The purpose of this study is to determine whether oral sodium nitrate administration prior to coronary artery bypass surgery can reduce perioperative levels of troponin T. In addition, plasma and urine surrogate markers of renal, hepatic and brain injury will be monitored.
Nitric oxide (NO) is an important mediator in the cardiovascular system and has been shown to have protective properties in ischemia-reperfusion injury. Inorganic nitrate, an oxidation product from endogenous NO production and also a constituent in green leafy vegetables, can be recycled, via nitrite, back to bioactive NO in the body. Recent research has shown beneficial effects of nitrate and nitrite in animal models of myocardial ischemia-reperfusion injury. Moreover, dietary nitrate reduces blood pressure and oxygen cost during exercise in humans. During coronary bypass surgery the heart undergoes ischemia-reperfusion injury and troponin T is most often released from the myocardium. The aim of the present study is to investigate if preoperative inorganic nitrate, in doses easily achievable from the diet, can affect troponin T release as well as other surrogate markers of injury to the liver, kidneys and the brain. In addition, plasma and urine samples will be collected for markers of oxidative stress and inflammation (sCRP and cytokines). Patients planned for bypass surgery who give their written informed consent will, the night before surgery, get a standardized, low-nitrate meal where after they receive sodium nitrate on two occasions preoperatively; the night before and in the morning before surgery. Plasma and urine samples will be collected at various time points up to 72 hours after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
QUADRUPLE
Enrollment
100
Preoperative oral administration of sodium nitrate. 700 mg the night before surgery and 700 mg three hours before surgery
Preoperative oral administration of sodium chloride the night before surgery and three hours before surgery
Karolinska University Hospital
Stockholm, Sweden
Troponin T release over the perioperative 72-hour period.
Time frame: 72 hours
Troponin T release over the perioperative 24-hour period.
Time frame: 24 h
Creatinine kinase myocardial fraction (CKMB) release over the perioperative 72-hour period
Time frame: 72 hours
Creatinine kinase myocardial fraction (CKMB) release over the perioperative 24-hour period
Time frame: 24 hours
Pro Brain natriuretic peptide (proBNP) release over the perioperative 72-hour period.
Time frame: 72 hours
Aspartate aminotransferase (AST) release over the perioperative 72-hour period.
Time frame: 72 hours
Alaninaminotransferas (ALAT) release over the perioperative 72-hour period.
Time frame: 72 hours
Alkaline phosphatase (ALP) release over the perioperative 72-hour period.
Time frame: 72 hours
Bilirubin release over the perioperative 72-hour period
Time frame: 72 hours
Creatinine release over the perioperative 72-hour period
Time frame: 72 h
Cystatin C release over the perioperative 72-hour period
Time frame: 72
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