UCL Institute of Cardiovascular Science


Ashraf Hamarneh

PhD Project Title: The effect of remote ischemic conditioning and glyceryl trinitrate on perioperative myocardial injury in cardiac bypass surgery patients: the ERIC-GTN study.

Supervisors: Professor Derek Yellon and Professor Derek Hausenloy

Lay summary: 

  • Introduction: Remote Ischaemic Conditioning (RIC) using transient limb ischemia/reperfusion has been reported to reduce peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery. The role of intravenous Glyceryl Trinitrate (GTN) therapy administered during cardiac surgery as a cardioprotective agent and whether it interferes with RIC cardioprotection is not clear and is investigated in the ERIC-GTN trial (Clinicaltrial.govidentifier:NCT01864252). 
  • Aims: The ERIC-GTN trial has been designed to determine whether intraoperatively administered IV GTN is cardioprotective during cardiac surgery and to investigate the interaction between RIC and IV GTN in their cardioprotective effects.

     Hypothesis 1: Intra-operative intravenous GTN will reduce PMI in patients undergoing CABG and/or valve surgery.
     Hypothesis 2: RIC will reduce PMI in the absence of GTN in patients undergoing CABG and/or valve surgery.
     Hypothesis 3: RIC will not reduce PMI in the presence of GTN in patients undergoing CABG and/or valve surgery.

  • Design:  The ERIC-GTN trial is a single site, double-blind, randomised placebo-controlled study. Consenting adult patients (>18 years) undergoing elective CABG ±valve surgery with blood cardioplegia will be eligible for inclusion. The primary endpoint will be peri-operative myocardial injury as quantified by the 72 hour area-under-the-curve (AUC) serum high sensitive Troponin-T.




Diagnostic performance of T1 and T2 mapping to detect intramyocardial hemorrhage in reperfused ST-segment elevation myocardial infarction (STEMI) patients.
Bulluck H, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M, Gonzalez-Lopez E, Ramlall M, Hamarneh A, Sirker A, Herrey AS, Manisty C, Yellon DM, Moon JC, Hausenloy DJ.
J Magn Reson Imaging. 2017 Sep;46(3):877-886. doi: 10.1002/jmri.25638. Epub 2017 Feb 15.

Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment-Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling.
Bulluck H, Rosmini S, Abdel-Gadir A, White SK, Bhuva AN, Treibel TA, Fontana M, Ramlall M, Hamarneh A, Sirker A, Herrey AS, Manisty C, Yellon DM, Kellman P, Moon JC, Hausenloy DJ.
Circ Cardiovasc Imaging. 2016 Oct;9(10). pii: e004940. 
Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post-Reperfused ST-Elevation Myocardial Infarction.
Bulluck H, Rosmini S, Abdel-Gadir A, White SK, Bhuva AN, Treibel TA, Fontana M, Gonzalez-Lopez E, Reant P, Ramlall M, Hamarneh A, Sirker A, Herrey AS, Manisty C, Yellon DM, Kellman P, Moon JC, Hausenloy DJ.
J Am Heart Assoc. 2016 Jul 11;5(7). pii: e003555. doi: 10.1161/JAHA.116.003555.

Effect of Remote Ischaemic Conditioning in Oncology Patients Undergoing Chemotherapy: Rationale and Design of the ERIC-ONC Study--A Single-Center, Blinded, Randomized Controlled Trial.
Chung R, Maulik A, Hamarneh A, Hochhauser D, Hausenloy DJ, Walker JM, Yellon DM.
Clin Cardiol. 2016 Feb;39(2):72-82. doi: 10.1002/clc.22507. Epub 2016 Jan 25.

Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery.
Hausenloy DJ, Candilio L, Evans R, Ariti C, Jenkins DP, Kolvekar S, Knight R, Kunst G, Laing C, Nicholas J, Pepper J, Robertson S, Xenou M, Clayton T, Yellon DM; ERICCA Trial Investigators.
N Engl J Med. 2015 Oct 8;373(15):1408-17. doi: 10.1056/NEJMoa1413534. Epub 2015 Oct 5.

The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC-GTN Study.
Hamarneh A, Sivaraman V, Bulluck H, Shanahan H, Kyle B, Ramlall M, Chung R, Jarvis C, Xenou M, Ariti C, Cordery R, Yellon DM, Hausenloy DJ.
Clin Cardiol. 2015 Nov;38(11):641-6. doi: 10.1002/clc.22445. Epub 2015 Sep 28.

Early targeted brain COOLing in the cardiac CATHeterisation laboratory following cardiac arrest (COOLCATH).
Islam S, Hampton-Till J, Watson N, Mannakkara NN, Hamarneh A, Webber T, Magee N, Abbey L, Jagathesan R, Kabir A, Sayer J, Robinson N, Aggarwal R, Clesham G, Kelly P, Gamma R, Tang K, Davies JR, Keeble TR.
Resuscitation. 2015 Dec;97:61-7. doi: 10.1016/j.resuscitation.2015.09.386. Epub 2015 Sep 26.

Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.
Hamarneh A.
Hosp Pract (1995). 2015;43(4):208-11. Epub 2015 Aug 3.

Exogenous SDF-1α Protects Human Myocardium from Hypoxia-Reoxygenation Injury via CXCR4.
Malik A, Bromage DI, He Z, Candilio L, Hamarneh A, Taferner S, Davidson SM, Yellon DM.
Cardiovasc Drugs Ther. 2015 Dec;29(6):589-592. doi: 10.1007/s10557-015-6622-5. 

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