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Use of Taurine During Rehabilitation After Cardiac Surgery
Abstract
The increasing availability of high-technology care, such as cardiac surgery, raises questions regarding patients’ rehabilitation in the post-surgical period. Recently, the development and maintenance of Centers for Cardiac Surgery all over the Russian Federation has been a major focus of medical community. However, less attention has been directed toward the issue of post-surgical rehabilitation.
The search for new pharmaceutical agents and methods of rehabilitation is a promising direction for the development of rehabilitation medicine. The present study reports the potential use of taurine during the recovery period following coronary bypass surgery or heart valve replacement surgery.
In patients undergoing heart valve replacement and coronary bypass surgery, the use of taurine results in an increase in left ventricular ejection fraction and a reduction in left ventricular myocardial mass index and triglyceride levels. The quality of life improved significantly. The results of “WAM” testing demonstrated the improved parameters of Well-being, Activity and Mood in the patients enrolled into the Taurine arm.
... The conclusions of the studies describe changes in cardiac function and related parameters with taurine supplementation: increased LVEF 17,18 , reduction in left ventricular myocardium mass index (LVMMi) 17 , reduction in left ventricular end-diastolic volume (LVEDV) 19 , improved diastolic failure 20 , improved left ventricular systolic function 21 , decreased pre-ejection period and quotient, increased exercise capacity 22 , and improved haemodynamic parameters (e.g., increased T wave and Q-T segment) and anti-atherogenic and anti-inflammatory effects (e.g., C-reactive protein and platelet count) 23,24 , and clinical course 25,26 . ...
... The conclusions of the studies describe changes in cardiac function and related parameters with taurine supplementation: increased LVEF 17,18 , reduction in left ventricular myocardium mass index (LVMMi) 17 , reduction in left ventricular end-diastolic volume (LVEDV) 19 , improved diastolic failure 20 , improved left ventricular systolic function 21 , decreased pre-ejection period and quotient, increased exercise capacity 22 , and improved haemodynamic parameters (e.g., increased T wave and Q-T segment) and anti-atherogenic and anti-inflammatory effects (e.g., C-reactive protein and platelet count) 23,24 , and clinical course 25,26 . ...
... However, the taurine treated group of patients had significant improvement in New York Heart Association Functional Classification (NYHA) (median; from 2 to 1, P = 0.002) while the control group showed improvement but without statistical significance 27 . Patient wellbeing was examined in one of the eleven studies; mean general improvement of quality of life and wellbeing in patients with HF was 22.6 % compared to 16.6% in the placebo arm, with increased improvement among women 17 . ...
Background: Taurine, 2-aminoethanesulfonic acid, is an amino acid found in animal products. Taurine is produced for human consumption as a supplement and ingredient in beverages. Supplementation is a safe, inexpensive, and effective treatment for dilated cardiomyopathy (DCM) in domestic mammals, however it is currently unlicensed in Europe and the United States for human medical treatment. Recent genome-wide association studies of DCM have identified the locus of the taurine transporter ( SLC6A6 ). To assess whether taurine supplementation may be a novel therapeutic option for DCM, we undertook a systematic review.
Methods: Four electronic databases (PubMed, Cochrane Central Register, Web of Science, Biomed Central) were searched until 11/03/21. Included studies of human participants reported measured phenotypes or symptoms for cardiomyopathy, heart failure (HF), or altered left ventricle structure or function, administering taurine in any formulation, by any method. Non-English articles were excluded. Meta-analysis was completed in R software (version 3.6.0). The Newcastle-Ottawa Scale quality assessment score (NOQAS) tool was used to assess bias.
Results: 285 articles were identified, of which eleven met our criteria for inclusion. Only one paper was deemed “high quality” using the NOQAS tool. Taurine supplementation varied across studies; by dose (500 mg to 6g per day), frequency (once to thrice daily), delivery method (tablet, capsule, drink, powder), and duration (2 to 48 weeks). Patient inclusion was all-cause HF patients with ejection fraction (EF) <50% and no study was specific to DCM. While improvements in diastolic and systolic function, exercise capacity, and haemodynamic parameters were described, only EF and stroke volume were measured in enough studies to complete a meta-analysis; the association was not significant with all-cause HF (P<0.05). No significant safety concerns were reported.
Conclusions: A formal clinical trial is needed to address whether taurine supplementation is beneficial to the approximately 1/250 individuals with DCM in the population.
... The results of studies presented in the literature confirm the possibility of using taurine in the prevention of a number of cardiovascular diseases [7,10,11]. It has been established that the wide spectrum of action of taurine is due to its metabolic nature and the regulating effect of this compound on the functional state of the organs and body systems, as well as various types of metabolism [6][7][8]10]. ...
95 patients with postinfarction cardiosclerosis and angina pectoris II and III functional classes were examined. The study included patients who refused intervention revascularization. The main group included 48 patients who were added taurine (Dibikor 750 mg / day) to enhance the effect of basic therapy, and the comparison group included 47 patients who received standard therapy and placebo. The duration of treatment was 3 months. The study demonstrated positive effects of taurine that was confirmed by significant improvements in the following indicators: subjective status, indicators of the Seattle questionnaire, echocardiographic parameters, cardiac arrhythmias. There was a decrease in the severity of fatigue by 2 times, a decrease in the intensity of complaints of palpitations by 72.3%, a decrease in the severity of dyspnea by 30.0% and a severity of pain in the heart area by 50%. Indicators of most scales of the Seattle questionnaire in patients of the main group at the end of the study significantly exceeded (p <0.05) the corresponding values in patients of the comparison group. In patients whose treatment was used taurine, a significant improvement in inotropic function was noted (the ejection fraction is significantly higher than in the comparison group, respectively 56.0 ± 1.8 and 53.5 ± 1.1%, p <0,05), the bathmotropic and chronotropic myocardial functions improved, which was shown by a 45% decrease in the number of ventricular extrasystoles, a 57% decrease in the frequency of supraventricular heart rhythm disturbances, a decrease in the incidence rate of ST segment depression (in the main group the number of episodes was significantly lower than p <0,05 than in the comparison group). The use of taurine in the complex treatment of patients with exertional angina, after suffering a myocardial infarction, is safe and not accompanied by side effects. Taurine is advisable to include in the complex treatment of patients with exertional angina pectoris, who have had a myocardial infarction in order to improve the myocardial inotropic function, enhance the antiarrhythmic and lipid-lowering effects of the basic therapy. The recommended dose of Taurine is 750 mg per day as a supplement to standard therapy with a duration of therapy of at least 3 months.
... The results of studies presented in the literature confirm the possibility of using taurine in the prevention of a number of cardiovascular diseases [7,10,11]. It has been established that the wide spectrum of action of taurine is due to its metabolic nature and the regulating effect of this compound on the functional state of the organs and body systems, as well as various types of metabolism [6][7][8]10]. ...
... Результаты исследований, представленные в литературе, подтверждают возможность применения таурина в профилактике ряда ССЗ [7,10,11]. Установлено, что широкий спектр действия таурина обусловлен его метаболической природой и регулирующим воздействием этого соединения на функциональное состояние органов и систем организма, а также различные виды обмена веществ [6][7][8]10]. ...
Aim . Study of efficacy and safety of taurin in management of stable angina patients with postinfarction cardiosclerosis.
Material and methods. Totally, 95 postinfarction cardiosclerosis patients included, with stable angina of II and III functional class. The patients that were included, had refused revascularization. To the main group, 48 were included with added taurin (Dibicor, “PIK-Pharma”, Russia, 750 mg daily), and to comparison group — 47 patients that were taking standard treatment and placebo. Treatment duration 3 months.
Results . Clinical efficacy of taurin in postinfarction cardiosclerosis and stable angina is confirmed by significant improvement of the following parameters: subjective state (decreased fatigue, less complaints on palpitation, less severity of dyspnea and rarer angina attacks), of the life quality parameters by Seattle questionnaire; echocardiographic parameters, normalized cardiac rhythm. Postive changes achieved on the basis therapy with taurin, remained for 3 months after drug discontinuation.
Conclusion. Positive influence of taurin on clinical and instrumental parameters of patients make it to recommend its prescription for stable angina treatment in postinfarction cardiosclerosis patients.
... A large number of studies have shown that taurine has many important physiological functions to human body. It can improve immunity, resist oxidation, delay senility, reduce blood pressure, promote recovery from acute hepatitis, etc. (Averin 2015;Wang et al. 2013;De Luca et al. 2015;Ito et al. 2012). In addition, taurine can also improve the metabolism of the nutrients and play an important role in the regulation of neuroendocrine (Cuttitta et al. 2013;Camargo et al. 2015). ...
As being a necessary amino acid, taurine plays an important role in the regulation of neuroendocrine functions and nutrition. In this study, effects of taurine on mice gut microbes and metabolism were investigated. BALB/C mice were randomly divided into three experimental groups: The first group was administered saline (CK), the second was administered 165 mg/kg natural taurine (NE) and the third one administered 165 mg/kg synthetic taurine (CS). Gut microbiota composition in mice feces was analyzed by metagenomics technology, and the content of short-chain fatty acids (SCFA) in mice feces was detected by gas chromatography (GC), while the concentrations of lipopolysaccharide (LPS) and superoxide dismutase (SOD) were detected by a LPS ELISA kit and a SOD assay kit, respectively. The results showed that the effect of taurine on gut microbiota could reduce the abundance of Proteobacteria, especially Helicobacter. Moreover, we found that the SCFA content was increased in feces of the NE group while LPS content was decreased in serum of the NE group; the SOD activity in serum and livers of the NE and CS groups were not changed significantly compare to that of the CK group. In conclusion, taurine could regulate the gut micro-ecology, which might be of benefit to health by inhibiting the growth of harmful bacteria, accelerating the production of SCFA and reducing LPS concentration.
Background: Taurine, 2-aminoethanesulfonic acid, is an amino acid found in animal products. Taurine is produced for human consumption as a supplement and ingredient in beverages. Supplementation is a safe, inexpensive, and effective treatment for dilated cardiomyopathy (DCM) in domestic mammals, however it is currently unlicensed in Europe and the United States for human medical treatment. Recent genome-wide association studies of DCM have identified the locus of the taurine transporter ( SLC6A6). To assess whether taurine supplementation may be a novel therapeutic option for DCM, we undertook a systematic review.
Methods: Four electronic databases (PubMed, Cochrane Central Register, Web of Science, Biomed Central) were searched until 11/03/21. Included studies of human participants reported measured phenotypes or symptoms for cardiomyopathy, heart failure (HF), or altered left ventricle structure or function, administering taurine in any formulation, by any method. Non-English articles were excluded. Meta-analysis was completed in R software (version 3.6.0). The Newcastle-Ottawa Scale quality assessment score (NOQAS) tool was used to assess bias.
Results: 285 articles were identified, of which eleven met our criteria for inclusion. Only one paper was deemed “high quality” using the NOQAS tool. Taurine supplementation varied across studies; by dose (500 mg to 6g per day), frequency (once to thrice daily), delivery method (tablet, capsule, drink, powder), and duration (2 to 48 weeks). Patient inclusion was all-cause HF patients with ejection fraction (EF) <50% and no study was specific to DCM. While improvements in diastolic and systolic function, exercise capacity, and haemodynamic parameters were described, only EF and stroke volume were measured in enough studies to complete a meta-analysis; the association was not significant with all-cause HF (P<0.05). No significant safety concerns were reported.
Conclusions: A formal clinical trial is needed to address whether taurine supplementation is beneficial to the approximately 1/250 individuals with DCM in the population.
Background: Taurine, 2-aminoethanesulfonic acid, is an amino acid found in animal products. Taurine is produced for human consumption as a supplement and ingredient in beverages. Supplementation is a safe, inexpensive, and effective treatment for dilated cardiomyopathy (DCM) in domestic mammals, however it is currently unlicensed in Europe and the United States for human medical treatment. Recent genome-wide association studies of DCM have identified the locus of the taurine transporter (SLC6A6). To assess whether taurine supplementation may be a novel therapeutic option for DCM, we undertook a systematic review. Methods: Four electronic databases (PubMed, Cochrane Central Register, Web of Science, Biomed Central) were searched until 11/03/21. Included studies of human participants reported measured phenotypes or symptoms for cardiomyopathy, heart failure (HF), or altered left ventricle structure or function, administering taurine in any formulation, by any method. Non-English articles were excluded. Meta-analysis was completed in R software (version 3.6.0). The Newcastle-Ottawa Scale quality assessment score (NOQAS) tool was used to assess bias. Results: 285 articles were identified, of which eleven met our criteria for inclusion. Only one paper was deemed “high quality” using the NOQAS tool. Taurine supplementation varied across studies; by dose (500 mg to 6g per day), frequency (once to thrice daily), delivery method (tablet, capsule, drink, powder), and duration (2 to 48 weeks). Patient inclusion was all-cause HF patients with ejection fraction (EF)
Taurine plays a pivotal role in regulating glucose and lipid metabolism, blood pressure homeostasis, and obesity largely due to its cytoprotective, antioxidant, and anti-inflammatory actions. Despite promising data from animal studies in this scenario, the efficacy of taurine supplementation in human studies has been inconsistent. The main objective of this meta-analysis was to appraise the effects of taurine supplementation on liver markers and, secondarily, to explore anthropometric measures as well. Pubmed, SCOPUS, Web of Science, and Google Scholar were searched from inception to April 2020. There were 12 eligible peer-reviewed studies meeting the inclusion criteria. Most studies were conducted in patients with liver or metabolic dysregulation (diabetes, hepatitis, fatty liver, obesity, cystic fibrosis, chronic alcoholism, and cardiac surgery). The taurine dosage varied from 0.5 to 6 g/d for 15 days to 6 months. Pooled effect sizes suggested a significant effect of taurine administration on systolic blood pressure (weighted mean difference (WMD): -4.67 mm Hg; 95%CI, -9.10 to -0.25), diastolic blood pressure (WMD: -2.90 mm Hg; 95%CI, -4.29 to -1.52), total cholesterol (WMD: -10.87 mg/dl; 95%CI, -16.96 to -4.79), and triglycerides (WMD: -13.05 mg/dl; 95%CI, -25.88 to -0.22); however, it had no effect on fasting blood glucose (WMD: 0.06 mg/dl), HDL-C (WMD: 0.90 mg/dl), LDL-C (WMD: -6.17 mg/dl), as well as on body mass index (WMD: -0.46 kg/m²) and body weight (WMD: -0.47 kg) as the anthropometric measures. These findings indicate that, in patients with liver dysregulation, taurine supplementation can lower blood pressure and improve the lipid profile by reducing total cholesterol and triglyceride levels.
Updates of clinical guidelines and publication of new research results entail changes in our approaches to diagnosing diseases and treating patients, as well as revising the criteria for choosing a particular drug to a specific patient. We are based on the fact that when managing patients with hypertension it is immediately necessary to use those classes of drugs and individual molecules that have proven to be highly effective, safe and adherent throughout the entire cardiovascular continuum. It is understood that the drugs should be shown in IHD and CHF. Among the ACE inhibitors, ramipril meets this requirement. Often, the choice falls precisely on ramipril because a convenient intake once a day at any time of the day and regardless of the meal increases the patient’s adherence to therapy. A wide range of indications, such as hypertension, chronic heart failure, post-infarction patients, diabetic and non-diabetic nephropathy, as well as a reduction in the risk of cardiovascular accidents, including in patients undergoing cardiac surgery, are a serious additional argument in favor of a wide range of ramipril. Moreover, ramipril can reduce the risk of developing new cases of diabetes mellitus and end-stage renal failure.
Aims:
Taurine has been widely evaluated as a potential therapeutic agent in chronic inflammatory disorders and various infections. However, the potential role of taurine in regulating allergic inflammatory responses is currently unknown.
Materials and methods:
The present study was designed to evaluate the in vitro effects of taurine on the levels of thymic stromal lymphopoietin (TSLP) and other pro-inflammatory cytokines and activation of caspase-1 and nuclear factor (NF)-κB as well as the phosphorylations of c-Jun N-terminal kinase (JNK) and p38 in phorbol 12-myristate 13-acetate and calcium ionophore A23187 (PMACI)-triggered human mast cell line, HMC-1 cells. Furthermore, we assessed the therapeutic effects of taurine on ovalbumin (OVA)-induced allergic rhinitis (AR) animal models.
Key findings and significance:
Here, the obtained results showed that taurine dose-dependently inhibited the production and mRNA expression of TSLP and pro-inflammatory cytokines in HMC-1 cells exposed to PMACI. Taurine attenuated the phosphorylation of JNK and p38 in activated HMC-1 cells. Moreover, taurine brought a significant inhibition of the activities of NF-κB and caspase-1. In an OVA-induced AR animal model, the increased levels of nose rubbing, histamine, immunoglobulin E, TSLP, and interleukin IL-1β were dramatically reduced by the administration of taurine. In summary, taurine could serve as potential novel remedy of allergic inflammatory disorders.
The aim of the present study was to investigate the cardioprotective effect of Taurine on the donor hearts during cold ischemic period.
32 rats were divided into four groups (sham, taurine, ischemia, treatment group, 8 rats in each). All rats were fed with rat food for three weeks. Taurine and treatment groups were given a 200 mg/kg/day dose of Taurine by oral gavage besides rat feed. Cardiectomy was performed in all rats after three weeks. In ischemia and treatment groups, harvested hearts were kept in 0.9% sodium chloride at +4 degrees C for 5 hours. Tissue samples were taken from left ventricle in all groups. These samples were evaluated by histopathologic and biochemical examination.
In the present study results of the biochemical and histopathological examination reveals the protective effects of Taurine. As a marker of lipid peroxidation, Malondialdehyde (MDA) levels in ischemia group were significantly higher than both Sham and Taurine groups. MDA values were recorded; 3.62 ± 0.197 in the sham group, 2.07 ± 0.751 in the Taurine group, 9.71 ± 1.439 in the ischemia group and 7.68 ± 1.365 in the treatment group. MDA levels decreased in treatment group. (p < 0.05) In accordance with MDA findings, while superoxide dismutase and glutathione peroxidase levels decreased in ischemia group, they increased in treatment group. (p < 0.05) There was no differences in Catalase (CAT) enzyme level between treatment and ischemia group (p = 1.000). CAT level results were recorded; 7.08 ± 0.609 in the sham group, 6.15 ± 0.119 in the Taurine group, 5.02 ± 0.62 in the ischemia group, and 5.36 ± 0.384 in the treatment group. Less intracellular edema and inflammatory cell reaction were observed in histologic examination in favor of treatment group. (p < 0.01)
Taurine decreased myocardial damage during cold ischemic period following global myocardial ischemia.
To study the changes in amino acid content of left ventricles of patients during cardiac surgery that involves cardiopulmonary bypass and cold cardioplegia.
Biopsy specimens (up to 10 mg wet weight) from the left ventricle of 30 patients undergoing coronary artery bypass graft and valve replacement surgery on cardiopulmonary bypass (protected by cold cardioplegia with St Thomas' solution) were taken immediately before the infusion of the cardioplegic solution and just before the removal of the cross clamp, and were analysed for their amino acid content.
Of the most abundant cellular amino acids in the left ventricle taurine, glutamine, glutamate, and aspartate, but not alanine, showed a significant fall during the period of cross clamping. A rise in intracellular sodium (Na) is known to occur during cold cardioplegic arrest so that an activation of an amino acid/Na efflux, similar to that seen in animal experiments, seems a likely mechanism. The anomalous behaviour of alanine suggests some recovery of metabolism.
The loss of alpha amino acids (by contrast with the loss of taurine) will depress protein synthesis and reduce energy reserves after cardiac surgery. Attempts to preserve the concentrations of intracellular alpha amino acids must be balanced against the need to regulate intracellular Na concentration and hence intracellular pH and calcium ions. The presence of alpha amino acids in the cardioplegic solution (or in a resuscitation solution) should maintain the intracellular concentrations and favour activation of the taurine/Na symport to oppose the rise in intracellular Na concentration. Because the reservoir of tissue taurine is limited, the potential benefits of increasing the concentration of taurine in the heart by diet before surgery and addition of alpha amino acids to the cardioplegic solution merits further assessment.
Cardiopulmonary bypass results in ischemia/reperfusion (I/R)-induced endotoxemia. We conducted a prospective randomized trial to investigate the effect of taurolidine, an antiendotoxin agent with antioxidant and membrane-stabilizing properties, on patients undergoing coronary artery bypass grafting (CABG).
A total of 60 patients undergoing CABG were randomized into 4 groups. St Thomas' Hospital cold crystalloid cardioplegia was used in groups A and B, and cold blood cardioplegia in groups C and D. Groups A and C received a placebo infusion of normal saline, whereas groups B and D were administered intravenous taurolidine. Arrhythmias induced by pro- and anti-inflammatory cytokines (interleukin [IL]-6 and IL-10), and I/R were assessed perioperatively.
Administration of taurolidine in crystalloid cardioplegia patients resulted in a significant decrease in serum IL-6 and an increase in serum IL-10 at 24 hours postaortic unclamping compared to placebo (P < .0001). Although not statistically significant, this trend in serum IL-6 decrease was mirrored in the blood cardioplegia patients (P = .068). Taurolidine treatment also significantly decreased I/R-induced arrhythmias compared to placebo in the crystalloid cardioplegia patients (P < .003). There were fewer I/R-induced arrhythmias compared to placebo in the blood cardioplegia patients; the difference, however, was marginal and not statistically significant (P = .583).
This study demonstrates that administration of taurolidine in CABG patients induces a potent anti-inflammatory response that is associated with a significant decrease in arrhythmias.
Quantification of cardiac chamber size, ventricular mass and function ranks among the most clinically important and most frequently requested tasks of echocardiography. Over the last decades, echocardiographic methods and techniques have improved and expanded dramatically, due to the introduction of higher frequency transducers, harmonic imaging, fully digital machines, left-sided contrast agents, and other technological advancements. Furthermore, echocardiography due to its portability and versatility is now used in emergency rooms, operating rooms, and intensive care units. Standardization of measurements in echocardiography has been inconsistent and less successful, compared to other imaging techniques and consequently, echocardiographic measurements are sometimes perceived as less reliable. Therefore, the American Society of Echocardiography, working together with the European Association of Echocardiography, a branch of the European Society of Cardiology, has critically reviewed the literature and updated the recommendations for quantifying cardiac chambers using echocardiography. This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.
National guideline on the diagnosis and treatment of CHF
- V Mareev
- F Ageev
- A Arutynov
National Guideline on the Diagnosis and Treatment of CHF. Journal
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