Research Article
Combined effects of the implementation of magnesium and ascorbic acid on myocardial ischemia-reperfusion in open heart surgery
Abstract
Aim: This study aimed to investigate the combined effects of magnesium (Mg) and high dose ascorbic acid on cardiac ischemia-reperfusion (IR) injury.
Material and Method: This study was performed on 45 patients that were scheduled for coronary artery bypass graft (CABG) operations. The patients were divided into three equal groups. Group C received 50 mg/kg ascorbic acid; Group CM received the same dose of ascorbic acid plus 30 mg/kg Mg; Group K received neither ascorbic acid nor Mg. At various times during the operation, the blood levels of malondialdehyde (MDA), serum creatine kinase MB (CK-MB), and lactate dehydrogenase (LDH) levels were analyzed.
Results: There were statistically significant decreases in arrhythmia requiring intervention in Group CM compared to Group K (P=0.026). MDA levels increased in all groups but MDA 2 and MDA 3 levels were found to be statistically significantly lower in Group C and Group CM than in Group K (P=0.009, P=0.012, P=0.009 and P=0.006 respectively). However, inhibition of lipid peroxidation in both Group C and Group CM was not parallel to cardiac enzymes and hemodynamic measurements. There was no significant statistical difference in the cardiac enzyme levels between Group K, Group C, and Group CM (p>0.05).
Conclusion: To reduce the IR, Mg with a high dose of ascorbic acid may be efficacious in patients undergoing cardiac surgery. A larger population group is needed to prove the results of this study.
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References
- Trachiotis GD, Weintraub WS, Johnston TS, et al. Coranary artery bypass grafting in patients with advanced left ventriculer dysfunction. Ann Thorac Surg 1998; 66: 1632-9.
- Allman KC, Shaw LJ, Hachamovitch R, Udelson RJ. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary arter disease and left ventrikular dysfonction: A meta analysis. J Am Coll Card 2002; 39: 1151-8.
- Ozcan V, Beşogul Y, Tunerir B, et al. The effect of glutamate and aspartate on myocardial protection at cardiopulmonary bypass. Anadolu Kardiyol Derg 2004; 4: 114-9.
- Piper MH, Meuter K, Schafer C. Cellular mechanism of ischemia-reperfusion injury. Ann Thorac Surg 2003; 75: 644-8.
- Moertel CG, Fleming TR, Creagan ET, Rubin J, O’Connell MJ, Ames MM. High dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. N Engl J Med 1985; 312: 137-41.
- Moukarbel GV, Ayoub MC, Abchee AB. Pharmacological therapy for myocardial reperfusion injury. Curr Opin Pharmacol 2004; 4: 47-53.
- Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocardial antioxidants in ischemia-reperfusion injury. Cardivasc Res 2000; 47: 446-56.
- Meerson FZ, Belkina LM, Sazontova TG, Saltykova VA, Arkhipenko Y. The role of lipid peroxidation in pathogenesis of arrhythmias and prevention of cardiac fibrillation with antioxidants. Basic Res Cardiol 1987; 82: 123-37.
- Inserte J, Garcia-Dorado D, Agullo L, Paniagua A, Soler-Soler J. Urodilatin limits acute reperfusion injury in the isolated rat heart. Cardiovasc Res 2000; 45: 351-9.
- Mak IT, Komarov AM, Wagner TL, Stafford RE, Dickens BF, Weglicki WB. Enhanced nitric oxide production during magnezyum defeciency and its role in madiating red cell glutation loss. Am J Physiol 1996; 271: 385-90.
- Esterbauer H, Cheeseman KH. Determination of aldehydic lipid peroxidation products: malonaldehyde and 4-hidroxynonenal. Methods Enzymol 1990; 186: 407-21.
- Josephson RA, Silverman HS, Lakatta EG, Stern MD, Zweier JL. Study of the mechanisms of hydrogen peroxide and hydroxyl free radical–induced cellular injury and calcium overload in cardiac myocytes. J Biol Chem 1991; 266: 2354-61.
- Britton J, Pavord I, Richards K, Wisniewski A, Knox A, Lewis S. Diatery magnesium lung function, wheesing and airway hiperactivity in a random adulth population sample. Lancet 1994; 334: 356-62.
- Becker LB. New concepts in reactive oxygen species and cardiovascular reperfusion physiology. Cardiovasc Res 2004; 61: 461-70.
- Gao WD, Liu Y, Mellgren R, Marban E. Intrinsic myofilament alterations underlying the decreased contractility of stunned myocardium: a consequence of Ca2-dependent proteolysis? Circ Res 1996; 78: 455-65.
- Wallerta M, Zieglera M, Wanga X, et al. α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biology 2019; 26: 101292-303.
- Braunwald E, Kloner RA. Myocardial reperfusion: a double-edged sword? J Clin invest 1985; 76: 1713-9.
- Bulkley BH, Hutchins GM. Myocardial consequences of coronary artery bypass graft surgery: the paradox of necrosis in areas of revascularization. Circulation 1977; 56: 906-13.
- Hsu CC, Wang JJ. L-ascorbic acid and alpha-tocopherol attenuates liver ischemia-reperfusion induced of cardiac function impairment. Transplantation Proceedings 2012; 44: 933-6.
- Dingchao H, Zhiduan Q, Liye H, Xiaodong F. The protective effects of high dose askorbic acid on myocardium against reperfusion injury during and after cardiopulmonary bypass. Torac Cardiovasc Surgeon 1994; 42: 276-8.
- Chung MK. Cardiac surgery: postoperative arrhythmias. Crit Care Med 2000; 28: 136-44.
- Hearse DJ, Tosaki A. Free radicals and calcium: Simultaneous interacting triggers as determinants of vulnerability to reperfusion induced arrhythias in the rat heart. J Mol Cell Cardiol 1988; 20: 213-23.
- Seitelberger R, Hannes W, Gleichauf M, Keilich M, Christoph M, Fasol R. Effects of diltiazem on perioperative ischemia, arrhythmias and myocardial function in patients undergoing elective coronary bypass grafting. J Thorac Cardiovasc Surg 1994; 107: 811-21.
- Baker WL, Coleman CI. Meta-analysis of ascorbic acid for prevention of postoperative atrial fibrillation after cardiac surgery. Am J Health-System Pharm 2016; 73: 2056-66.
- Hearse DJ, Tosaki A. Reperfusion-induced arrhythmias and free radicals: studies in the rat heart with DMPO. J Cardiovasc Pharmacol 1987; 9: 641-50.
- Bolli R, Marban E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev 1999; 79: 609-34.
- Gao WD, Liu Y, Mellgren R, Marban E. Intrinsic myofilament alterations underlying the decreased contractility of stunned myocardium: a consequence of Ca2-dependentproteolysis? CircRes. 1996; 78: 455-65.
- Woods KL, Barnett DB. Magnesium in acute myokardial infarction. BMJ. 1995; 310: 1669-70.
- Beşogul Y, Tunerir B, Ozdemir C, Aslan R. Magnesium-flush infusion into the aortic root just before reperfusion reduces the requirement for internal defibrillation and early post-perfusion arrhythmias. J Int Med Res 2003; 31: 202-9.
- Baradari1 AG, Zeydi AE, Ghafari R, Aarabi M, Jafari M. A double-blind randomized clinical trial comparing different doses of magnesium in cardioplegic solution for prevention of atrial fibrillation after coronary artery bypass graft surgery. Cardiovascular Therapeutics 2016; 34: 276-82.
- Kobara M, Tatsumi T, Kambayashi D, et al. Effects of ACE inhibition on myocardial apoptosis in an ischemia–reperfusion rat heart model. J Cardiovasc Pharmacol 2003; 41: 880-9.
- Beyesdorf F, Allen BS. Myocardial protection with integrated blood cardioplegia. In: Franco KL, Verrior ED, eds. Advanced therapy in cardiac surgery, 2nd ed. Hamilton London: B C Decker inc; 1999: 16: 201-13.
- Horn B. Magnesium and the cardiovascular system. Magnesium 1987; 6: 109-11.
- Armstrong SC. Protein kinase activation and myocardial ischemia/reperfusion injury. Cardiovasc Res 2004; 61: 427-36.
- Schafer C, Ladilov Y, Inserte J, et al. Role of the reverse mode of the Na+/Ca2+ exchanger in reoxygenationinduced cardiomyocyte injury. Cardiovasc Res 2001; 51: 241-50.
- Inserte J, Garcia-Dorado D, Ruiz-Meana M, et al. Effect of inhibition of Na+/Ca2+ exchanger at the time of myocardial reperfusion on hypercontracture and cell death. Cardiovasc Res 2002; 55: 739–48.
- Kroner A, Seitelberger R, Schirnhofer J, et al. Diltiazem during reperfusion preserves high energy phosphates by protection of mitochondrial integrity. Eur J Cardiothorac Surg 2002; 21: 224-31.
- Ballmer PE, Reinhart WH, Jordan P, Bühler E, Moser UK, Gey KF. Depletion of plazma vitamin C but not vitamin E in response to cardiac operations. J Thorac Cardiovasc Surg 1994; 108: 311-20.
- Dingchao H, Zhiduan Q, Liye H, Xiaodong F. The protective effects of high dose askorbic acid on myocardium against reperfusion injury during and after cardiopulmonary bypass. Torac Cardiovasc Surgeon 1994; 42: 276-8.
- Demirag K, Askar FZ, Uyar M, et al. The protective effects of high dose ascorbic acid and diltiazem on myocardial ischaemia-reperfusion injury. Middle East J Anaesthesiol 2001; 16: 67-79.
Year 2021,
Volume: 3 Issue: 4, 319 - 326, 24.09.2021
Abstract
Project Number
No
References
- Trachiotis GD, Weintraub WS, Johnston TS, et al. Coranary artery bypass grafting in patients with advanced left ventriculer dysfunction. Ann Thorac Surg 1998; 66: 1632-9.
- Allman KC, Shaw LJ, Hachamovitch R, Udelson RJ. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary arter disease and left ventrikular dysfonction: A meta analysis. J Am Coll Card 2002; 39: 1151-8.
- Ozcan V, Beşogul Y, Tunerir B, et al. The effect of glutamate and aspartate on myocardial protection at cardiopulmonary bypass. Anadolu Kardiyol Derg 2004; 4: 114-9.
- Piper MH, Meuter K, Schafer C. Cellular mechanism of ischemia-reperfusion injury. Ann Thorac Surg 2003; 75: 644-8.
- Moertel CG, Fleming TR, Creagan ET, Rubin J, O’Connell MJ, Ames MM. High dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. N Engl J Med 1985; 312: 137-41.
- Moukarbel GV, Ayoub MC, Abchee AB. Pharmacological therapy for myocardial reperfusion injury. Curr Opin Pharmacol 2004; 4: 47-53.
- Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocardial antioxidants in ischemia-reperfusion injury. Cardivasc Res 2000; 47: 446-56.
- Meerson FZ, Belkina LM, Sazontova TG, Saltykova VA, Arkhipenko Y. The role of lipid peroxidation in pathogenesis of arrhythmias and prevention of cardiac fibrillation with antioxidants. Basic Res Cardiol 1987; 82: 123-37.
- Inserte J, Garcia-Dorado D, Agullo L, Paniagua A, Soler-Soler J. Urodilatin limits acute reperfusion injury in the isolated rat heart. Cardiovasc Res 2000; 45: 351-9.
- Mak IT, Komarov AM, Wagner TL, Stafford RE, Dickens BF, Weglicki WB. Enhanced nitric oxide production during magnezyum defeciency and its role in madiating red cell glutation loss. Am J Physiol 1996; 271: 385-90.
- Esterbauer H, Cheeseman KH. Determination of aldehydic lipid peroxidation products: malonaldehyde and 4-hidroxynonenal. Methods Enzymol 1990; 186: 407-21.
- Josephson RA, Silverman HS, Lakatta EG, Stern MD, Zweier JL. Study of the mechanisms of hydrogen peroxide and hydroxyl free radical–induced cellular injury and calcium overload in cardiac myocytes. J Biol Chem 1991; 266: 2354-61.
- Britton J, Pavord I, Richards K, Wisniewski A, Knox A, Lewis S. Diatery magnesium lung function, wheesing and airway hiperactivity in a random adulth population sample. Lancet 1994; 334: 356-62.
- Becker LB. New concepts in reactive oxygen species and cardiovascular reperfusion physiology. Cardiovasc Res 2004; 61: 461-70.
- Gao WD, Liu Y, Mellgren R, Marban E. Intrinsic myofilament alterations underlying the decreased contractility of stunned myocardium: a consequence of Ca2-dependent proteolysis? Circ Res 1996; 78: 455-65.
- Wallerta M, Zieglera M, Wanga X, et al. α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biology 2019; 26: 101292-303.
- Braunwald E, Kloner RA. Myocardial reperfusion: a double-edged sword? J Clin invest 1985; 76: 1713-9.
- Bulkley BH, Hutchins GM. Myocardial consequences of coronary artery bypass graft surgery: the paradox of necrosis in areas of revascularization. Circulation 1977; 56: 906-13.
- Hsu CC, Wang JJ. L-ascorbic acid and alpha-tocopherol attenuates liver ischemia-reperfusion induced of cardiac function impairment. Transplantation Proceedings 2012; 44: 933-6.
- Dingchao H, Zhiduan Q, Liye H, Xiaodong F. The protective effects of high dose askorbic acid on myocardium against reperfusion injury during and after cardiopulmonary bypass. Torac Cardiovasc Surgeon 1994; 42: 276-8.
- Chung MK. Cardiac surgery: postoperative arrhythmias. Crit Care Med 2000; 28: 136-44.
- Hearse DJ, Tosaki A. Free radicals and calcium: Simultaneous interacting triggers as determinants of vulnerability to reperfusion induced arrhythias in the rat heart. J Mol Cell Cardiol 1988; 20: 213-23.
- Seitelberger R, Hannes W, Gleichauf M, Keilich M, Christoph M, Fasol R. Effects of diltiazem on perioperative ischemia, arrhythmias and myocardial function in patients undergoing elective coronary bypass grafting. J Thorac Cardiovasc Surg 1994; 107: 811-21.
- Baker WL, Coleman CI. Meta-analysis of ascorbic acid for prevention of postoperative atrial fibrillation after cardiac surgery. Am J Health-System Pharm 2016; 73: 2056-66.
- Hearse DJ, Tosaki A. Reperfusion-induced arrhythmias and free radicals: studies in the rat heart with DMPO. J Cardiovasc Pharmacol 1987; 9: 641-50.
- Bolli R, Marban E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev 1999; 79: 609-34.
- Gao WD, Liu Y, Mellgren R, Marban E. Intrinsic myofilament alterations underlying the decreased contractility of stunned myocardium: a consequence of Ca2-dependentproteolysis? CircRes. 1996; 78: 455-65.
- Woods KL, Barnett DB. Magnesium in acute myokardial infarction. BMJ. 1995; 310: 1669-70.
- Beşogul Y, Tunerir B, Ozdemir C, Aslan R. Magnesium-flush infusion into the aortic root just before reperfusion reduces the requirement for internal defibrillation and early post-perfusion arrhythmias. J Int Med Res 2003; 31: 202-9.
- Baradari1 AG, Zeydi AE, Ghafari R, Aarabi M, Jafari M. A double-blind randomized clinical trial comparing different doses of magnesium in cardioplegic solution for prevention of atrial fibrillation after coronary artery bypass graft surgery. Cardiovascular Therapeutics 2016; 34: 276-82.
- Kobara M, Tatsumi T, Kambayashi D, et al. Effects of ACE inhibition on myocardial apoptosis in an ischemia–reperfusion rat heart model. J Cardiovasc Pharmacol 2003; 41: 880-9.
- Beyesdorf F, Allen BS. Myocardial protection with integrated blood cardioplegia. In: Franco KL, Verrior ED, eds. Advanced therapy in cardiac surgery, 2nd ed. Hamilton London: B C Decker inc; 1999: 16: 201-13.
- Horn B. Magnesium and the cardiovascular system. Magnesium 1987; 6: 109-11.
- Armstrong SC. Protein kinase activation and myocardial ischemia/reperfusion injury. Cardiovasc Res 2004; 61: 427-36.
- Schafer C, Ladilov Y, Inserte J, et al. Role of the reverse mode of the Na+/Ca2+ exchanger in reoxygenationinduced cardiomyocyte injury. Cardiovasc Res 2001; 51: 241-50.
- Inserte J, Garcia-Dorado D, Ruiz-Meana M, et al. Effect of inhibition of Na+/Ca2+ exchanger at the time of myocardial reperfusion on hypercontracture and cell death. Cardiovasc Res 2002; 55: 739–48.
- Kroner A, Seitelberger R, Schirnhofer J, et al. Diltiazem during reperfusion preserves high energy phosphates by protection of mitochondrial integrity. Eur J Cardiothorac Surg 2002; 21: 224-31.
- Ballmer PE, Reinhart WH, Jordan P, Bühler E, Moser UK, Gey KF. Depletion of plazma vitamin C but not vitamin E in response to cardiac operations. J Thorac Cardiovasc Surg 1994; 108: 311-20.
- Dingchao H, Zhiduan Q, Liye H, Xiaodong F. The protective effects of high dose askorbic acid on myocardium against reperfusion injury during and after cardiopulmonary bypass. Torac Cardiovasc Surgeon 1994; 42: 276-8.
- Demirag K, Askar FZ, Uyar M, et al. The protective effects of high dose ascorbic acid and diltiazem on myocardial ischaemia-reperfusion injury. Middle East J Anaesthesiol 2001; 16: 67-79.
There are 40 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Project Number | No |
| Publication Date | September 24, 2021 |
| Published in Issue | Year 2021 Volume: 3 Issue: 4 |
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