Autonomic State, Cardiovascular Control and Outcomes in Coronary Surgery

NCT ID: NCT03169608

Last Updated: 2017-05-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

200 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-04-03

Study Completion Date

2019-07-14

Brief Summary

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Characterization of the perioperative autonomic nervous system state, cardiovascular and cerebrovascular control and microcirculation in order to predict postoperative atrial fibrillation and acute kidney injury in patients undergoing coronary artery bypass graft surgery

Detailed Description

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Atrial fibrillation (AF) and acute kidney injury (AKI) are common postoperative complications in patients undergoing coronary artery bypass graft (CABG) surgery. AKI increases postoperative mortality and AF prolongs the hospital stay.

Autonomic dysfunction, baroreflex impairment and an inadequate microvascular perfusion may play a relevant role in triggering AF and AKI.

The perioperative characterization of the autonomic nervous system (ANS) and of the microcirculation might improve risk stratification and help in the prevention and early treatment of AF and AKI in CABG surgery.

The study aims are: i) to collect a number of perioperative indices describing the state of the ANS and of the microcirculation; ii) to assess the correlation among the different indices and their association with AF and AKI; iii) to develop a predictive model of postoperative outcomes (AF and AKI) accounting for perioperative autonomic indices and microcirculatory variables.

Population: 200 adults subjects scheduled for CABG surgery, with or without additional intervention Methods: perioperative (in the operating room) acquisition of ECG, arterial blood pressure, cerebral blood flow velocity as derived from transcranial doppler technique, microcirculation parameters as derived from sidestream dark field images Statistics: receiver operating characteristic (ROC) curve analysis with adequate cut-off values

Conditions

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Atrial Fibrillation Acute Kidney Injury

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* age over 18
* sinus rhythm
* absence of pathologies affecting autonomic nervous system (e.g. diabetes with neuropathy)
* informed consent signed
* elective or urgent surgery

Exclusion Criteria

* age under 18
* absence of sinus rhythm
* pathologies affecting autonomic nervous system
* emergency surgery (to be operated immediately)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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IRCCS Policlinico S. Donato

OTHER

Sponsor Role lead

Responsible Party

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Marco Ranucci

Director of Cardiothoracic Anesthesia and ICU Dept

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Marco Ranucci, MD, FESC

Role: PRINCIPAL_INVESTIGATOR

IRCCS Policlinico S. Donato

Locations

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IRCCS Policlinico San Donato

San Donato Milanese, Milan, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Vlasta Bari, PhD

Role: CONTACT

0039025277 ext. 4381

Valeria Pistuddi

Role: CONTACT

0039025277 ext. 4754

Facility Contacts

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Vlasta Bari, PhD

Role: primary

0039025277 ext. 4381

References

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Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, Lopez JA, Rasekh A, Wilson JM, Massumi A. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004 Mar 3;43(5):742-8. doi: 10.1016/j.jacc.2003.11.023.

Reference Type BACKGROUND
PMID: 14998610 (View on PubMed)

Provenchere S, Plantefeve G, Hufnagel G, Vicaut E, de Vaumas C, Lecharny JB, Depoix JP, Vrtovsnik F, Desmonts JM, Philip I. Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: incidence, risk factors, and effect on clinical outcome. Anesth Analg. 2003 May;96(5):1258-1264. doi: 10.1213/01.ANE.0000055803.92191.69.

Reference Type BACKGROUND
PMID: 12707117 (View on PubMed)

Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65. No abstract available.

Reference Type BACKGROUND
PMID: 8598068 (View on PubMed)

Pagani M, Montano N, Porta A, Malliani A, Abboud FM, Birkett C, Somers VK. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation. 1997 Mar 18;95(6):1441-8. doi: 10.1161/01.cir.95.6.1441.

Reference Type BACKGROUND
PMID: 9118511 (View on PubMed)

Faes L, Porta A, Rossato G, Adami A, Tonon D, Corica A, Nollo G. Investigating the mechanisms of cardiovascular and cerebrovascular regulation in orthostatic syncope through an information decomposition strategy. Auton Neurosci. 2013 Nov;178(1-2):76-82. doi: 10.1016/j.autneu.2013.02.013. Epub 2013 Mar 27.

Reference Type BACKGROUND
PMID: 23541295 (View on PubMed)

Ince C. The microcirculation is the motor of sepsis. Crit Care. 2005;9 Suppl 4(Suppl 4):S13-9. doi: 10.1186/cc3753. Epub 2005 Aug 25.

Reference Type BACKGROUND
PMID: 16168069 (View on PubMed)

Singh P, Porta A, Ranucci M, Cairo B, Gelpi F, Caruso R, Magon A, Baroni I, Conte G, Bari V. Identifying and preliminary validating patient clusters in coronary artery bypass grafting: integrating autonomic function with clinical and demographic data for personalized care. Eur J Cardiovasc Nurs. 2025 Sep 5;24(6):898-910. doi: 10.1093/eurjcn/zvaf059.

Reference Type DERIVED
PMID: 40186491 (View on PubMed)

Other Identifiers

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GR-2013-02356272

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

GR2013

Identifier Type: -

Identifier Source: org_study_id

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