Glutamate Infusion Reduces Myocardial Dysfunction after Coronary Artery Bypass Grafting According to NT-proBNP: Summary of 2 Randomized Controlled Trials (GLUTAmate for Metabolic Intervention in Coronary Surgery [GLUTAMICS I-II])

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Fältnamn	Indikatorer	Metadata
000		04729naa a2200325 4500
001		oai:DiVA.org:liu-199563
003		SwePub
008		231211s2023 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-1995632 URI
024	7	a https://doi.org/10.1016/j.ajcnut.2023.08.0122 DOI
040		a (SwePub)liu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Holm, Jonasu Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Thorax-kärlkliniken i Östergötland4 aut0 (Swepub:liu)jonho41
245	1 0	a Glutamate Infusion Reduces Myocardial Dysfunction after Coronary Artery Bypass Grafting According to NT-proBNP: Summary of 2 Randomized Controlled Trials (GLUTAmate for Metabolic Intervention in Coronary Surgery [GLUTAMICS I-II])
264	1	b ELSEVIER SCIENCE INC,c 2023
338		a print2 rdacarrier
500		a Funding Agencies\|Swedish Heart Lung Foundation [20030595, 20140633]; Region Ostergotland [RO 796412, RO 693091, RO 610951]
520		a Background: Glutamate is reported to enhance the recovery of oxidative metabolism and contractile function of the heart after ischemia. The effect appears to be blunted in diabetic hearts. Elevated plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction. In the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS) II trial, the proportion of patients with diabetes had nearly doubled to 47% compared with the cohort used for sample size estimation, and a significant effect on the postoperative rise in NT-proBNP was only observed in patients without diabetes. Objective: We aimed to summarize the pooled NT-proBNP results from both GLUTAMICS trials and address the impact of diabetes. Methods: Data from 2 prospective, randomized, double-blind multicenter trials with similar inclusion criteria and endpoints were pooled. Patients underwent a coronary artery bypass grafting (CABG) +/- valve procedure and had a left-ventricular ejection fraction of <= 0.30 or a European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) of >= 3.0 with at least 1 cardiac risk factor. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was started 10-20 min before reperfusion and continued for 150 min. The primary endpoint was the difference between pre-operative and day 3 postoperative NT-proBNP levels. Results: A total of 451 patients, 224 receiving glutamate and 227 controls, fulfilled the inclusion criteria. Glutamate was associated with a reduced primary endpoint (5344 +/- 5104 ng/L and 6662 +/- 5606 ng/L in glutamate and control groups, respectively; P = 0.01). Postoperative mortality at <= 30 d was 0.9% and 3.5% (P = 0.11), whereas stroke at <= 24 h was 0.4% and 2.6% in glutamate and control groups, respectively (P = 0.12). No adverse events related to glutamate were observed. A significant interaction regarding the primary endpoint was only detected between glutamate and insulin -treated diabetes groups (P = 0.04). Among patients without insulin-treated diabetes, the primary endpoint was 5047 +/- 4705 ng/L and 7001 +/- 5830 ng/L in the glutamate and control groups, respectively (P = 0.001). Conclusions: Infusion of glutamate reduced the postoperative rise in NT-proBNP after CABG in medium-to high-risk patients. A significantly blunted effect was observed only in insulin-treated patients with diabetes. Clinical trial details: This trial was registered at www.clinicaltrials.gov as NCT02592824.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
653		a glutamate; heart failure; cardiac surgery; coronary artery disease; postoperative complications
700	1	a Vanky, Farkasu Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Thorax-kärlkliniken i Östergötland4 aut0 (Swepub:liu)farva32
700	1	a Svedjeholm, Rolfu Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Thorax-kärlkliniken i Östergötland4 aut0 (Swepub:liu)rolsv84
710	2	a Linköpings universitetb Avdelningen för diagnostik och specialistmedicin4 org
773	0	t American Journal of Clinical Nutritiond : ELSEVIER SCIENCE INCg 118:5, s. 930-937q 118:5<930-937x 0002-9165x 1938-3207
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-199563
856	4 8	u https://doi.org/10.1016/j.ajcnut.2023.08.012

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Av författaren/redakt...: Holm, Jonas; Vanky, Farkas; Svedjeholm, Rolf

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