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The effect of oral triiodothyronine supplementation on lactate and pyruvate after paediatric cardiac surgery

Published online by Cambridge University Press:  10 November 2020

Eva M. Marwali Open the ORCID record for Eva M. Marwali [Opens in a new window] ,
Putri Caesa ,
Muhammad Rayhan ,
Poppy S. Roebiono ,
Dicky Fakhri ,
Nikolaus A. Haas ,
Masaki Kajimoto  and
Michael A. Portman
Eva M. Marwali*
Affiliation:
Pediatric Cardiac Intensive Care Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Putri Caesa
Affiliation:
Pediatric Cardiac Intensive Care Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Muhammad Rayhan
Affiliation:
Pediatric Cardiac Intensive Care Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Poppy S. Roebiono
Affiliation:
Pediatric Cardiac Intensive Care Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Department of Cardiology, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Dicky Fakhri
Affiliation:
Department of Thoracic Cardiovascular Surgery, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Nikolaus A. Haas
Affiliation:
Department of Pediatric Cardiology and Pediatric Intensive Care, Medical Hospital of the University of Munich, Munich, Germany
Masaki Kajimoto
Affiliation:
Department of Pediatrics, University of Washington School of Medicine and Division of Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
Michael A. Portman
Affiliation:
Department of Pediatrics, University of Washington School of Medicine and Division of Cardiology, Seattle Children’s Hospital, Seattle, WA, USA
*
Author for correspondence: Eva M. Marwali, MD, PhD, Pediatric Cardiac ICU Division, National Cardiovascular Center Harapan Kita Jakarta, Indonesia. Jl. Let. Jend. S. Parman Kav. 87, Slipi, Jakarta11420, Indonesia. Tel: +62 21 5684085 ext. 2807; Fax: +62 21 5684230. E-mail: [email protected]
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Abstract

Objective:

To determine if triiodothyronine alters lactate, glucose, and pyruvate metabolism, and if serum pyruvate concentration could serve as a predictor of low cardiac output syndrome in children after cardiopulmonary bypass procedures.

Methods:

This study was ancillary to the Oral Triiodothyronine for Infants and Children undergoing Cardiopulmonary bypass (OTICC) trial. Serum pyruvate was measured in the first 48 patients and lactate and glucose were measured in all 208 patients enrolled in the OTICC study on the induction of anaesthesia, 1 and 24 hours post-aortic cross-clamp removal. Patients were also defined as having low cardiac output syndrome according to the OTICC trial protocol.

Result:

Amongst the designated patient population for pyruvate analysis, 22 received placebo, and 26 received triiodothyronine (T3). Lactate concentrations were nearly 20 times greater than pyruvate. Lactate and pyruvate levels were not significantly different between T3 and placebo group. Glucose levels were significantly higher in the placebo group mainly at 24-hour post-cross-clamp removal. Additionally, lactate and glucose levels peaked at 1-hour post-cross-clamp removal in low cardiac output syndrome and non-low cardiac output syndrome patients, but subsequently decreased at a slower rate in low cardiac output syndrome. Lactate and pyruvate concentrations correlated with glucose only prior to surgery.

Conclusion:

Thyroid supplementation does not alter systemic lactate/pyruvate metabolism after cardiopulmonary bypass and reperfusion. Pyruvate levels are not useful for predicting low cardiac output syndrome. Increased blood glucose may be regarded as a response to hypermetabolic stress, seen mostly in patients with low cardiac output syndrome.

Keywords

Lactatepyruvateeuthyroid sick syndromecongenital heart diseasecardiopulmonary bypasslow cardiac output syndromethyroid hormone replacement
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 205 - 211
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Andersen, L, Mackenhauer, J, Roberts, J, et al. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 2013; 88: 1127–1140.CrossRefGoogle ScholarPubMed
Agrawal, N, Das, J, Varma, A, et al. Point of care serum lactate levels as a prognostic marker of outcome in complex pediatric cardiac surgery patients: can we utilize it? Indian J Crit Care Med 2012; 16: 193.Google Scholar
Schumacher, K, Reichel, R, Vlasic, J, et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2014; 148: 589–595.CrossRefGoogle ScholarPubMed
Duke, T. Dysoxia and lactate. Arch Dis Child 1999; 81: 343–350.CrossRefGoogle ScholarPubMed
Olson, A, Hyyti, O, Cohen, G, et al. Superior cardiac function via anaplerotic pyruvate in the immature swine heart after cardiopulmonary bypass and reperfusion. Am J Physiol Heart Circ Physiol 2008; 295: H2315–H2320.CrossRefGoogle ScholarPubMed
Murzi, B, Iervasi, G, Masini, S, et al. Thyroid hormones homeostasis in pediatric patients during and after cardiopulmonary bypass. Ann Thorac Surg 1995; 59: 481–485.10.1016/0003-4975(94)00879-CCrossRefGoogle ScholarPubMed
Marwali, EM, Boom, CE, Budiwardhana, N, et al. Oral triiodothyronine for infants and children undergoing cardiopulmonary bypass. Ann Thorac Surg 2017; 104: 688–695.CrossRefGoogle ScholarPubMed
Portman, MA, Slee, A, Olson, AK, et al. Triiodothyronine supplementation in infants and children undergoing cardiopulmonary bypass (TRICC): a multicenter placebo-controlled randomized trial: age analysis. Circulation 2010; 122: S224–S233.CrossRefGoogle ScholarPubMed
Marwali, EM, Caesa, P, Darmaputri, S, et al. Oral triiodothyronine supplementation decreases low cardiac output syndrome after pediatric cardiac surgery. Pediatr Cardiol 2019; 40: 1238–1246.CrossRefGoogle ScholarPubMed
Danzi, S, Klein, I. Thyroid hormone-regulated cardiac gene expression and cardiovascular disease. Thyroid 2002; 12: 467–472.CrossRefGoogle ScholarPubMed
Fazio, S. Effects of thyroid hormone on the cardiovascular system. Recent Prog Horm Res 2004; 59: 31–50.CrossRefGoogle Scholar
Files, MD, Kajimoto, M, O’Kelly Priddy, CM, et al. Triiodothyronine facilitates weaning from extracorporeal membrane oxygenation by improved mitochondrial substrate utilization. J Am Heart Assoc 2014; 3: e000680.CrossRefGoogle ScholarPubMed
Kajimoto, M, Priddy, CM, Ledee, DR, et al. Effects of continuous triiodothyronine infusion on the tricarboxylic acid cycle in the normal immature swine heart under extracorporeal membrane oxygenation in vivo. Am J Physiol Heart Circ Physiol 2014; 306: H1164–H1170.10.1152/ajpheart.00964.2013CrossRefGoogle ScholarPubMed
Olson, AK, Bouchard, B, Ning, XH, et al. Triiodothyronine increases myocardial function and pyruvate entry into the citric acid cycle after reperfusion in a model of infant cardiopulmonary bypass. Am J Physiol Heart Circ Physiol 2012; 302: H1086–H1093.CrossRefGoogle Scholar
Hoffman, TM, Wernovsky, G, Atz, AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002.CrossRefGoogle ScholarPubMed
Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score for congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 185–191.CrossRefGoogle ScholarPubMed
Stanley, WC, Lopaschuk, GD, Hall, JL, et al. Regulation of myocardial carbohydrate metabolism under normal and ischaemic conditions: potential for pharmacological interventions. Cardiovasc Res 1997; 33: 243–257.CrossRefGoogle ScholarPubMed
Kajimoto, M, Ledee, DR, Xu, C, et al. Triiodothyronine activates lactate oxidation without impairing fatty acid oxidation and improves weaning from extracorporeal membrane oxygenation. Circ J 2014; 78: 2867–2875.10.1253/circj.CJ-14-0821CrossRefGoogle ScholarPubMed
Levy, B, Sadoune, LO, Gelot, AM, et al. Evolution of lactate/pyruvate and arterial ketone body ratios in the early course of catecholamine-treated septic shock. Crit Care Med 2000; 28: 114–119.CrossRefGoogle ScholarPubMed
Rimachi, R, Bruzzi de Carvahlo, F, Orellano-Jimenez, C, et al. Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock. Anaesth Intensive Care 2012; 40: 427–432.CrossRefGoogle ScholarPubMed
Hatherill, M, Salie, S, Waggie, Z, et al. The lactate:pyruvate ratio following open cardiac surgery in children. Intensive Care Med 2007; 33: 822–829.CrossRefGoogle ScholarPubMed
Adelsmayr, G, Brunner, R, Holzinger, U. Impact of blood glucose on blood lactate levels in a medical ICU: a retrospective cohort study. Crit Care 2012; 16 (Suppl 1): 165.CrossRefGoogle Scholar
Floh, AA, Manlhiot, C, Redington, AN, et al. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg 2015; 150: 498–504.CrossRefGoogle ScholarPubMed
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