Skip to main content

Advertisement

SpringerLink
Log in

The acute cardioprotective effect of glucocorticoid in myocardial ischemia–reperfusion injury occurring during cardiopulmonary bypass

  • ORIGINAL ARTICLE
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate the acute cardioprotective effect of high-dose methylprednisolone (25 mg/kg) in the controlled in vivo model of myocardial ischemia–reperfusion injury occurring during cardiopulmonary bypass. Forty nondiabetic male patients with three-vessel disease undergoing first-time bypass surgery were enrolled for this double-blind prospective study. Patients were randomized to be given 25 mg/kg methylprednisolone (Group I) and saline (Group II) 1 h before cardiopulmonary bypass. The levels of cardiac troponin-I (cTnI) were used as a marker of myocardial tissue damage in myocardial ischemia–reperfusion injury. The cTnI levels were measured before surgery, at the second hour after cardiopulmonary bypass, at the 6th and 24th hours, and 5th day postoperatively. There was no significant difference between the two groups in respect to the duration of ischemia and reperfusion. The preoperative cTnI levels were 0.22 ± 0.29 ng/ml in Group I and 0.23 ± 0.28 ng/ml in Group II. cTnI levels increased to 2.40 ± 1.0 ng/ml in Group I and 3.19 ± 0.88 ng/ml in Group II at the 2nd hour after cardiopulmonary bypass. When the differences between T1 and T0 level that showed the amount of troponin release occurring due to ischemia–repefusion injury was calculated and then compared, there was a significant difference between Groups I and II (P = 0.024). The cTnI levels measured at 6 h after CPB were 1.98 ± 0.63 ng/ml in Group I and 2.75 ± 1.15 ng/ml in Group II (P = 0.049). cTnI levels decreased to 0.22 ± 0.10 ng/ml in Group I and 0.49 ± 0.25 ng/ml in Group II on the postoperative day 5 (P = 0.0001). Univalent regression analysis showed that preoperative high-dose corticosteroid usage decreased the troponin release in about 12% and this effect was statistically significant (R 2 = 0.12, P < 0.05). A single dose of intravenous methylpredisolone (25 mg/kg) given 1 h before ischemia reduced myocardial ischemia–reperfusion injury. These results demonstrated that the acute cardioprotective effect of corticosteroids has much potential in the future for reducing ischemia–reperfusion injury occurring during cardiopulmonary bypass when it is inevitable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. P Libby PR Maroko CM Bloor BE Soble E Baraunwald (1973) ArticleTitleReduction of experimental myocardial infarct size by corticosteroid administration J Clin Invest 52 599–607 Occurrence Handle4685084 Occurrence Handle1:CAS:528:DyaE3sXhtVKgtL8%3D

    PubMed  CAS  Google Scholar 

  2. JA Spath DL Lane AM Lefer (1974) ArticleTitleProtective action of methylprednisolone on the myocardium during experimental myocardial ischemia in the cat Circ Res 35 44–51 Occurrence Handle4841252 Occurrence Handle1:CAS:528:DyaE2cXls1els74%3D

    PubMed  CAS  Google Scholar 

  3. DE Sholter PW Armstrong (2000) ArticleTitleAdverse effects of corticosteroids on the cardiovascular system Can J Cardiol 16 505–511 Occurrence Handle10787466 Occurrence Handle1:CAS:528:DC%2BD3cXjslKns70%3D

    PubMed  CAS  Google Scholar 

  4. HA Katus A Remppis S Looser K Hallermeyer T Scheffold W Kubler (1989) ArticleTitleEnzyme linked immunoassay of cardiac troponin T for the detection of acute myocardial infarction in patients J Mol Cell Cardiol 21 1349–1353 Occurrence Handle2632816 Occurrence Handle1:CAS:528:DyaK3cXhtFGhtro%3D Occurrence Handle10.1016/0022-2828(89)90680-9

    Article  PubMed  CAS  Google Scholar 

  5. GS Bodor S Porter S Landt JH Ladenson (1992) ArticleTitleDevelopment of monoclonal antibodies for an assay of cardiac troponin-I and preliminary in suspected cases of myocardial infarction Clin Chem 38 2203–2214 Occurrence Handle1424112 Occurrence Handle1:CAS:528:DyaK3sXjt12q

    PubMed  CAS  Google Scholar 

  6. HA Katus S Loser K Hallermayer et al. (1992) ArticleTitleDevelopment and in vitro characterization of a new immunoassay of cardiac troponin T Clin Chem 38 386–393 Occurrence Handle1547556 Occurrence Handle1:CAS:528:DyaK38XlvVOlur4%3D

    PubMed  CAS  Google Scholar 

  7. J Mair CH Wieser I Seibt et al. (1991) ArticleTitleTroponin T to diagnose myocardial infarction in bypass surgery Lancet 337 334–335

    Google Scholar 

  8. A Hafezi-Moghadam T Simoncini E Yang FP Limbourg JC Plumier MC Rebsamen CM Hsieh DS Chui KL Thomas AJ Prorock VE Laubach MA Moskowitz BA French K Ley JK Liao (2002) ArticleTitleAcute cardiovascular protective effects of corticosteroids are mediated by non-transcriptional activation of endothelial nitric oxide synthase Nat Med 8 IssueID5 473–479 Occurrence Handle11984591 Occurrence Handle1:CAS:528:DC%2BD38Xjt1Kgtbk%3D Occurrence Handle10.1038/nm0502-473

    Article  PubMed  CAS  Google Scholar 

  9. PB Becker B Gloss W Schmid U Strahle G Schultz (1986) ArticleTitleIn vivo protein-DNA interactions in a glucocorticoid response element require the presence of the hormone Nature 324 686–688 Occurrence Handle2879246 Occurrence Handle1:CAS:528:DyaL2sXnvFGmsg%3D%3D Occurrence Handle10.1038/324686a0

    Article  PubMed  CAS  Google Scholar 

  10. J Loscalzo (1995) ArticleTitleNitric oxide and vascular disease N Engl J Med 333 251–253 Occurrence Handle7540723 Occurrence Handle1:STN:280:ByqA3M3gsVU%3D Occurrence Handle10.1056/NEJM199507273330410

    Article  PubMed  CAS  Google Scholar 

  11. R De Caterina et al. (1995) ArticleTitleNitric oxide decreases cytokine-induced endothelial activation. Nitric oxide selectively reduces endothelial expression of adhesion molecules and prointflammatory cytokines J Clin Invest 96 60–68 Occurrence Handle7542286 Occurrence Handle1:CAS:528:DyaK2MXmslyrurs%3D Occurrence Handle10.1172/JCI118074

    Article  PubMed  CAS  Google Scholar 

  12. C Thiemermann (2002) ArticleTitleCorticosteroids and cardioprotection Nat Med 8 IssueID5 453–455 Occurrence Handle11984585 Occurrence Handle1:CAS:528:DC%2BD38Xjt1Kgtb8%3D Occurrence Handle10.1038/nm0502-453

    Article  PubMed  CAS  Google Scholar 

  13. M La A Tailor M D’Amico RJ Flower M Perretti (2001) ArticleTitleAnalysis of the protection afforded by annexin 1 in ischaemia-reperfusion injury: focus on neutrophil recruitment Eur J Pharmacol 429 IssueID1–3 263–278 Occurrence Handle11698046 Occurrence Handle1:CAS:528:DC%2BD3MXotFWit7g%3D Occurrence Handle10.1016/S0014-2999(01)01325-5

    Article  PubMed  CAS  Google Scholar 

  14. M La M D’Amico S Bandiera C Di Filippo SM Oliani FN Gavins RJ Flower M Perretti (2001) ArticleTitleAnnexin 1 peptides protect against experimental myocardial ischemia-reperfusion: analysis of their mechanism of action FASEB J 15 IssueID12 2247–2256 Occurrence Handle11641252 Occurrence Handle1:CAS:528:DC%2BD3MXnsV2mtrY%3D Occurrence Handle10.1096/fj.01-0196com

    Article  PubMed  CAS  Google Scholar 

  15. A Anselmi A Abbate F Girola G Nasso GG Biondi-Zoccai G Possati M Gaudino (2004) ArticleTitleMyocardial ischemia, stunning, inflammation, and apoptosis during cardiac surgery: a review of evidence Eur J Cardiothorac Surg 25 304–311 Occurrence Handle15019653 Occurrence Handle10.1016/j.ejcts.2003.12.003

    Article  PubMed  Google Scholar 

  16. R Bolli E Marbán (1999) ArticleTitleMolecular and cellular mechanisms of myocardial stunning Physiol Rev 79 609–634 Occurrence Handle10221990 Occurrence Handle1:CAS:528:DyaK1MXivFektbo%3D

    PubMed  CAS  Google Scholar 

  17. E Kilger F Weis J Briegel L Frey AE Goetz D Reuter A Nagy A Schuetz P Lamm A Knoll P Klaus (2003) ArticleTitleStress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery Crit Care Med 31 1068–1074 Occurrence Handle12682474 Occurrence Handle1:CAS:528:DC%2BD3sXis12qtrg%3D Occurrence Handle10.1097/01.CCM.0000059646.89546.98

    Article  PubMed  CAS  Google Scholar 

  18. S Zahler P Massoudy H Hartl C Hahnel H Meisner BF Becker (1999) ArticleTitleAcute cardiac inflammatory responses to postischemic reperfusion during cardiopulmonary bypass Cardiovasc Res 41 722–730 Occurrence Handle10435044 Occurrence Handle1:CAS:528:DyaK1MXhvVGhtLw%3D Occurrence Handle10.1016/S0008-6363(98)00229-6

    Article  PubMed  CAS  Google Scholar 

  19. S Wan A Yim (1999) ArticleTitleCytokines in myocardial injury: impact on cardiac surgical approach Eur J Cardiothorac Surg 16 IssueID1 S107–111 Occurrence Handle10536961 Occurrence Handle10.1016/S1010-7940(99)00200-6

    Article  PubMed  Google Scholar 

  20. H te Velthius PG Jansen HM Oudemans-van Straaten A Sturk L Eijsman CR Wildevuur (1995) ArticleTitleMyocardial performance in elderly patients after cardiopulmonary bypass is suppressed by tumor necrosis factor J Thorac Cardiovasc Surg 110 1663–1669 Occurrence Handle10.1016/S0022-5223(95)70028-5

    Article  Google Scholar 

  21. BS Cain DR Meldrum CA Dinarello X Meng KS Joo A Banerjee AH Harken (1999) ArticleTitleTumor necrosis factor-alpha and interleukin-1beta synergistically depress human myocardial function Crit Care Med 27 1309–1318 Occurrence Handle10446825 Occurrence Handle1:STN:280:DyaK1MznsVCqsw%3D%3D Occurrence Handle10.1097/00003246-199907000-00018

    Article  PubMed  CAS  Google Scholar 

  22. D Paparella TM Yau E Young (2002) ArticleTitleCardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update Eur J Cardiothorac Surg 21 232–244 Occurrence Handle11825729 Occurrence Handle1:STN:280:DC%2BD38%2Fps1Shug%3D%3D Occurrence Handle10.1016/S1010-7940(01)01099-5

    Article  PubMed  CAS  Google Scholar 

  23. T Kawamura K Inada N Nara R Wakusawa S Endo (1999) ArticleTitleInfluence of methylprednisolone on cytokine balance during cardiac surgery Crit Care Med 27 545–548 Occurrence Handle10199534 Occurrence Handle1:STN:280:DyaK1M3htlKhtA%3D%3D Occurrence Handle10.1097/00003246-199903000-00033

    Article  PubMed  CAS  Google Scholar 

  24. JB Celik N Gormus S Okesli ZI Gormus H Solak (2004) ArticleTitleMethylprednisolone prevents inflammatory reaction occurring during cardiopulmonary bypass: effects on TNF-alpha, IL-6, IL-8, IL-10 Perfusion 19 IssueID3 185–191 Occurrence Handle15298427 Occurrence Handle10.1191/0267659104pf733oa

    Article  PubMed  Google Scholar 

  25. S Wan JL LeClere CH Huynh D Schmartz JM DeSmet AP Jim JL Vincent (1999) ArticleTitleDoes steroid pretreatment increase endotoxin release during clinical cardiopulmonary bypass? J Thorac Cardiovasc Surg 117 1004–1008 Occurrence Handle10220696 Occurrence Handle1:CAS:528:DyaK1MXjtlGku7Y%3D Occurrence Handle10.1016/S0022-5223(99)70382-X

    Article  PubMed  CAS  Google Scholar 

  26. JM Pearl DP Nelson SM Schwartz CJ Wagner SM Bauer EA Setser JY Duffy (2002) ArticleTitleGlucocorticoids reduce ischemia-reperfusion-induced myocardial apoptosis in immature hearts Ann Thorac Surg 74 IssueID3 830–836 Occurrence Handle12238847 Occurrence Handle10.1016/S0003-4975(02)03843-2

    Article  PubMed  Google Scholar 

  27. N Paquot P Schneiter E Jequier L Tappy (1995) ArticleTitleEffects of glucocorticoids and sympathomimetic agents on basal and insulin-stimulated glucose metabolism Clin Physiol 15 231–240 Occurrence Handle7621645 Occurrence Handle1:CAS:528:DyaK2MXmtFGmu7o%3D

    PubMed  CAS  Google Scholar 

  28. T Iwamoto Y Kagawa Y Naito S Kuzuhara M Kojima (2004) ArticleTitleSteroid-induced diabetes mellitus and related risk factors in patients with neurologic diseases Pharmacotherapy 24 508–514 Occurrence Handle15098806 Occurrence Handle10.1592/phco.24.5.508.33355

    Article  PubMed  Google Scholar 

  29. A Bourbon M Vionnet P Leprince E Vaissier J Copeland P McDonagh P Debre I Gandjbakhch (2004) ArticleTitleThe effect of methylprednisolone treatment on the cardiopulmonary bypass-induced systemic inflammatory response Eur J Cardiothorac Surg 26 IssueID5 932–938 Occurrence Handle15519185 Occurrence Handle1:STN:280:DC%2BD2crpsVOltQ%3D%3D Occurrence Handle10.1016/j.ejcts.2004.07.044

    Article  PubMed  CAS  Google Scholar 

  30. I Birdi GD Angelini AJ Bryan (1997) ArticleTitleBiochemical marker of myocardial injury during cardiac operation Ann Thorac Surg 63 879–884 Occurrence Handle9066431 Occurrence Handle1:STN:280:ByiB3MbhtlU%3D Occurrence Handle10.1016/S0003-4975(96)01275-1

    Article  PubMed  CAS  Google Scholar 

  31. PA Checchia CL Backer RA Bronicki HP Baden SE Crawford TP Green C Mavroudis (2003) ArticleTitleDexamethasone reduces postoperative troponin levels in children undergoing cardiopulmonary bypass Crit Care Med 31 IssueID6 1742–1745 Occurrence Handle12794414 Occurrence Handle1:CAS:528:DC%2BD3sXlvVSltbo%3D Occurrence Handle10.1097/01.CCM.0000063443.32874.60

    Article  PubMed  CAS  Google Scholar 

  32. S Hammer M Loeff H Reichenspurner S Daebritz A Tiete R Kozlik-Feldmann B Reichart H Netz (2001) ArticleTitleEffect of cardiopulmonary bypass on myocardial function, damage and inflammation after cardiac surgery in newborns and children Thorac Cardiovasc Surg 49 IssueID6 349–354 Occurrence Handle11745058 Occurrence Handle1:STN:280:DC%2BD3MnpvVyqsg%3D%3D Occurrence Handle10.1055/s-2001-19011

    Article  PubMed  CAS  Google Scholar 

  33. IYP Wan AA Arifi S Wan JHY Yip ADL Sihoe KH Thung EMC Wong APC Yim (2004) ArticleTitleBeating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study J Thorac Cardiovasc Surg 127 1624–1631 Occurrence Handle15173716 Occurrence Handle10.1016/j.jtcvs.2003.10.043

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Yavuz Enc

    Present address: , Baglarbası Mah. Fetih Sok. No:9, 41700, Darıca, Gebze, Turkey

Authors and Affiliations

  1. Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey

    Yavuz Enc, Pelin Karaca, Umut Ayoglu, Gercek Camur, Erol Kurc & Sertac Cicek

Authors
  1. Yavuz Enc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pelin Karaca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Umut Ayoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gercek Camur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erol Kurc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sertac Cicek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yavuz Enc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Enc, Y., Karaca, P., Ayoglu, U. et al. The acute cardioprotective effect of glucocorticoid in myocardial ischemia–reperfusion injury occurring during cardiopulmonary bypass. Heart Vessels 21, 152–156 (2006). https://doi.org/10.1007/s00380-005-0887-8

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-005-0887-8

Key words

Search

Navigation