The role of sodium-hydrogen ion exchange in patients undergoing coronary artery bypass grafting.
Sodium-hydrogen ion exchange (NHE) is one of the principal mechanisms of restoring intracellular pH following ischemia and reperfusion. However, up-regulation of the NHE process results in a compensatory increase in the activity of the sodium-calcium exchanger. Intracellular hypercalcemia, resulting from the exchange of sodium for calcium, precipitates myocardial stunning and cell death. It has been postulated that NHE inhibition can protect the ischemic/reperfused myocardium, and preclinical studies have uniformly supported this concept. The Guard During Ischemia Against Necrosis (GUARDIAN) trial suggested benefits of NHE inhibition in subjects undergoing coronary artery bypass grafting (CABG). The sodium-hydrogen eXchange inhibition to Prevent coronary Events in acute cardiac conDITIONs (EXPEDITION) trial will further explore the use of cariporide in a randomized, controlled trial of CABG subjects at risk of myocardial necrosis.
Bolli
Roberto
R
Division of Cardiology, University of Louisville, Louisville, Kentucky 40292, USA. rbolli@louisville.edu
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006146:Guanidines / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control*; D017682:Myocardial Stunning / Q000209:etiology / Q000503:physiopathology; D017923:Sodium-Hydrogen Exchangers / Q000037:antagonists & inhibitors* / Q000378:metabolism*; D013450:Sulfones / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D006146:Guanidines; D017923:Sodium-Hydrogen Exchangers; D013450:Sulfones; C093373:cariporide