title: The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC-GTN Study.
abstract: Remote ischemic conditioning (RIC) using transient limb ischemia/reperfusion has been reported to reduce perioperative myocardial injury in patients undergoing coronary artery bypass grafting and/or valve surgery. The role of intravenous glyceryl trinitrate (GTN) therapy administered during cardiac surgery as a cardioprotective agent and whether it interferes with RIC cardioprotection is not clear and is investigated in the ERIC-GTN trial ( http://www.clinicaltrials.gov: NCT01864252). The ERIC-GTN trial is a single-site, double-blind, randomized, placebo-controlled study. Consenting adult patients (age > 18 years) undergoing elective coronary artery bypass grafting ± valve surgery with blood cardioplegia will be eligible for inclusion. Two hundred sixty patients will be randomized to 1 of 4 treatment groups following anesthetic induction: (1) RIC alone, a RIC protocol comprising three 5-minute cycles of simultaneous upper-arm and thigh cuff inflation/deflation followed by an intravenous (IV) placebo infusion; (2) GTN alone, a simulated sham RIC protocol followed by an IV GTN infusion; (3) RIC + GTN, a RIC protocol followed by an IV GTN infusion; and (4) neither RIC nor GTN, a sham RIC protocol followed by IV placebo infusion. The primary endpoint will be perioperative myocardial injury as quantified by the 72-hour area-under-the-curve serum high-sensitivity troponin T. The ERIC-GTN trial will determine whether intraoperative GTN therapy is cardioprotective during cardiac surgery and whether it affects RIC cardioprotection.
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamarneh
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.
authors.forename: Vivek
authors.initials: V
authors.lastname: Sivaraman
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: The Heart Hospital, London, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Shanahan
authors.affiliation: The Heart Hospital, London, United Kingdom.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Kyle
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.
authors.forename: Manish
authors.initials: M
authors.lastname: Ramlall
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.
authors.forename: Robin
authors.initials: R
authors.lastname: Chung
authors.affiliation: The Heart Hospital, London, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Jarvis
authors.affiliation: The Heart Hospital, London, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Xenou
authors.affiliation: Nuffield Trust, London, United Kingdom.
authors.forename: Cono
authors.initials: C
authors.lastname: Ariti
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Cordery
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.|The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, United Kingdom.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.affiliation: The Hatter Cardiovascular Institute University College London, London, United Kingdom.|The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, United Kingdom.|National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.|Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D019194:Ischemic Preconditioning / Q000009:adverse effects / Q000379:methods*; D008131:London; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000009:adverse effects; D012039:Regional Blood Flow; D012107:Research Design; D013848:Thigh / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D034941:Upper Extremity / Q000098:blood supply*; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D020107:Troponin T; D014665:Vasodilator Agents; D005996:Nitroglycerin