The candidate's ultimate goal is to become an independent, patient-oriented researcher investigating innovative ways to decrease morbidity and mortality in critically ill patients undergoing high-risk cardiac surgical procedures. This Mentored Patient-Oriented Research Career Development Award will provide the knowledge, training, and experience necessary to achieve this goal. Specifically, this Award will provide for: 1) coursework in clinical research, statistics, and study design to provide the background for a successful career in clinical research;2) an in-depth investigative experience under exceptional mentorship to gain invaluable experience and training in investigation of critically ill cardiac surgical patients;3) development of advanced echocardiographic skills with important research applications for investigating perioperative care of complex cardiac surgical patients;4) an investigation in basic science research to elucidate the cellular effects of hyperglycemia and cardioprotection;and 5) an opportunity to acquire preliminary data and apply for an NIH Project Grant (R01), examining the means to improve care of high-risk critically ill cardiac surgical patients. These goals will be met by collaboration with an integrated, multidisciplinary team of expert researchers and clinicians. Clinical Investigation: Hyperglycemia during cardiac surgery is associated with increased risk of morbidity and mortality. Provision of exogenous glucose while treating hyperglycemia has improved morbidity and mortality in surgical patients. The hyperinsulinemic normoglycemic clamp (HNC) provides exogenous glucose while normalizing blood glucose, which is expected to provide beneficial effects by increasing myocardial uptake and utilization of glucose resulting in improved myocardial function. The purpose of this investigation is to determine whether normalization of blood glucose using HNC promotes cardiomyocyte utilization of glucose, provides cellular protection from the adverse effects of hyperglycemia, and improves myocardial global and regional function. Patients will be randomly assigned to either glucose control with HNC versus standard glucose management. To the extent that HNC improves myocardial function, outcomes in high-risk cardiac surgical patients may improve.

Public Health Relevance

The purpose of this study is to determine whether controlling blood glucose during heart surgery using a hyperinsulinemic-normoglycemic clamp improves heart function, increases the use of glucose as fuel for the heart, and protects the heart from the adverse effects of excessive glucose. Patients, who undergo heart surgery, will be randomly assigned to either glucose control with the hyperinsulinemic- normoglycemic clamp or standard glucose management. To the extent that the hyperinsulinemic- normoglycemic clamp improves heart function, the risk associated with having heart surgery may be decreased.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-X (O1))
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Scott, Jane
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Cleveland Clinic Lerner
Schools of Medicine
United States
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Alfirevic, Andrej; Duncan, Andra; You, Jing et al. (2014) Recombinant factor VII is associated with worse survival in complex cardiac surgical patients. Ann Thorac Surg 98:618-24
Duncan, Andra E; Alfirevic, Andrej; Sessler, Daniel I et al. (2014) Perioperative assessment of myocardial deformation. Anesth Analg 118:525-44
Paik, Paul Y; Capdeville, Michelle; Duncan, Andra E (2014) Turbulence in the left ventricular outflow tract caused by an eccentric mitral inflow jet masquerades as aortic regurgitation. Anesth Analg 118:76-9
Wehbe, Edgard; Duncan, Andra E; Dar, Gohar et al. (2013) Recovery from AKI and short- and long-term outcomes after lung transplantation. Clin J Am Soc Nephrol 8:19-25
O'Donoghue, Rory D; Duncan, Andra E; Fraser, Thomas G et al. (2011) An echocardiographic evaluation of valvular function and ventricular patch repair during surgical exclusion of left ventricular pseudoaneurysm. Anesth Analg 113:713-6