Hyperinsulinemic glucose control and myocardial function during cardiac surgery

心脏手术期间高胰岛素血糖控制和心肌功能

• 批准号: 8677949
• 负责人: Andra E Duncan
• 金额: $ 15.6万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8677949
• 关键词: 6-Phosphofructokinase; Acetylglucosamine; Advanced Development; Adverse effects; Adverse event; Anabolism; Award; Basic Science; Biochemical; Blood Glucose; Brain natriuretic peptide; Cardiac; Cardiac Myocytes; Cardiac Output; Cardiac Surgery procedures; Caring; Cessation of life; Clinical; Clinical Data; Clinical Research; Clinical Trials; Collaborations; Complex; Critical Illness; Data; Enzymes; FOS gene; Glucose; Glyceraldehyde-3-Phosphate Dehydrogenases; Goals; Grant; Growth; Heart; Heart Atrium; Hexosamines; Hospitalization; Hyperglycemia; Infusion procedures; Injury; Insulin; Investigation; Ischemia; Kidney Failure; Knowledge; Left Ventricular Dysfunction; Left Ventricular Function; Link; Low Cardiac Output; Measures; Mentored Patient-Oriented Research Career Development Award; Mentorship; Metabolic Pathway; Metabolism; Methods; Morbidity - disease rate; Myocardial; Myocardial Ischemia; Myocardial tissue; N-terminal; Operative Surgical Procedures; Outcome; Pathway interactions; Patients; Perioperative Care; Physiologic intraventricular pressure; Postoperative Complications; Postoperative Period; Potassium; Proto-Oncogene Proteins c-jun; Randomized; Reporting; Research; Research Design; Research Personnel; Research Project Grants; Risk; Serum; Serum Markers; Stroke; Techniques; Testing; Therapeutic; Thrombospondin 1; Tissues; Training; Translational Research; Troponin T; United States National Institutes of Health; Ventricular; blood glucose regulation; career; experience; glucose uptake; heart function; hemodynamics; high risk; improved; indexing; innovation; meetings; mortality; multidisciplinary; patient oriented; patient population; pyruvate dehydrogenase; response; skills; standard care; statistics; tool; uptake

DESCRIPTION (provided by applicant): The candidate's ultimate goal is to become an independent, patient-oriented researcher investigating innovative ways to decrease morbidity and mortality in critically ill patients undergoing high-risk cardiac surgical procedures. This Mentored Patient-Oriented Research Career Development Award will provide the knowledge, training, and experience necessary to achieve this goal. Specifically, this Award will provide for: 1) coursework in clinical research, statistics, and study design to provide the background for a successful career in clinical research; 2) an in-depth investigative experience under exceptional mentorship to gain invaluable experience and training in investigation of critically ill cardiac surgical patients; 3) development of advanced echocardiographic skills with important research applications for investigating perioperative care of complex cardiac surgical patients; 4) an investigation in basic science research to elucidate the cellular effects of hyperglycemia and cardioprotection; and 5) an opportunity to acquire preliminary data and apply for an NIH Project Grant (R01), examining the means to improve care of high-risk critically ill cardiac surgical patients. These goals will be met by collaboration with an integrated, multidisciplinary team of expert researchers and clinicians. Clinical Investigation: Hyperglycemia during cardiac surgery is associated with increased risk of morbidity and mortality. Provision of exogenous glucose while treating hyperglycemia has improved morbidity and mortality in surgical patients. The hyperinsulinemic normoglycemic clamp (HNC) provides exogenous glucose while normalizing blood glucose, which is expected to provide beneficial effects by increasing myocardial uptake and utilization of glucose resulting in improved myocardial function. The purpose of this investigation is to determine whether normalization of blood glucose using HNC promotes cardiomyocyte utilization of glucose, provides cellular protection from the adverse effects of hyperglycemia, and improves myocardial global and regional function. Patients will be randomly assigned to either glucose control with HNC versus standard glucose management. To the extent that HNC improves myocardial function, outcomes in high-risk cardiac surgical patients may improve.

描述（由申请人提供）：候选人的最终目标是成为一个独立的，以病人为导向的研究人员，研究创新的方法，以减少发病率和死亡率在危重病人接受高风险的心脏外科手术。这个指导以患者为导向的研究职业发展奖将提供实现这一目标所需的知识，培训和经验。具体而言，该奖项将提供：1）临床研究，统计学和研究设计的课程，为临床研究的成功职业生涯提供背景; 2）在特殊指导下的深入调查经验，以获得宝贵的经验和危重心脏手术患者的调查培训; 3）发展先进的超声心动图技术，并在调查复杂心脏手术患者的围手术期护理方面具有重要的研究应用; 4）基础科学研究的调查，以阐明高血糖和心脏保护的细胞效应;和5）获得初步数据和申请NIH项目资助（R 01）的机会，研究改善高危危重心脏手术患者护理的方法。这些目标将通过与专家研究人员和临床医生组成的综合多学科团队合作来实现。临床研究：心脏手术期间高血压与发病率和死亡率风险增加相关。在治疗高血糖症的同时提供外源性葡萄糖可改善手术患者的发病率和死亡率。高胰岛素正常血糖钳夹（HNC）提供外源性葡萄糖，同时使血糖正常化，预期通过增加心肌对葡萄糖的摄取和利用，从而改善心肌功能，从而提供有益作用。本研究的目的是确定使用HNC使血糖正常化是否促进心肌细胞对葡萄糖的利用，提供细胞保护以免受高血糖症的不良影响，并改善心肌整体和局部功能。患者将被随机分配至HNC血糖控制组和标准血糖管理组。在一定程度上，HNC改善心肌功能，在高风险的心脏手术患者的结果可能会改善。

项目成果

An echocardiographic evaluation of valvular function and ventricular patch repair during surgical exclusion of left ventricular pseudoaneurysm.

左心室假性动脉瘤手术排除期间瓣膜功能和心室补片修复的超声心动图评估。

• DOI: 10.1213/ane.0b013e3182291361
• 发表时间: 2011
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: O'Donoghue,RoryD;Duncan,AndraE;Fraser,ThomasG;Thomas,JamesD
• 通讯作者: Thomas,JamesD

Early Left and Right Ventricular Response to Aortic Valve Replacement.

• DOI: 10.1213/ane.0000000000001108
• 发表时间: 2017-02
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Duncan AE;Sarwar S;Kateby Kashy B;Sonny A;Sale S;Alfirevic A;Yang D;Thomas JD;Gillinov M;Sessler DI
• 通讯作者: Sessler DI

Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery.

术中使用高胰岛素正常血糖进行严格血糖控制会增加心脏手术后的谵妄。

• DOI: 10.1097/aln.0000000000000669
• 发表时间: 2015
• 期刊: Anesthesiology
• 影响因子: 8.8
• 作者: Saager,Leif;Duncan,AndraE;Yared,Jean-Pierre;Hesler,BrianD;You,Jing;Deogaonkar,Anupa;Sessler,DanielI;Kurz,Andrea
• 通讯作者: Kurz,Andrea

Perioperative assessment of myocardial deformation.

• DOI: 10.1213/ane.0000000000000088
• 发表时间: 2014-03
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Duncan AE;Alfirevic A;Sessler DI;Popovic ZB;Thomas JD
• 通讯作者: Thomas JD

Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory Analysis.

• DOI: 10.1177/10892532221114791
• 发表时间: 2022-09
• 期刊: SEMINARS IN CARDIOTHORACIC AND VASCULAR ANESTHESIA
• 影响因子: 1.4
• 作者: Zhang, Kan;Kumar, Nikhil;Alfirevic, Andrej;Sale, Shiva;You, Jing;Bauer, Andrew;Duncan, Andra E.
• 通讯作者: Duncan, Andra E.