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
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Zhang, Kan; Sheu, Richard; Zimmerman, Nicole M et al. (2018) A Comparison of Global Longitudinal, Circumferential, and Radial Strain to Predict Outcomes After Cardiac Surgery. J Cardiothorac Vasc Anesth :
Sonny, Abraham; Alfirevic, Andrej; Sale, Shiva et al. (2018) Reduced Left Ventricular Global Longitudinal Strain Predicts Prolonged Hospitalization: A Cohort Analysis of Patients Having Aortic Valve Replacement Surgery. Anesth Analg 126:1484-1493
Maheshwari, A; McCormick, P J; Sessler, D I et al. (2017) Prolonged concurrent hypotension and low bispectral index ('double low') are associated with mortality, serious complications, and prolonged hospitalization after cardiac surgery. Br J Anaesth 119:40-49
Duncan, Andra E; Sarwar, Sheryar; Kateby Kashy, Babak et al. (2017) Early Left and Right Ventricular Response to Aortic Valve Replacement. Anesth Analg 124:406-418
Walsh, Michael; Whitlock, Richard; Garg, Amit X et al. (2016) Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial. CMAJ 188:329-36
Geube, Mariya A; Perez-Protto, Silvia E; McGrath, Tory L et al. (2016) Increased Intraoperative Fluid Administration Is Associated with Severe Primary Graft Dysfunction After Lung Transplantation. Anesth Analg 122:1081-8
Geube, Mariya A; Duncan, Andra E; Yang, Dongsheng et al. (2016) In Response. Anesth Analg 123:795-6
Abdelmalak, Basem B; Duncan, Andra E; Bonilla, Angela et al. (2016) The intraoperative glycemic response to intravenous insulin during noncardiac surgery: a subanalysis of the DeLiT randomized trial. J Clin Anesth 29:19-29
Saager, Leif; Duncan, Andra E; Yared, Jean-Pierre et al. (2015) Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery. Anesthesiology 122:1214-23
Duncan, Andra E; Kateby Kashy, Babak; Sarwar, Sheryar et al. (2015) Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery: A Randomized Trial. Anesthesiology 123:272-87

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