Not provided
| ID | Type | Description | Link |
|---|---|---|---|
| 246009 | Registry Identifier | IRAS | |
| 18/EM/0254 | Other Identifier | REC East Midlands - Leics Central |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The PRE-OP ENERGY Trial proposes to test the overarching hypothesis that a pre-surgery high energy diet will protect patients against organ damage during cardiac surgery with cardiopulmonary bypass.
PRE-OP ENERGY is a single centre, unblinded, parallel group, randomised controlled trial of a pre-operative high energy diet, versus a control group receiving standard care.
The trial will test a number of specific hypotheses:
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A: Control | No Intervention | Standard Care | |
| Group B: High energy diet | Experimental | High energy diet for 8-12 weeks pre-surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| High energy diet | Dietary Supplement | An overfeeding regime of 135% required energy intake per day, set from baseline energy requirements consisting of high (saturated) fat snacks, added to the usual diet, supervised by a dietitian. |
| Measure | Description | Time Frame |
|---|---|---|
| Change of Serum Creatinine level | Measurement of Serum Creatinine level and expressed as umol/L. | Baseline, 0-6, 6-12, 24, 48, 72, and up to 96 hours post-operatively |
| Change of Serum Troponin I level | Measurement of Serum Troponin level and expressed as ng/L. | Baseline, 0-6, 6-12, 24, 48 and 72 hours post-operatively |
| Measure | Description | Time Frame |
|---|---|---|
| Post-surgery organ injury: Sepsis-related Organ Failure | Sepsis-related Organ Failure Assessment (SOFA) Score. Range 0-3, 3 being the worse score | Baseline, pre-operatively, 0-6, 6-12, 24, 48, 72 and 96 hours post-operatively |
| Post-surgery organ injury: Kidney Injury (Urinary Biomarkers) - NGAL (Neutrophil gelatinase associated lipocalcin) |
| Measure | Description | Time Frame |
|---|---|---|
| Body Composition: Bone Density Scan (DEXA) | Assessments of muscle mass/sarcopenia (Appendicular lean mass taken from the DEXA scan) | Baseline, pre-assessment and 3 months post-surgery |
| Imaging Assessment of Cardiometabolic Status: Trans-Oesophageal Echo |
Inclusion Criteria:
ALL of the following:
Exclusion Criteria:
Any of the following:
Exclusion criteria for optional MRI research procedure:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mustafa Zakkar, PhD | Contact | 0116258 | 3019 | mz207@le.ac.uk |
| Hardeep Aujla | Contact | 0116250 | 2650 | ha200@le.ac.uk |
| Name | Affiliation | Role |
|---|---|---|
| Gavin J Murphy, MD | BHF Professor of Cardiac Surgery, University of Leicester | Study Chair |
| Mustafa Zakkar, PhD | Associate Professor, University of Leicester | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Leicester | Recruiting | Leicester | Leicestershire | LE3 9QP | United Kingdom |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D006349 | Heart Valve Diseases |
| D003324 | Coronary Artery Disease |
| D009102 | Multiple Organ Failure |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
Not provided
Not provided
Unblinded randomised controlled trial
Not provided
Not provided
Not provided
Not provided
Urine samples will be analysed for biomarkers of renal injury. Measurement of NGAL level will be expressed as μg/L. |
| Baseline, 1 day pre-op, 6-12, 24 and 48 hours post-operatively |
| Post-surgery organ injury: Kidney Injury (Urinary Biomarkers) - microRNA (Neutrophil gelatinase associated lipocalcin) | Urine samples will be analysed for biomarkers of renal injury. Measurement of microRNA in urine samples will be represented by the frequency (%) of identified microRNA. | Baseline, 1 day pre-op, 6-12, 24 and 48 hours post-operatively |
| Post-surgery organ injury: Kidney Injury | Absolute change from baseline for serum creatinine | Daily for 5 days from Baseline |
| Post-surgery organ injury: Kidney Injury | Serum creatinine and eGFR in all patients using the Modification of Diet in Renal Disease equation. The following is the IDMS-traceable MDRD Study equation (for creatinine methods calibrated to an IDMS reference method) GFR (mL/min/1.73 m2) = 175 × (Scr)-1.154 × (Age)-0.203 × (0.742 if female) × (1.212 if African American) The equation does not require weight or height variables because the results are reported normalized to 1.73 m2 body surface area, which is an accepted average adult surface area. | At 6 weeks and then 3 months post-surgery |
| Post-surgery organ injury: Lung Injury using the Berlin ARDS Score | Using the Berlin ARDS score, the measurement of Arterial Alveolar oxygen ratio expressed in kPa/L. | Baseline, immediately pre-surgery, 0-6, 6-12, 24, 48, 72 and 96 hours post-operatively |
| Post-surgery organ injury: GI Tract injury (Biomarker) - AST (Aspartate Transaminase) | Measurement of AST levels in serum and expressed in IU/L. Acute liver injury will be defined as an acute derangement of three times the upper limit of normal. | Baseline, pre-assessment, pre-operatively, 0-6 and at 6-12, 24, 48, 72 and 96 hours post-operatively. |
| Post-surgery organ injury: GI Tract injury (Biomarker) - ALT (Alanine Transaminase) | Measurement of ALT levels in serum and expressed in IU/L. Acute liver injury will be defined as an acute derangement of three times the upper limit of normal. | Baseline, pre-assessment, pre-operatively, 0-6 and at 6-12, 24, 48, 72 and 96 hours post-operatively. |
| Post-surgery organ injury: GI Tract injury (Biomarker) - Bilirubin | Measurement of Bilirubin levels in serum and expressed in μmol/L. Acute liver injury will be defined as an acute derangement of three times the upper limit of normal. | Baseline, pre-assessment, pre-operatively, 0-6 and at 6-12, 24, 48, 72 and 96 hours post-operatively. |
| Post-surgery organ injury: GI Tract injury (Biomarker) - Alkaline Phosphatase | Measurement of Alkaline Phosphatase levels in serum and expressed in IU/L. Acute liver injury will be defined as an acute derangement of three times the upper limit of normal. | Baseline, pre-assessment, pre-operatively, 0-6 and at 6-12, 24, 48, 72 and 96 hours post-operatively. |
| Post-surgery organ injury: GI Tract injury (Biomarker) - Serum Amylase | Measurement of Amylase levels in serum and expressed in IU/L. Acute pancreatitis will be defined as a serum amylase concentration >1000 ng/ml. | Baseline, pre-assessment, pre-operatively, 0-6 and at 6-12, 24, 48, 72 and 96 hours post-operatively. |
| Assessment of resource use: Extubation | Time until extubation | Time (hours) measured from the start of surgery to extubation (up to 30 days) |
| Assessment of resource use: Intensive Care Unit | Length of stay in Intensive Care Unit. Number of hours between admission and discharge from the High Dependency Unit (HDU) | Time (hours) measured from the start of surgery to discharge from ICU (up to 30 days) |
| Assessment of resource use: Hospital Stay | Length of stay in hospital. Number of days between admission and discharge from the hospital | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Sepsis | Sepsis will be defined as suspected or documented infection and an acute change in total SOFA score ≥2 points consequent to the infection. For the purposes of the trial suspected or documented infection will be defined as the commencement of intravenous antibiotics. The rise in SOFA score will be assessed within 72 hours of the commencement of antibiotics. Range of SOFA is 0 to 3, 3 being the worse. For the purposes of the study suspected or documented infection will be defined as the commencement of intravenous antibiotics. The rise in SOFA score will be assessed within 72 hours of the commencement of antibiotics. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Peak lactate | Peak lactate within 24 hours of surgery and time to resolution of hyperlactataemia (arterial serum lactate >2.5 mmol/L) post peak. | Within 24 hours of surgery |
| Clinical events: Acute Lung Injury | Measurement of PaO2/FiO2 ratio and expressed in kPa/L. | Baseline, immediately pre-surgery, 0-6, 6-12, 24, 48, 72 and 96 hours post-operatively |
| Clinical events: Low cardiac output | Low cardiac output, defined as new intra-or postoperative intra-aortic balloon pump insertion or a cardiac index of <2.2 L/min/ m2 refractory to appropriate intravascular volume expansion after correction or attempted correction of any dysrhythmias, or the administration of the inotropes Dobutamine, Enoximone, Milrinone or Levosimendan. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Stroke | Stroke; diagnosed by brain imaging (CT or MRI), in association with new onset focal or generalized neurological deficit (defined as deficit in motor, sensory or co-ordination functions) | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Acute Liver Injury - AST (Aspartate Transaminase) | Acute liver injury will be defined as an acute derangement of liver enzymes three times the upper limit of normal, or a serum amylase concentration >1000 ng/m. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Acute Liver Injury - ALT (Alanine Transaminase) | Acute liver injury will be defined as an acute derangement of liver enzymes three times the upper limit of normal, or a serum amylase concentration >1000 ng/m. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Acute Liver Injury - Bilirubin | Acute liver injury will be defined as an acute derangement of liver enzymes three times the upper limit of normal, or a serum amylase concentration >1000 ng/m. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Acute Liver Injury - Alkaline Phosphatase | Acute liver injury will be defined as an acute derangement of liver enzymes three times the upper limit of normal, or a serum amylase concentration >1000 ng/m. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Acute Liver Injury - Serum Amylase | Acute liver injury will be defined as an acute derangement of liver enzymes three times the upper limit of normal, or a serum amylase concentration >1000 ng/m. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Acute Intestinal Injury | Acute intestinal injury will be defined a radiological, operative or post-mortem evidence of gut ischaemia. | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Clinical events: Rate of mortality | Rate of mortality at 30-days and 1 year from the date of surgery | Within 30-days from surgery and at 1 year from surgery |
| Clinical events: A composite endpoint Organ Injury, Mortality and Sepsis | As above for description of organ injury, mortality and sepsis | Time (days) measured from the start of surgery to discharge from hospital (up to 90 days) |
| Bleeding and Transfusion | The total number of units of red cells and other blood components transfused during the operative period and post-operative hospital stay will be recorded | Blood loss at 6 hours post-operatively |
| Mechanism study: Mitochondrial function of microvessels from tissue biopsies | 50-100 mg biopsies obtained from pedicled left internal mammary artery biopsies. The mitochondrial function will be measured through the Bioenergetic Health Index. The Bioenergetic Health Index (BHI) is calculated using the following formula: BHI=(ATP-linked×reserve capacity)/(proton leak×non-mitochondrial) - as described by Chacko et al. The expected range is 0-100. | At time of surgery |
| Mechanism study: microRNA isolation of microvessels from tissue biopsies | The findings will be represented by the frequency (%) of identified microRNA. 50-100 mg biopsies obtained from pedicled left internal mammary artery biopsies. | At time of surgery |
| Mechanism study: Chromatin Immunoprecipitation (ChIP) of microvessels from tissue biopsies | To identify protein binding sites that may help identify functional elements in the genome. Findings will be represented by the number (n) of binding sites. 50-100 mg biopsies obtained from pedicled left internal mammary artery biopsies. | At time of surgery |
| Mechanism study: Mitochondrial function measured in right atrium myocardium tissue biopsies | 50-100 mg myocardial biopsies will be obtained from the right atrium at surgery. The mitochondrial function will be measured through the Bioenergetic Health Index. The Bioenergetic Health Index (BHI) is calculated using the following formula: BHI=(ATP-linked×reserve capacity)/(proton leak×non-mitochondrial) - as described by Chacko et al. The expected range is 0-100. | At time of surgery |
| Mechanism study: microRNA isolation in right atrium myocardium tissue biopsies | 50-100 mg myocardial biopsies will be obtained from the right atrium at surgery. The findings will be represented by the frequency (%) of identified microRNA. | At time of surgery |
| Mechanism study: Chromatin Immunoprecipitation (ChIP) in right atrium myocardium tissue biopsies | 50-100 mg myocardial biopsies will be obtained from the right atrium at surgery. To identify protein binding sites that may help identify functional elements in the genome. Findings will be represented by the number (n) of binding sites. | At time of surgery |
| Mechanism study: Mitochondrial function measured in adipose tissue biopsies | Adipose tissue collected from epicardial fat at time of surgery. The mitochondrial function will be measured through the Bioenergetic Health Index. The Bioenergetic Health Index (BHI) is calculated using the following formula: BHI=(ATP-linked×reserve capacity)/(proton leak×non-mitochondrial) - as described by Chacko et al. The expected range is 0-100. | At time of surgery |
| Mechanism study: microRNA isolation in adipose tissue biopsies | Adipose tissue collected from epicardial fat at time of surgery. The findings will be represented by the frequency (%) of identified microRNA. | At time of surgery |
| Mechanism study: Chromatin Immunoprecipitation (ChIP) in adipose tissue biopsies | Adipose tissue collected from epicardial fat at time of surgery. To identify protein binding sites that may help identify functional elements in the genome. Findings will be represented by the number (n) of binding sites. | At time of surgery |
| Mechanism study: Measurement of microvesicles in urine samples | Identification of microvesicles. The findings will be represented by the frequency (%) of each identified microvesicle. | Baseline,1 day before surgery, 6-12, 24 and 48 hours post-operatively. |
| Mechanism study: Measurement of microRNA in urine samples | The findings will be represented by the frequency (%) of identified microRNA. | Baseline,1 day before surgery, 6-12, 24 and 48 hours post-operatively. |
| Mechanism study: Measurement of histone acetylation in urine samples | The findings will be reported as acetylated H3 (ug/mg) over time (hours) | Baseline,1 day before surgery, 6-12, 24 and 48 hours post-operatively. |
| Mechanism study: Measurement of gene expression in urine samples | Whole genome sequencing will be achieved through ATAC sequencing. The identified genes will be characterised by average expression count over ATAC. | Baseline,1 day before surgery, 6-12, 24 and 48 hours post-operatively. |
Diastolic and systolic left ventricular function will be evaluated using intra-operative trans-oesophageal echo in all patients, as per standard care.
| At time of surgery |
| Imaging Assessment (optional): Cardiac Magnetic Resonance Imaging - Cardiac Function | Assessment of cardiac function, by assessing ventricular function. This will be expressed as ejection fraction (%). Intravenous contrast will be administered via an indwelling venous catheter. | Baseline, pre-assessment and 3 months post-surgery |
| Imaging Assessment (optional): Cardiac Magnetic Resonance Imaging - Cardiac adiposity content | Assessment of cardiac adiposity content. A percentage of adipose tissue over total body mass will be calculated. Intravenous contrast will be administered via an indwelling venous catheter. | Baseline, pre-assessment and 3 months post-surgery |
| Imaging Assessment (optional): Cardiac Magnetic Resonance Imaging - Visceral adiposity content | Assessment of visceral adiposity content. A percentage of adipose tissue over total body mass will be calculated. Intravenous contrast will be administered via an indwelling venous catheter. | Baseline, pre-assessment and 3 months post-surgery |
| Fitness, Frailty and Muscle Strength: Six Minute Walk Test | Fitness will be assessed using the 6-minute walk test (6MWT) which is a standardized test that provides a valid assessment of functional performance. It provides a global assessment of exercise capacity and may better reflect daily activity than more traditional laboratory tests. | Baseline, pre-assessment and 3 months post-surgery |
| Fitness, Frailty and Muscle Strength: Hand Grip Test | Hand grip strength will be measured quantitatively by using a dynamometer. The result provides an objective index of general upper body strength and combined with appendicular lean mass (taken from the DEXA scan) could be used to define sarcopenia. | Baseline, pre-assessment and 3 months post-surgery |
| Fitness, Frailty and Muscle Strength: PRISMA-7 Questionnaire | Frailty assessment will be by use of the PRISMA-7 Questionnaire. The questions asked are: 1. Are you older than 85 years? 2. Are you male? 3. In general, do you have any health problems that require you to limit your activities? 4. Do you need someone to help you on a regular basis? 5. In general, do you have any health problems that require you to stay at home? 6. If you need help, can you count on someone close to you? 7. Do you regularly use a stick, walker or wheelchair to move about? The participant is asked to answer Yes or No to all 7 questions. SCORING: If the respondent had 3 or more "yes" answers, this indicates an increased risk of frailty and the need for further clinical review. | Baseline, pre-assessment and 3 months post-surgery |
| Activity Levels and Sleep: Accelerometer Assessments | Activity levels and sleep are measured by the use of seven day accelerometer assessments | Baseline, pre-assessment and 3 months post-surgery |
| Comorbidity and Inflammation - CRP (C-Reactive-Protein) assay (Abcam) | Pre-existing inflammation, renal impairment and heart failure will be assessed using highly sensitive CRP assay, NT-proBNP (both Abcam), and estimated Glomerular Filtration Rate (from serum creatinine). The acceptable range for CRP values using the abcam kit is 34.29 - 25,000 pg/mL. For values above 25ng/mL, the samples will be diluted and re-assayed. Samples < 34.29 pg/mL will be re-assayed at higher concentration when possible; otherwise the concentrations will be accepted if higher than assay detection limit (2 pg/L). For samples <2pg/mL a no-expression value will be assigned. | Baseline, pre-assessment and 3 months post-surgery |
| Comorbidity and Inflammation - NT-proBNP (Abcam) | Pre-existing inflammation, renal impairment and heart failure will be assessed using highly sensitive CRP assay, NT-proBNP (both Abcam), and estimated Glomerular Filtration Rate (from serum creatinine). The acceptable range for NT-proBNP values using the abcam kit is 0.14 - 100 ng/mL. For values above 100ng/mL, the samples will be diluted and re-assayed. Samples < 0.14 ng/mL will be re-assayed at higher concentration when possible; otherwise a no-expression value will be assigned. | Baseline, pre-assessment and 3 months post-surgery |
| Comorbidity and Inflammation - estimated Glomerular Filtration Rate | Pre-existing inflammation, renal impairment and heart failure will be assessed using highly sensitive CRP assay, NT-proBNP (both Abcam), and estimated Glomerular Filtration Rate (from serum creatinine). Formula for GFR (mL/min/1.73 m2) = 175 × (Scr)-1.154 × (Age)-0.203 × (0.742 if female) × (1.212 if African American) The equation does not require weight or height variables because the results are reported normalized to 1.73 m2 body surface area, which is an accepted average adult surface area. | Baseline, pre-assessment and 3 months post-surgery |
| Endothelial function: Blood samples | Markers of endothelial activation will be measured in blood samples using flow cytometry. | Baseline, 6-12 and 48 hours post-surgery |
| Endothelial function: Reactive Hyperaemia Peripheral Arterial Tonometry (RH-PAT) | Regional endothelial dysfunction will be measured as the reactive hyperaemia peripheral arterial tonometry (RH-PAT) index using the Endo-PAT 2000 (Itamar Medical Ltd., Caesarea, Israel) | 1 day before surgery and 24 hours post-surgery |
| Endothelial function: Global endothelial dysfunction | Global endothelial dysfunction will also be measured indirectly as the measured time to resolution of oxygen debt defined as the period of time from the end of surgery until the measured serum arterial lactate level falls below 2.5 mmol/L. | End of surgery, 0-6, 6-12, 24, 48, 72 and 96 hours post-operatively (until the timepoint serum arterial lactate falls below 2.5 mmol/L) |
| D001161 |
| Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D012769 | Shock |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |