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On perhexiline and its application to myocardial protection during cardiac surgery

Drury, Nigel Edward (2012)
Ph.D. thesis, University of Birmingham.

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Abstract

Perhexiline is an anti-anginal drug that is thought to shift myocardial metabolism from $$\beta$$-oxidation of fatty acids to glucose utilisation. An associated improvement in energy efficiency may be beneficial in ischaemia-reperfusion as an adjunct to established techniques for myocardial protection during cardiac surgery. In this thesis, I conduct a prospective double-blind randomised placebo-controlled trial of oral perhexiline in patients undergoing coronary artery surgery, obtaining samples of serum, right atrium and left ventricle. I measure the concentration of perhexiline using high performance liquid chromatography and find that although highly concentrated in the heart, it may not have reached steady-state in the ventricular myocardium. I perform enzymatic colourimetry and ultra-high resolution mass spectrometry to detect changes in carbohydrate and lipid metabolism; however, the myocardial metabolic profiles of patients on perhexiline are indistinguishable from controls. On analysing the results of the clinical trial, I find no improvement in the primary endpoint, the incidence of a low cardiac output episode, or any secondary outcomes. I conclude that preoperative oral perhexiline does not improve clinical markers of myocardial protection and despite significant accumulation in the myocardium, it has no significant effect on the measurable metabolic profile of the heart at the time of surgery.

Type of Work: Ph.D. thesis. Pagano, Domenico and Frenneaux, Michael and Freemantle, Nick and Viant, Mark Colleges (2008 onwards) > College of Medical & Dental Sciences Department of Cardiovascular Medicine QH301 BiologyQP PhysiologyR Medicine (General) University of Birmingham 3640
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