Related Experiment Video
Updated: Jul 9, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Myocardial protection with phosphocreatine in high-risk cardiac surgery patients: a randomized trial
Vladimir Lomivorotov1,2, Dmitry Merekin2, Evgeny Fominskiy3
1Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Insights
Phosphocreatine (PCr) supplementation did not reduce troponin I levels in patients undergoing cardiac surgery. This pilot study found PCr to be safe but ineffective in improving clinical outcomes following valve repair or replacement surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Cardiac surgery often involves prolonged aortic cross-clamping and cardiopulmonary bypass (CPB), potentially leading to myocardial injury.
- Phosphocreatine (PCr) is an endogenous high-energy phosphate compound that plays a crucial role in cellular energy metabolism.
Purpose of the Study:
- To investigate the efficacy of intravenous and cardioplegia-adjuvanted phosphocreatine (PCr) in reducing post-operative troponin I levels.
- To evaluate the impact of PCr on various clinical outcomes in patients undergoing cardiac valve surgery.
Main Methods:
- A randomized, double-blind, placebo-controlled pilot study involving 120 patients undergoing double/triple valve repair/replacement.
- Patients received either PCr (intravenously and in cardioplegic solution) or normosaline placebo.
- Primary endpoint was peak post-operative troponin I concentration; secondary endpoints included serum creatinine, inotropic support, arrhythmias, and length of stay.
Main Results:
- No significant difference was observed in peak troponin I levels between the PCr group (10,508 pg/ml) and the placebo group (11,328 pg/ml) (p=0.24).
- Secondary outcomes, including peak serum creatinine, need for inotropic support, defibrillations, ICU stay, and hospitalization duration, also showed no significant differences between groups.
- The study demonstrated the safety of PCr administration, with no increase in adverse events or mortality.
Conclusions:
- Phosphocreatine administration is safe for patients undergoing cardiac valve surgery with CPB.
- PCr supplementation did not lead to a reduction in post-operative troponin I levels or improve other clinical outcomes.
- The findings suggest that PCr has no beneficial effect on myocardial protection or recovery in this patient population.
Background:
This study was conducted to test the hypothesis that phosphocreatine (PCr), administered intravenously and as cardioplegia adjuvant in patients undergoing cardiac surgery with prolonged aortic cross clamping and cardiopulmonary bypass (CPB) time, would decrease troponin I concentration after surgery.
Methods:
In this randomized, double-blind, placebo-controlled pilot study we included 120 patients undergoing double/triple valve repair/replacement under cardiopulmonary bypass in the cardiac surgery department of a tertiary hospital. The treatment group received: intravenous administration of 2 g of PCr after anesthesia induction; 2.5 g of PCr in every 1 L of cardioplegic solution (concentration = 10 mmol/L); intravenous administration of 2 g of PCr immediately after heart recovery following aorta declamping; 4 g of PCr at intensive care unit admission. The control group received an equivolume dose of normosaline.
Results:
The primary endpoint was peak concentration of troponin I after surgery. Secondary endpoints included peak concentration of serum creatinine, need for, and dosage of inotropic support, number of defibrillations after aortic declamping, incidence of arrhythmias, duration of Intensive Care Unit (ICU) stay, length of hospitalization. There was no difference in peak troponin I concentration after surgery (PCr, 10,508 pg/ml [IQR 6,838-19,034]; placebo, 11,328 pg/ml [IQR 7.660-22.894]; p = 0.24). There were also no differences in median peak serum creatinine (PCr, 100 µmol/L [IQR 85.0-117.0]; placebo, 99.5 µmol/L [IQR 90.0-117.0]; p = 0.87), the number of patients on vasopressor/inotropic agents (PCr, 49 [88%]; placebo, 57 [91%]; p = 0.60), the inotropic score on postoperative day 1 (PCr, 4.0 (0-7); placebo, 4.0 (0-10); p = 0.47), mean SOFA score on postoperative day 1 (PCr, 5.25 ± 2.33; placebo, 5,45 ± 2,65; p = 0.83), need for defibrillation after declamping of aorta (PCr, 22 [39%]; placebo, 25 [40%]; p = 0.9),, duration of ICU stay and length of hospitalization as well as 30-day mortality (PCr, 0 (0%); placebo,1 (4.3%); p = 0.4).
Conclusion:
PCr administration to patients undergoing double/triple valve surgery under cardiopulmonary bypass is safe but is not associated with a decrease in troponin I concentration. Phosphocreatine had no beneficial effect on clinical outcomes after surgery.
Trial Registration:
The study is registered at ClinicalTrials.gov with the Identifier: NCT02757443. First posted (published): 02/05/2016.
More Related Videos
08:22In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
07:40Protection of H9c2 Myocardial Cells from Oxidative Stress by Crocetin via PINK1/Parkin Pathway-Mediated Mitophagy
Published on: May 26, 2023
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:26Heart Failure Drugs: Inotropic Agents