injury and exert its influence through Rev-Erba on perioperative mortality, with afternoon surgeries doing better than morning ones! [9].…”

mentioning

confidence: 99%

Sound of music—or is it noise in OR?

Yadava

2017

Indian J Thorac Cardiovasc Surg

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Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study

Cited by 250 publications

References 30 publications

Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

The Role of the Body Clock in Asthma and COPD: Implication for Treatment

Sound of music—or is it noise in OR?

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