Gene Regulatory Control of Myocardial Energy Metabolism Predicts Postoperative Cardiac Function in Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery

Abstract

Anesthetic-induced and constitutive gene regulatory control of myocardial substrate metabolism predicts postoperative cardiac function in patients undergoing off-pump coronary artery bypass graft surgery. The authors' analysis further points to novel cardiac survival pathways as potential therapeutic targets in perioperative cardioprotection.

Remote Ischemic Preconditioning Is Redundant in Patients Undergoing Coronary Artery Bypass Graft Surgery Who Are Already Protected by Volatile Anesthetics

“…4 Using microarray analysis from atrial biopsies, we demonstrated that the release of NTpro-BNP, a marker of myocardial function/injury, clearly correlated with isoflurane-induced transcriptional changes in fatty-acid metabolism and DNA damage signaling (previously established hallmarks of isoflurane-induced transcriptional changes 5 ), but not with rIPC-induced changes. This observation and other research suggest that volatile anesthetics 6,7 and opioids 7,8 potentially attenuate or even abolish signaling from ischemia-reperfusion damage.…”

Propofol cardioprotection for on-pump aortocoronary bypass surgery in patients with type 2 diabetes mellitus (PRO-TECT II): a phase 2 randomized-controlled trial

“…12 Furthermore, propofol induced transcriptional changes in fatty acid metabolism and DNA damage signalling, correlating with release of N-terminal pro-brain natriuretic peptide (NT-proBNP), a biomarker of cardiac dysfunction. 37 Propofol concentrations were not measured and were likely suboptimal. Interestingly, a recent randomized multicentre trial concluded that inhalational anesthesia was not superior to total intravenous anesthesia in patients undergoing high-risk cardiac surgery.…”

Letter by Zaugg and Lucchinetti Regarding Article, “Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery”

“…4 Mimicking more closely noncardiac surgical conditions, we could confirm this beneficial effect on N-terminal prohormone of brain natriuretic peptide release and cardiac function in patients undergoing off-pump coronary artery bypass graft surgery, and further show anti-inflammatory coronary plaque stabilizing actions elicited by sevoflurane. 5 That study also reported differences in cardiac gene expression between sevoflurane-versus propofoltreated patients and related these differences to cardiac physiology and biomarkers. 5 It appears that ischemia as determined by a limited 3-lead Holter ECG analysis may neither be the most reliable nor the sole surrogate marker for assessing cardiovascular protection of sevoflurane.…”

“…5 That study also reported differences in cardiac gene expression between sevoflurane-versus propofoltreated patients and related these differences to cardiac physiology and biomarkers. 5 It appears that ischemia as determined by a limited 3-lead Holter ECG analysis may neither be the most reliable nor the sole surrogate marker for assessing cardiovascular protection of sevoflurane.…”