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Does diltiazem inhibit the inflammatory response in cardiopulmonary bypass?
Iyad Fansa1, Mehmet Gol, Vedat Nisanoglu
1T rkiye Y ksek Ihtisas Hospital, Cardiovascular Surgery Clinic, Sihhiye, Ankara, Turkey.
Insights
Diltiazem demonstrated anti-inflammatory effects by inhibiting Interleukin-6 (IL-6) release during cardiopulmonary bypass (CPB). This finding suggests diltiazem can mitigate systemic inflammation post-CPB surgery.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Pharmacology
Background:
- Systemic inflammation is a significant concern following cardiopulmonary bypass (CPB).
- Calcium channel blockers, like diltiazem, are being investigated for their potential anti-inflammatory properties in surgical contexts.
Purpose of the Study:
- To evaluate the anti-inflammatory effect of diltiazem during CPB.
- To assess diltiazem's inhibitory action on the systemic inflammatory response post-CPB.
Main Methods:
- A controlled prospective study involving 30 coronary artery bypass graft candidates.
- Diltiazem infusion (1 µg/kg/min) during CPB in the study group versus saline in the control group.
- Measurement of Interleukin-6 (IL-6) and Interleukin-10 (IL-10) systemic arterial blood levels at five time points.
Main Results:
- Significantly higher IL-6 levels were observed in the control group compared to the diltiazem group post-CPB (p=0.015) and 3 hours later (p=0.002).
- IL-10 levels were higher in the control group, but this difference was not statistically significant.
- Diltiazem effectively reduced the pro-inflammatory marker IL-6.
Conclusions:
- Diltiazem exhibits a notable anti-inflammatory effect by inhibiting IL-6 release during CPB.
- Inhibiting inflammation during CPB and post-ischemia-reperfusion is clinically crucial for patient outcomes and myocardial function.
Background:
The objective of our study was to investigate the anti-inflammatory effect and inhibiting action of diltiazem, a calcium channel blocking agent, on the systemic inflammatory response seen after cardiopulmonary bypass (CPB) in humans, in a controlled prospective study.
Material/Methods:
Two groups of 15 candidates for coronary artery bypass graft were enrolled in the study. In the study group, 1 g/kg/min of diltiazem was infused during cardiopulmonary bypass, while the control group received saline. Interleukin-6 and 10 (IL-6, IL-10) levels were measured from systemic arterial blood at five time points.
Results:
The levels of IL-6, a marker of the severity of systemic inflammation, were significantly higher in the control group at the end of CPB and 3 hours later. At the end of CPB, the mean IL-6 level in the control group was significantly higher than in the diltiazem group (p=0.015), and at 3 hours after CPB the difference was even greater (p=0.002). The levels of IL-10, an anti-inflammatory cytokine that limits the effects of pro-inflammatory cytokines, were higher in the control group, but not statistically significant at any time point.
Conclusions:
Diltiazem inhibits the release of the pro-inflammatory cytokine IL-6, which is strong evidence for its anti-inflammatory effect. It is clinically important to inhibit the inflammation that takes place during CPB and the inflammation of myocardium encountered after ischemia-reperfusion, since these effect the clinical status of the patient after CPB, as well as myocardial functions.
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