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Salikhanov I, Koechlin L, Gahl B, Zellweger MJ, Haaf P, Müller C, Berdajs D. In-Hospital Graft Occlusion in Post-Coronary Artery Bypass Grafting Patients in the Early Postoperative Period: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5514. [PMID: 39337001 PMCID: PMC11432121 DOI: 10.3390/jcm13185514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: The objectives of this paper are to evaluate the incidence of early graft occlusion during hospital stays following coronary bypass surgery (CABG) and to assess the factors influencing the odds of in-hospital early graft occlusion. Methods: Reports evaluating the early in-hospital occlusion of coronary bypass grafts were identified through PubMed, Embase, and Cochrane databases. The primary endpoint was to determine the incidence of early graft occlusion following CABG before discharge and to identify and quantify the impact of demographic, clinical, and procedural risk factors on the occurrence of early graft occlusion. The meta-analysis was conducted using a random-effects inverse-variance model with the DerSimonian-Laird estimator, assessing incidence rates, risk factors, and study heterogeneity, with statistical analysis performed using Stata. Results: A total of 22 studies with 35,798 patients were included in the analysis. The overall incidence of in-hospital early graft occlusion was 5% (95% CI: 3% to 7%). In studies using symptom-driven patency assessment, the incidence of occlusion was 2%, whereas in those employing systematic graft patency assessment, it was 6%. Only the presence of a vein graft OR 2.13 (95% CI: 1.19-3.82) was significantly associated with in-hospital graft occlusion. Conclusions: The incidence of in-hospital early graft occlusion seems substantially underestimated if imaging is restricted only to symptomatic patients. Moreover, female gender, increased PI, and the presence of a composite graft could also be potential risk factors for this complication.
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Affiliation(s)
- Islam Salikhanov
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Christian Müller
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
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2
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Pölzl L, Lohmann R, Sterzinger P, Nägele F, Hirsch J, Graber M, Engler C, Eder J, Abfalterer H, Ulmer H, Griesmacher A, Grimm M, Bonaros N, Ruttmann-Ulmer E, Holfeld J, Gollmann-Tepeköylü C. Complexity of coronary artery disease and the release of cardiac biomarkers after CABG. Front Cardiovasc Med 2024; 11:1345439. [PMID: 38370160 PMCID: PMC10870426 DOI: 10.3389/fcvm.2024.1345439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Objective In patients with complex coronary artery disease (CAD) undergoing cardiac surgery, myocardial protection might be impaired due to microvascular obstruction, resulting in myocardial injury and subsequent biomarker release. Therefore, this study investigated the correlation between the complexity of CAD, reflected by the SYNTAX Score, and the release of cardiac biomarkers after CABG. Methods In a consecutive series of 919 patients undergoing isolated CABG SYNTAX scores I and II were calculated to assess the complexity of CAD. Levels of high sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-myocardial band (CK-MB) were routinely measured once before and serially after surgery. Patients were divided into tertiles according to their SYNTAX Scores I and II. Spearman correlations and regression models were performed to measure the degree of association between the release of hs-cTnT and CK-MB and the SYNTAX Scores. Results Patients with a higher SYNTAX Score I had more comorbidities reflected in a higher EuroSCORE II. Preoperatively, higher levels of cardiac biomarkers were found in patients with higher SYNTAX Score II. No correlation was observed between hs-cTnT, CK-MB and SYNTAX Score I or II. Regression models did not show any association between cardiac biomarkers and the complexity of CAD. Conclusion The complexity of CAD is not associated with the release of cardiac biomarkers after CABG. Factors influencing postoperative biomarker release need to be elucidated in future trials to include postoperative biomarker release into risk stratification models predicting outcome after cardiac surgery.
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Affiliation(s)
- Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronja Lohmann
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Sterzinger
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Engler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jonas Eder
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannes Abfalterer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Clinical Chemistry and Laboratory Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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3
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Li X, Xu C, Chen H, Yi F, Liao J, Han J, Li C, Han W, Han RPS, Chen H. A capillary-based microfluidic chip with the merits of low cost and easy fabrication for the rapid detection of acute myocardial infarction. Talanta 2023; 265:124924. [PMID: 37437393 DOI: 10.1016/j.talanta.2023.124924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
Point-of-care testing methods currently utilize rapid, portable, inexpensive, and multiplexed on-site detection. Microfluidic chips have become a very promising platform with broad development prospects due to their breakthrough improvement in miniaturization and integration. However, the conventional microfluidic chips still have disadvantages, such as difficulty in fabrication processing, long production time and high cost, which hinder its applications in the fields of POCT and in vitro diagnostics. In this study, a capillary-based microfluidic chip with the characteristics of low cost and easy fabrication was developed for the rapid detection of acute myocardial infarction (AMI). Several short capillaries, which were already conjugated with the capture antibodies respectively, were connected by peristaltic pump tubes and then formed the working capillary. Two working capillaries were encapsulated in the plastic shell and ready for the immunoassay. Multiplex detection of Myoglobin (Myo), cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) were chosen to demonstrate the feasibility and analytical performance of the microfluidic chip, which requires rapid and accurate detection during diagnosis and therapy for AMI. The capillary-based microfluidic chip required tens of minutes to prepared, and its cost was less than $1. The limit of detection (LOD) was 0.5 ng/mL for Myo, 0.1 ng/mL for cTnI and 0.5 ng/mL for CK-MB respectively. The capillary-based microfluidic chips with easy fabrication and low cost hold promise for the portable and low-cost detection of target biomarkers.
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Affiliation(s)
- Xiuxiu Li
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, Fujian, 361005, China
| | - Chenglong Xu
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, Fujian, 361005, China
| | - Hao Chen
- Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, 330004, China
| | - Fei Yi
- Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, 330004, China
| | - Jiaqi Liao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, Fujian, 361005, China
| | - Jianmei Han
- Shenzhen Shaanxi Coal Hi-tech Research Institute Co., Ltd, Shenzhen, Guangdong, 518000, China
| | - Chonghao Li
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, Fujian, 361005, China
| | - Weihua Han
- School of Materials and Environmental Engineering, Chengdu Technological University, Chengdu, Sichuan, 611730, China
| | - Ray P S Han
- Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, 330004, China.
| | - Hong Chen
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, Fujian, 361005, China; Jiujiang Research Institute of Xiamen University, Jiujiang, Jiangxi, 332000, China.
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4
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Heuts S, Gollmann-Tepeköylü C, Denessen EJS, Olsthoorn JR, Romeo JLR, Maessen JG, van ‘t Hof AWJ, Bekers O, Hammarsten O, Pölzl L, Holfeld J, Bonaros N, van der Horst ICC, Davidson SM, Thielmann M, Mingels AMA. Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications. Eur Heart J 2023; 44:100-112. [PMID: 36337034 PMCID: PMC9897191 DOI: 10.1093/eurheartj/ehac604] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
The use of biomarkers is undisputed in the diagnosis of primary myocardial infarction (MI), but their value for identifying MI is less well studied in the postoperative phase following coronary artery bypass grafting (CABG). To identify patients with periprocedural MI (PMI), several conflicting definitions of PMI have been proposed, relying either on cardiac troponin (cTn) or the MB isoenzyme of creatine kinase, with or without supporting evidence of ischaemia. However, CABG inherently induces the release of cardiac biomarkers, as reflected by significant cTn concentrations in patients with uncomplicated postoperative courses. Still, the underlying (patho)physiological release mechanisms of cTn are incompletely understood, complicating adequate interpretation of postoperative increases in cTn concentrations. Therefore, the aim of the current review is to present these potential underlying mechanisms of cTn release in general, and following CABG in particular (Graphical Abstract). Based on these mechanisms, dissimilarities in the release of cTnI and cTnT are discussed, with potentially important implications for clinical practice. Consequently, currently proposed cTn biomarker cut-offs by the prevailing definitions of PMI might warrant re-assessment, with differentiation in cut-offs for the separate available assays and surgical strategies. To resolve these issues, future prospective studies are warranted to determine the prognostic influence of biomarker release in general and PMI in particular.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Ellen J S Denessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Jamie L R Romeo
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Arnoud W J van ‘t Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Otto Bekers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ola Hammarsten
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Iwan C C van der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Alma M A Mingels
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
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5
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Yousefi F, Movahedpour A, Shabaninejad Z, Ghasemi Y, Rabbani S, Sobnani-Nasab A, Mohammadi S, Hajimoradi B, Rezaei S, Savardashtaki A, Mazoochi M, Mirzaei H. Electrochemical-Based Biosensors: New Diagnosis Platforms for Cardiovascular Disease. Curr Med Chem 2020; 27:2550-2575. [DOI: 10.2174/0929867326666191024114207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023]
Abstract
One of the major reasons for mortality throughout the world is cardiovascular diseases.
Therefore, bio-markers of cardiovascular disease are of high importance to diagnose and manage procedure.
Detecting biomarkers provided a promising procedure in developing bio-sensors. Fast, selective,
portable, accurate, inexpensive, and sensitive biomarker sensing instruments will be necessary for
detecting and predicting diseases. One of the cardiac biomarkers may be ordered as C-reactive proteins,
lipoprotein-linked phospho-lipase, troponin I or T, myoglobin, interleukin-6, interleukin-1, tumor necrosis
factor alpha, LDL and myeloperoxidase. The biomarkers are applied to anticipate cardio-vascular
illnesses. Initial diagnoses of these diseases are possible by several techniques; however, they are laborious
and need costly apparatus. Current researches designed various bio-sensors for resolving the respective
issues. Electrochemical instruments and the proposed bio-sensors are preferred over other
methods due to its inexpensiveness, mobility, reliability, repeatability. The present review comprehensively
dealt with detecting biomarkers of cardiovascular disease through electro-chemical techniques.
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Affiliation(s)
- Fatemeh Yousefi
- Department of Biological Sciences, Faculty of Genetics, Tarbiat Modares University, Tehran, Iran
| | - Ahmad Movahedpour
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shabaninejad
- Department of Biological Sciences, Faculty of Nanotechnology, Tarbiat Modares University, Tehran, Iran
| | - Younes Ghasemi
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Rabbani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sobnani-Nasab
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Mohammadi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Hajimoradi
- Cardiology Department of Shohaday-e-Tajrish Hospital Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Samaneh Rezaei
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Savardashtaki
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Mazoochi
- Department of Cardiology, Cardiac Electrophysiology Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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6
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Pangi M, Govindaiah S, Siddaiah V, Samraaj J. Relevance of Cardiac Troponin in Predicting Postoperative Myocardial Infarction. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Thielmann M, Sharma V, Al-Attar N, Bulluck H, Bisleri G, Bunge J, Czerny M, Ferdinandy P, Frey UH, Heusch G, Holfeld J, Kleinbongard P, Kunst G, Lang I, Lentini S, Madonna R, Meybohm P, Muneretto C, Obadia JF, Perrino C, Prunier F, Sluijter JPG, Van Laake LW, Sousa-Uva M, Hausenloy DJ. ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J 2019; 38:2392-2407. [PMID: 28821170 PMCID: PMC5808635 DOI: 10.1093/eurheartj/ehx383] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Vikram Sharma
- Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.,The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Nawwar Al-Attar
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Agamemnon Street, G81 4DY, Clydebank, UK
| | - Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, 99 University Avenue, Kingston, Ontario K7L 3N6, Canada
| | - Jeroen Bunge
- Department of Intensive Care, Erasmus Medical Center,'s-Gravendijkwal 230, 3015 CE Rotterdam, Holland
| | - Martin Czerny
- Department of Cardiac Surgery, University Heart Center Freiburg-Bad Krozingen, Hugstetterstrasse 55, Freiburg, D-79106, Germany
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, H - 1085 Budapest, Hungary.,Pharmahungary Group, Szeged, Graphisoft Park, 7 Záhony street, Budapest, H-1031, Hungary
| | - Ulrich H Frey
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany
| | - Johannes Holfeld
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Christoph-Probst-Platz 1, Innrain 52, A-6020 Innsbruck, Austria
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany
| | - Gudrun Kunst
- Department of Anaesthetics, King's College Hospital and King's College London, Denmark Hill, London, SE5 9RS, UK
| | - Irene Lang
- Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Vienna, Austria
| | - Salvatore Lentini
- Department of Cardiac Surgery, The Salam Center for Cardiac Surgery, Soba Hilla, Khartoum, Sudan, Italy
| | - Rosalinda Madonna
- Center of Aging Sciences and Translational Medicine-CESI-Met and Institute of Cardiology, Department of Neurosciences, Imaging and Clinical Sciences "G. D"'Annunzio University, Via dei Vestini, 66100 Chieti, Italy.,The Center for Cardiovascular Biology and Atherosclerosis Research, Department of Internal Medicine, The University of Texas Medical School at Houston, 6431 Fannin Street, MSB 1.240, Houston, TX 77030, USA
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Claudio Muneretto
- Department of Cardiac Surgery, University of Brescia Medical School. P.le Spedali Civili, 1., Brescia, 25123, Italy
| | - Jean-Francois Obadia
- Department of Cardiothoracic Surgery, Louis Pradel Hospital, 28 Avenue du Doyen Jean Lépine, 69677 Bron Cedex, Lyon, France
| | - Cinzia Perrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Corso Umberto I 40 - 80138 Naples, Italy
| | - Fabrice Prunier
- Department of Cardiology, Institut MITOVASC, University of Angers, University Hospital of Angers, 2 rue Lakanal, 49045 Angers Cedex 01, Angers, France
| | - Joost P G Sluijter
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Linda W Van Laake
- Department of Cardiology, Division of Heart and Lungs and Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Miguel Sousa-Uva
- Department of Cardiothoracic Surgery, Hospital da Cruz Vermelha, Lisbon, Portugal
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Maple House Suite A 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK.,Cardiovascular and Metabolic Disorder Research Program, Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
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8
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Al-Riyami AZ, Al-Khabori M, Baskaran B, Al-Lawati H, Mukaddirov M, Al-Sabti HA. Impact of Blood Transfusion on Troponin I Levels and Outcomes after Cardiac Surgery: A Cohort Study. Oman Med J 2019; 34:14-19. [PMID: 30671179 PMCID: PMC6330194 DOI: 10.5001/omj.2019.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives Increased cardiac troponin I (TI) has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries. Methods We conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours (TI24) (> 6.5 µg/L vs. ≤ 6.5 µg/L). The impact of transfusion on TI levels was estimated using logistic regression and adjusted for using a multivariable model that included aortic cross-clamp time and preoperative ejection fraction. The effect of TI on the clinical outcomes was examined. Results Red blood cell (RBC) transfusion was found to be associated with high TI levels (odds ratio (OR) = 2.33, p = 0.007, 95% confidence interval (CI): 1.30–4.30). A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for (OR = 2.06, p = 0.080, 95% CI: 0.90–4.70). An association was found between aortic cross-clamp time and high TI levels in the multivariable model (OR = 1.01, p = 0.028, 95% CI: 1.00–1.02). Elevated TI levels was associated with higher mortality (OR = 4.15, p = 0.017, 95% CI: 1.29–13.08), renal failure (OR = 2.99, p = 0.004, 95% CI: 1.41–6.32), and increased length of stay in-hospital (OR = 4.50, p = 0.020, 95% CI: 0.69–8.30). Conclusions RBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Balan Baskaran
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Hilal A Al-Sabti
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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9
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Troponin I levels before bypass surgery after acute myocardial infarction; When to operate? JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.416286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Thielmann M, Pasa S, Holst T, Wendt D, Dohle DS, Demircioglu E, Sharma V, Jakob H. Heart-Type Fatty Acid Binding Protein and Ischemia-Modified Albumin for Detection of Myocardial Infarction After Coronary Artery Bypass Graft Surgery. Ann Thorac Surg 2017; 104:130-137. [PMID: 28189274 DOI: 10.1016/j.athoracsur.2016.10.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Heart-type fatty acid binding protein (hFABP) and ischemia-modified albumin (IMA) have been put forward as novel biomarkers to detect myocardial injury shortly after onset of ischemia. We compared hFABP and IMA with cardiac troponin I (cTnI) for speed and reliability in the diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass graft surgery (CABG). METHODS In all, 210 consecutive patients undergoing isolated CABG with cardiopulmonary bypass were enrolled in a prospective study. Blood samples were taken perioperatively and throughout the first 72 hours after surgery; clinical data and events were recorded. In cohort A, serum concentrations of hFABP and cTnI were measured using a combined quantitative bedside assay. In cohort B, IMA and cTnI serum concentrations were measured using an albumin cobalt binding test. Perioperative myocardial infarction was defined using a cTnI cutoff of greater than 10.5 ng/mL occurring within 24 hours of CABG or new electrocardiographic changes. RESULTS In cohort A, 14 patients were identified with PMI (group 1), whereas 94 had no PMI and served as controls (group 2). Both hFABP and cTnI were increased in group 1 as compared with group 2 (p < 0.001). Although cTnI did not differ before 12 hours, hFABP diverged much earlier, at 1 hour postoperatively (p < 0.001). An hFABP concentration of 20 μg/mL at 1 hour detected PMI with an area under the curve of 77.1%. In cohort B, 18 patients were identified with PMI (group 3), and 84 patients served as controls (group 4). No difference in cTnI values could be observed between the groups until 12 hours postoperatively. Ischemia-modified albumin failed to differentiate at any postoperative time point; the low discriminative power of IMA was confirmed with an area under the curve of 53.3% at 1 hour, 48.5% at 6 hours, and 39.3% at 12 hours postoperatively. CONCLUSIONS Heart-type fatty acid binding protein is a sensitive and rapid biomarker that detected PMI reliably at 1 hour after CABG, much earlier than cTnI. The diagnostic value of IMA for detection of PMI appears to be very limited in this setting.
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Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
| | - Susanne Pasa
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany
| | - Torulv Holst
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany
| | - Daniel-Sebastian Dohle
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany
| | - Ender Demircioglu
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany
| | - Vikram Sharma
- Hatter Cardiovascular Institute, London, United Kingdom, and Department of Internal Medicine, The Cleveland Clinic, Cleveland, Ohio
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany
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11
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Hultgren K, Andreasson A, Axelsson TA, Albertsson P, Lepore V, Jeppsson A. Acute coronary angiography after coronary artery bypass grafting. SCAND CARDIOVASC J 2016; 50:123-7. [PMID: 26853097 DOI: 10.3109/14017431.2016.1143112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Coronary angiography is the golden standard when myocardial ischemia after CABG occurs. We summarize our experience of acute coronary angiography after CABG. DESIGN All 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG 2007 to 2012 were included in this retrospective observational study. Incidence, indications, findings, measures of acute angiography after CABG was assessed. Outcome variables were compared between patients who underwent angiography and those who did not. RESULTS Eighty-seven patients (2%) underwent acute coronary angiography. Patients undergoing angiography had ECG changes (92%), echocardiographic alterations (48%), hemodynamic instability (28%), angina (15%), and/or arrhythmia (13%). Positive findings were detected in 69% of the cases. Only ECG changes as indication for angiography had a moderate association with positive findings, but the precision increased if other sign(s) of ischemia were present. Thirty-day mortality (7% versus 2%, p = 0.002) was higher and long-term-cumulative survival lower (77% versus 87% at five years, p = 0.043) in angiography patients. CONCLUSIONS Acute angiography is a rare event after CABG. Postoperative myocardial ischemia leading to acute coronary angiography is associated with increased short-term and long-term mortality.
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Affiliation(s)
- Karin Hultgren
- a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Anders Andreasson
- a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Tomas A Axelsson
- b Faculty of Medicine , Landspitali University Hospital, University of Iceland , Reykjavik , Iceland
| | - Per Albertsson
- c Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Vincenzo Lepore
- a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Anders Jeppsson
- a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden ;,d Department of Molecular and Clinical Medicine , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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12
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Cardiac troponin T is an important predictor of mortality after cardiac surgery. J Crit Care 2016; 38:41-46. [PMID: 27837691 DOI: 10.1016/j.jcrc.2016.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Serum troponin (cTnT) levels, a commonly measured biomarker of myocardial injury, has rarely been considered in risk models after cardiac surgery. MATERIALS AND METHODS Retrospective study of patients undergoing any cardiac surgery between 2004 and 2012. Patients with a history of recent myocardial injury (<21 days) were excluded. The minimum P value approach was used to determine categories of peak cTnT associated with in-hospital death. A multivariable analysis was performed to identify independent predictors of mortality. RESULTS A total of 5318 patients without evidence of preoperative ischemia underwent a number of cardiac surgical interventions ranging from isolated coronary revascularization to combined valve coronary artery bypass grafting. The unadjusted in-hospital mortality rate was 3.3% (n = 175 patients). Four categories of peak cTnT were identified using the minimum P value approach: less than or equal to 0.6 ng/mL, 0.7 to 1.9 ng/mL, 2.0 to 3.1 ng/mL, and greater than 3.1 ng/mL with unadjusted mortality rates of 1.0%, 3.6%, 10.1%, and 33.1%, respectively. Multivariate logistic regression demonstrated that all peak cTnT levels greater than 0.6 ng/mL were independent predictors of in-hospital mortality in a dose-dependent manner. CONCLUSIONS We demonstrate that in patients without preoperative myocardial ischemia, the demonstration of myocardial injury (>0.6 ng/mL) in the postoperative period is highly predictive of in-hospital death.
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van Beek D, van Zaane B, Looije M, Peelen L, van Klei W. Typical rise and fall of troponin in (peri-procedural) myocardial infarction: A systematic review. World J Cardiol 2016; 8:293-301. [PMID: 27022461 PMCID: PMC4807318 DOI: 10.4330/wjc.v8.i3.293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/18/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the typical shape of the rise and fall curve of troponin (Tn) following the different types of myocardial infarction (MI).
METHODS: We conducted a systematic search in PubMed and Embase including all studies which focused on the kinetics of Tn in MI type 1, type 4 and type 5. Tn levels were standardized using the 99th percentile, a pooled mean with 95%CI was calculated from the weighted means for each time point until 72 h.
RESULTS: A total of 34 of the 2528 studies identified in the systematic search were included. The maximum peak level of the Tn was seen after 6 h after successful reperfusion of an acute MI, after 12 h for type 1 MI and after 72 h for type 5 MI. In type 1 MI there were additional smaller peaks at 1 h and at 24 h. After successful reperfusion of an acute MI there was a second peak at 24 h. There was not enough data available to analyze the Tn release after MI associated with percutaneous coronary intervention (type 4).
CONCLUSION: The typical rise and fall of Tn is different for type 1 MI, successful reperfusion of an acute MI and type 5 MI, with different timing of the peak levels and different slopes of the fall phase.
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14
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Deng MH, Lin CW, Sun YN, Zeng XL, Wen F. Role of E-selectin for diagnosing myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia. Ann Clin Biochem 2016; 54:49-54. [PMID: 26843511 DOI: 10.1177/0004563216631570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Backgrounds Effects of myocardial injury on E-selectin remain unclear. Thus, we investigated the diagnostic value of E-selectin for myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia. Methods In this prospective and blinded clinical study, plasma E-selectin, cardiac troponin I, creatine kinase isoenzyme MB, interleukin-6 and tumor necrosis factor alpha concentrations were measured in paediatric patients with mycoplasma pneumoniae pneumonia (MPP group, n = 138). The control group comprised 120 healthy children. The definition of cardiac injury was based on cardiac troponin I or CK-MB (with or possibly without abnormal electrocardiogram evidence). Diagnostic value of E-selectin for myocardial injury was determined by analysing receiver operating characteristic curves. Results Among the 138 mycoplasma pneumoniae pneumonia patients, 40 patients were identified with myocardial injury, while 98 patients were identified without myocardial injury. Plasma E-selectin concentrations were: 40.22 ± 4.80 ng/mL, in patients with myocardial injury; 18.55 ± 2.16 ng/mL, in patients without myocardial injury and 12.39 ± 3.27 ng/mL, in healthy children. For the 40 patients identified with myocardial injury, area under the receiver operating characteristic curve value for plasma E-selectin concentrations was 0.945 (95% CI: 0.899-0.991), and optimal diagnostic cut-off value was 29.93 ng/mL (positive likelihood ratio = 72.5). Conclusion E-selectin was shown to be an effective index for myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia, and its role in other causes of myocardial injury warrants further investigation.
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Affiliation(s)
- Ming-Hong Deng
- The Affiliated Shunde Women and Children's Hospital of Jinan University, Shunde, Guangdong, P. R. China
| | - Chun-Wang Lin
- The Affiliated Shunde Women and Children's Hospital of Jinan University, Shunde, Guangdong, P. R. China
| | - Yan-Na Sun
- The Affiliated Shunde Women and Children's Hospital of Jinan University, Shunde, Guangdong, P. R. China
| | - Xiang-Lin Zeng
- The Affiliated Shunde Women and Children's Hospital of Jinan University, Shunde, Guangdong, P. R. China
| | - Fang Wen
- The Affiliated Shunde Women and Children's Hospital of Jinan University, Shunde, Guangdong, P. R. China
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15
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Kocak EF, Kocak C, Aksoy A, Isiklar OO, Akcilar R, Ozdomanic IF, Unsal C, Celenk M, Altuntas I. High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery. Cardiovasc J Afr 2015. [PMID: 26212819 PMCID: PMC4780022 DOI: 10.5830/cvja-2015-052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim To determine whether there is a correlation between cardiac markers and peri-operative myocardial injury (PMI) and apoptosis in coronary artery bypass graft (CABG) surgery and to compare the efficacy of cardiac markers to detect PMI. Methods The study population consisted of 37 patients (24 male, 13 female, mean age 63.4 ± 8.9 years) undergoing elective CABG. Arterial and coronary sinus blood samples were collected just before aortic cross-clamping (pre-ACC) and after aortic declamping (post-ACC). Creatine kinase-MB isoenzyme (CK-MB) activity, and high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB isoenzyme mass (CK-MB mass) and cardiac troponin I (cTnI) concentrations were measured in blood samples. Myocardial injury and apoptosis were examined in atrial biopsies. Results CABG caused PMI and apoptosis in all cases. Concentrations and net releases of cardiac markers significantly increased after aortic declamping (p < 0.001 for CK-MB and CK-MB mass, p < 0.01 for cTnI, p < 0.05 for hs-cTnT). A positive correlation was found between apoptotic index (r = 0.611, p < 0.001 for cTnI; r = 0.806, p < 0.001 for hs-cTnT), myocardial injury score (r = 0.544, p < 0.001 for cTnI; r = 0.719, p < 0.001 for hs-cTnT) and cTnI and hs-cTnT values in the post-ACC period. A positive correlation was found between apoptotic index (r = 0.507, p < 0.001), myocardial injury score (r = 0.416, p = 0.010) and net release of hs-cTnT. Furthermore, a positive correlation was found between aortic cross-clamp (ACC) time (r = 0.448, p = 0.007), cardiopulmonary bypass (CPB) time (r = 0.342, p = 0.047) and net release of hs-cTnT. Conclusion Although both cTnI and hs-cTnT may be specific and efficacious markers of myocardial apoptosis and injury occurring during CABG with CPB, hs-cTnT may be a more useful marker than cTnI to detect peri-operative myocardial apoptosis and injury.
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Affiliation(s)
- Emel Fatma Kocak
- Department of Medical Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
| | - Cengiz Kocak
- Department of Pathology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Ahmet Aksoy
- Department of Cardiovascular Surgery, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey
| | - Ozden Ozben Isiklar
- Department of Medical Biochemistry, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey
| | - Raziye Akcilar
- Department of Physiology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Ibrahim Fevzi Ozdomanic
- Department of Cardiovascular Surgery, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey
| | - Cevher Unsal
- Department of Anesthesiology and Reanimation, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey
| | - Merve Celenk
- Department of Medical Biochemistry, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey
| | - Irfan Altuntas
- Department of Medical Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
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16
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Perrotti A, Luporsi P, Durst C, Vernerey D, Chocron S. Early detection of asymptomatic bypass graft abnormalities using a cardiac troponin I ratio following coronary artery bypass surgery. J Card Surg 2015; 30:319-23. [PMID: 25644326 DOI: 10.1111/jocs.12517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We sought to identify the best cardiac Troponin I (cTnI) ratio to detect asymptomatic graft or anastomoses anomalies after myocardial revascularization. METHODS Patients with a rising cTnI profile, based on measurements at 6 and 12 hours (cTnI 12 hours : 6 hours ratio >1) after the last anastomosis in off-pump surgery or after cardiopulmonary bypass in on-pump surgery, underwent a coronary angiogram, despite an uncomplicated postoperative course and absence of electrocardiogram changes. The optimal threshold value for the ratio was determined using a receiving operator characteristic (ROC) curve. RESULTS From April 2005 to May 2011, among 1693 patients undergoing isolated coronary artery bypass graft (CABG), 29 (1.7%) had a cTnI ratio >1 and underwent postoperative angiography. Twenty abnormalities were observed in 16 patients (55%). In the anastomoses, there were four occlusions and four stenosis. In the grafts, there were 12 stenosis: two of the Y graft anastomosis, two dissections, five hematomas and three kinking. TIMI flow grade based on results of the Thrombolysis In Myocardial Infarction trial was 3 in six patients, 1 in five, and 0 in five. In the 16 patients with lesions, the cTnI ratio was 2.1 ± 1.4 versus 1.4 ± 0.3 in patients with no lesions (p = 0.09). A ratio of 1.3 (p = 0.003) was determined by ROC curve analysis as having the greatest discriminant capacity, with associated sensitivity of 87.5% and specificity of 62%. CONCLUSION A cTnI 12 hours : 6 hours ratio >1.3 may be indicative of these abnormalities. Early identification of these anomalies may avoid adverse outcomes.
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Affiliation(s)
- Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
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17
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Grobben RB, Nathoe HM, Januzzi JL, van Kimmenade RRJ. Cardiac markers following cardiac surgery and percutaneous coronary intervention. Clin Lab Med 2014; 34:99-111, vii. [PMID: 24507790 DOI: 10.1016/j.cll.2013.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Differentiation between procedure-related necrosis and postprocedural myocardial infarction (MI) is challenging because of the inherent association of these procedures to varying levels of myocardial injury. To improve risk stratification of patients at risk of an acute MI, the universal definition of MI implemented cardiac biomarker thresholds. The cutoff points for these thresholds, however, are largely arbitrary and lack therapeutic implications. Measurement of cardiac marker concentrations after percutaneous coronary intervention and cardiac surgery should, therefore, be used as a marker of baseline risk, atherosclerosis burden, and procedural complexity rather than a conclusive marker to diagnose acute MI.
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Affiliation(s)
- Remco B Grobben
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - James L Januzzi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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18
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van Boxtel AGM, Bramer S, Soliman Hamad MA, van Straten AHM. Perioperative serum aspartate aminotransferase level as a predictor of survival after coronary artery bypass grafting. Ann Thorac Surg 2012; 94:1492-8. [PMID: 22841017 DOI: 10.1016/j.athoracsur.2012.05.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elevated cardiac enzymes after coronary artery bypass grafting (CABG) surgery have been identified as a risk factor for worse postoperative outcome. Cardiac enzymes play an important role in the diagnosis of perioperative myocardial infarction. This study aims to investigate the predictive value of aspartate aminotransferase (AST) with respect to early and late mortality after CABG. METHODS Patients undergoing isolated CABG in a single center between January 1998 and December 2010 were prospectively enrolled in our database. Patients were arbitrarily divided into 4 groups according to the postoperative AST level: group 1 (AST < 50 U/L), group 2 (AST = 51 to 100 U/L), group 3 (AST = 101 to 200 U/L), group 4 (AST = 201 to 300 U/L), and group 5 (AST > 300 U/L). The impact of biomedical variables on early mortality was determined using univariate and multivariate logistic regression analyses. Risk factors for late mortality were identified using Cox proportional hazard regression analyses. RESULTS The study population consisted of 13,505 patients who underwent isolated CABG. Postoperative AST level was identified as a risk factor for early (odds ratio = 3.6 [2.5 to 5.4], p < 0.0001) and late mortality (hazard ratio = 1.4 [1.2 to 1.7], p < 0.001). After correction for other risk factors, AST level was an independent predictor of worse survival. CONCLUSIONS Elevated postoperative AST level is an independent predictor of early and late mortality after CABG. Although it is not a specific indicator for cardiac damage, it can reflect ischemic effects on the other organs as an indirect sign of depressed cardiac function.
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Affiliation(s)
- Astrid G M van Boxtel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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19
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Thielmann M. Remote ischemic preconditioning in cardiac surgery: caught between clinical relevance and statistical significance? Basic Res Cardiol 2012; 107:259. [DOI: 10.1007/s00395-012-0259-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 01/05/2023]
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20
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Amin AP, Mukhopadhyay E, Napan S, Mamtani M, Kelly RF, Kulkarni H. Value of early cardiac troponin I to predict long-term adverse events after coronary artery bypass graft surgery in patients presenting with acute coronary syndromes. Clin Cardiol 2010; 32:386-92. [PMID: 19609893 DOI: 10.1002/clc.20579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher rates of short-term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear. HYPOTHESIS Measurement of cTnI very early after admission to the emergency room can be used as a prognosticator for long-term outcomes after CABG. METHODS We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow-up of 290.42 person-years. Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to determine whether early cTnI measurement can independently predict the adverse outcomes in the study subjects. RESULTS In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise in early cTnI is associated with a 3% (95% confidence interval [CI]: 2%- 5%, p < 0.001) faster progression to long-term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times faster to adverse outcomes (95% CI: 1.05-6.36, p = 0.039). This effect remained after adjustment for other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and electrocardiographic ischemia. CONCLUSION Early cTnI measurement after admission can predict adverse outcomes after CABG. This association extends to long-term adverse events after CABG.
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Affiliation(s)
- Amit P Amin
- The John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
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Diagnóstico y alternativas terapéuticas en la isquemia miocárdica aguda perioperatoria en cirugía coronaria. Med Intensiva 2010; 34:64-73. [DOI: 10.1016/j.medin.2008.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 11/18/2008] [Accepted: 11/29/2008] [Indexed: 11/20/2022]
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Petäjä L, Salmenperä M, Pulkki K, Pettilä V. Biochemical injury markers and mortality after coronary artery bypass grafting: a systematic review. Ann Thorac Surg 2009; 87:1981-92. [PMID: 19463650 DOI: 10.1016/j.athoracsur.2008.12.063] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Revised: 12/12/2008] [Accepted: 12/15/2008] [Indexed: 11/30/2022]
Abstract
The strength of the association between cardiac biomarker release and prognosis is uncertain. We performed a systematic literature search to find articles regarding these markers and death after coronary surgical interventions, and evaluated the results with meta-analytic methods. We found 23 articles concerning 29,483 patients that reported the MB fraction of creatine kinase (CK-MB) and troponin T and I. Heterogeneity of existing studies prevented the pooling of the results of troponin studies. The pooled data of the CK-MB studies suggest that after coronary artery bypass grafting, CK-MB release of more than five to eight times the upper limit of the reference range is associated with an increased risk of death during the next 40 months.
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Affiliation(s)
- Liisa Petäjä
- Department of Anesthesiology and Intensive Care Medicine of Helsinki University Central Hospital, Helsinki, Finland.
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Guney MR, Ketenci B, Yapici F, Sokullu O, Firat MF, Uyarel H, Yapici N, Cinar B, Demirtas M. Results of Treatment Methods in Cardiac Arrest Following Coronary Artery Bypass Grafting. J Card Surg 2009; 24:227-33. [DOI: 10.1111/j.1540-8191.2008.00760.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chowdhury UK, Malik V, Yadav R, Seth S, Ramakrishnan L, Kalaivani M, Reddy SM, Subramaniam GK, Govindappa R, Kakani M. Myocardial injury in coronary artery bypass grafting: On-pump versus off-pump comparison by measuring high-sensitivity C-reactive protein, cardiac troponin I, heart-type fatty acid–binding protein, creatine kinase-MB, and myoglobin release. J Thorac Cardiovasc Surg 2008; 135:1110-9, 1119.e1-10. [DOI: 10.1016/j.jtcvs.2007.12.029] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 12/17/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
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Simon C, Capuano F, Roscitano A, Benedetto U, Comito C, Sinatra R. Cardiac troponin I vs EuroSCORE: myocardial infarction and hospital mortality. Asian Cardiovasc Thorac Ann 2008; 16:97-102. [PMID: 18381864 DOI: 10.1177/021849230801600203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perioperative myocardial infarction is the most common cause of morbidity and mortality in cardiac surgery. It occurs in 8% to 35% of patients. The primary aim of this prospective study was to determine the level of cardiac troponin I that indicates perioperative myocardial infarction in patients undergoing coronary artery bypass. A secondary goal was to establish the best independent predictor of hospital death. There were 180 consecutive patients undergoing isolated coronary artery bypass surgery enrolled in this study. Values of cardiac troponin I > 12.9 ng.mL(-1) at 8 hours postoperatively predicted perioperative myocardial infarction with a sensitivity of 100% and a specificity of 93.2%. Compared to patients who survived, those who suffered hospital death were significantly older (74 +/- 7 vs 63 +/- 10 years), had significantly higher levels of cardiac troponin I at 24 hours (9 +/- 17 vs 27.3 +/- 16 ng.mL(-1)) and 48 hours (6.9 +/- 19 vs 30.3 +/- 24 ng.mL(-1)) postoperatively, and a significantly higher EuroSCORE (9 +/- 2 vs 4 +/- 3). At 8 hours postoperatively, cardiac troponin I led to an earlier diagnosis of perioperative myocardial infarction, while EuroSCORE was the strongest independent predictor of hospital death.
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Affiliation(s)
- Caterina Simon
- Department of Cardiac Surgery, St. Andrea Hoursospital, University of Rome "La Sapienza", Rome, Italy.
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Paparella D, Cappabianca G, Malvindi P, Paramythiotis A, Galeone A, Veneziani N, Fondacone C, de Luca Tupputi Schinosa L. Myocardial injury after off-pump coronary artery bypass grafting operation. Eur J Cardiothorac Surg 2007; 32:481-7. [PMID: 17643993 DOI: 10.1016/j.ejcts.2007.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 05/29/2007] [Accepted: 06/14/2007] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Perioperative myocardial ischemia is less pronounced in off-pump coronary artery bypass (OPCAB) compared to on-pump coronary artery bypass; however, the threshold over which the postoperative release of cardiac troponin I (cTnI) release and creatine kinase-MB (CK-MB) after OPCAB should be considered clinically relevant is unknown. The study was designated to evaluate if perioperative myocardial damage, measured by means of postoperative release of cTnI and CK-MB, has an influence on short- and mid-term outcome after OPCAB operations. METHODS Two hundred and sixty-one unselected patients undergoing OPCAB had cTnI and CK-MB measured preoperatively and nine times postoperatively. Postoperative peak values were evaluated and the 80th percentiles were used to segregate the population into two groups for each marker. The following cut-offs were used: 7.1 ng/dl for cTnI peak and 36.3 ng/dl for CK-MB peak. RESULTS Patients with cTnI>7.1 ng/ml (n=51) and CK-MB>36.3 ng/ml (n=48) had a longer mechanical ventilation and ICU length of stay. Nevertheless, hospital mortality did not differ between groups. Survival after 3 years was 92.8+/-2.3% and 81.8+/-6.2 for patients with postoperative cTnI peak<or=7.1 ng/ml and >7.1 ng/ml, respectively (p=0.003). It was 93+/-2.2% and 80+/-6.8% for patients with CK-MB<or=36.3 ng/ml and >36.3 ng/ml, respectively (p=0.005). Adjusted hazard ratios for mid-term mortality were HR 2.7 (CI 1-7.6), p=0.05 for cTnI>7.1 ng/dl and HR 3.1 (CI 1-9.1), p=0.04 for CK-MB>36.3 ng/ml. CONCLUSION Perioperative myocardial damage should not be considered an innocuous event following OPCAB operations since the survival rate over 3 years is significantly worse in patients with the highest postoperative peak release of cTnI and CK-MB.
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Affiliation(s)
- Domenico Paparella
- Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Italy.
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Hofmann D, Buettner M, Rissner F, Wahl M, Sakka SG. Prognostic value of serum myoglobin in patients after cardiac surgery. J Anesth 2007; 21:304-10. [PMID: 17680179 DOI: 10.1007/s00540-007-0507-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 01/29/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE Serum myoglobin as a marker of myocardial damage and injury has been shown to be of prognostic value in patients with cardiovascular events. In this study, we analyzed the prognostic value of serum myoglobin in comparison to other parameters of muscle damage and renal function in patients after cardiac surgery. METHODS We retrospectively analyzed data from 373 cardiac surgical patients (mean age, 66 +/- 10 years; range, 30-88 years) by using the highest levels of serum myoglobin, creatinine, and creatine phosphokinase (CK) within the first 24 h after admission to the Intensive Care Unit (ICU). Patients' severity of illness was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II score. Predictive properties, in terms of ICU mortality and need for renal replacement therapy (RRT), were analyzed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC). RESULTS Serum myoglobin was significantly higher in nonsurvivors (n = 29) than in survivors (n = 344; median, 1449 vs 356 microg x l(-1); P < 0.001). With respect to ICU mortality, AUCs were 0.81 for myoglobin, 0.80 for creatinine, and 0.63 for CK. For comparison, an AUC of 0.82 was found for the APACHE II score. In terms of the need for RRT, AUCs were 0.87 for myoglobin, 0.92 for creatinine, and 0.60 for CK. For both endpoints, the AUCs of myoglobin and creatinine were significantly higher than that for CK. CONCLUSION Serum myoglobin is associated with outcome in patients after cardiac surgery. Prediction of ICU mortality and need for RRT was comparable for myoglobin and creatinine, while both were significantly superior to CK.
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Affiliation(s)
- Denis Hofmann
- Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany
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Leineweber K, Bogedain P, Wolf C, Wagner S, Weber M, Jakob HG, Heusch G, Philipp T, Brodde OE. In patients chronically treated with metoprolol, the demand of inotropic catecholamine support after coronary artery bypass grafting is determined by the Arg389Gly-β1-adrenoceptor polymorphism. Naunyn Schmiedebergs Arch Pharmacol 2007; 375:303-9. [PMID: 17541557 DOI: 10.1007/s00210-007-0166-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 05/04/2007] [Indexed: 11/25/2022]
Abstract
In vitro, the Arg389Gly-beta(1)-adrenoceptor (AR) polymorphism exhibits decreased receptor signaling. In vivo, dobutamine infusion evoked smaller heart rate and/or contractility increases in subjects carrying Gly389Gly-beta(1)AR vs subjects carrying Arg389Arg-beta(1)AR. The aim of this study was to find out whether the Arg389Gly-beta(1)AR polymorphism might also determine demand of catecholamine-induced inotropic support in patients with low cardiac index (CI) after coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). For this purpose, we assessed in 82 patients, who were preoperatively chronically treated with metoprolol, after CABG surgery with CPB, the dose and duration of adrenaline-induced inotropic support in relation to the Arg389Gly-beta(1)AR genotype. Patients homozygous for the Arg389-beta(1)AR variant (n = 45) required, in comparison to patients homozygous for the Gly389-beta(1)AR variant (n = 9), lower adrenaline doses (53 +/- 24 vs 164 +/- 39 ng/kg body weight/min, p < 0.05) to reach a stable and comparable hemodynamic status and a CI >or= 3.0 l/min/m(2). Moreover, the time necessary for inotropic support tended to be shorter in patients homozygous for the Arg389-beta(1)AR than in patients homozygous for the Gly389-beta(1)AR (10.5 +/- 6 vs 20.5 +/- 12 h). Values for patients heterozygous for the Arg389Gly-beta(1)AR (n = 28) were in between. We conclude that the Arg389Gly-beta(1)AR polymorphism appears to be a determinant of cardiac responses to catecholamine stimulation. Thus, by assessment of the Arg389Gly-beta(1)AR polymorphism, it might be possible to predict demand of and therapeutic responses to beta AR agonist treatment.
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Affiliation(s)
- Kirsten Leineweber
- Department of Pathophysiology and Nephrology, University of Essen School of Medicine, Hufelandstr. 55, 45147, Essen, Germany
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Newall N, Oo AY, Palmer ND, Grayson AD, Hine TJ, Stables RH, Fabri BM, Ramsdale DR. Intermediate and high peri-operative cardiac enzyme release following isolated coronary artery bypass surgery are independently associated with higher one-year mortality. J Cardiothorac Surg 2006; 1:20. [PMID: 16911773 PMCID: PMC1560125 DOI: 10.1186/1749-8090-1-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 08/15/2006] [Indexed: 11/16/2022] Open
Abstract
Background The relationship between cardiac enzyme (CE) release following coronary artery bypass surgery (CABG) and medium term outcome is unclear. We sought to determine the relationship between post-operative CE release and one-year survival following isolated CABG. Methods Over three years 3,024 consecutive patients underwent isolated CABG. Patient characteristics were prospectively recorded in a cardiac surgical database. CE release, taken as the highest single measurement recorded in the first 24 hours post-op, was abstracted from an electronic archive. All cause mortality was taken from a national registry of deaths. Results Data were complete for 2,860 (94.6%) patients. CK-MB isoenzyme (reference range 5–24 U/l) was recorded in 2,568 (89.8%), total CK in 292 (10.2%). CE release three or more times the upper limit of the reference range (ULR) were recorded in 498 (17.4%) patients, 163 (5.7%) patients had CE more than six times ULR. There were 122 deaths (4.3%). Cox proportional hazards analysis showed that CE release 3–6 times ULR (adjusted HR 2.1 [95% CI: 1.6 to 2.6], p = 0.002) and CE release six or more times the ULR (adjusted HR 5.0 [95% CI: 4.5 to 5.4], p < 0.001) were independently associated with increased one-year mortality. Conclusion Cardiac enzyme release following CABG is associated with increased one-year all-cause mortality. The definition of peri-operative myocardial infarction following CABG should include elevation of CK-MB three or more times the upper limit of normal.
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Affiliation(s)
- N Newall
- Department of Cardiology, Arrowe Park Hospital, Wirral, UK
| | - AY Oo
- Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool, UK
| | - ND Palmer
- Department of Cardiology, The Cardiothoracic Centre, Liverpool, UK
| | - AD Grayson
- Department of Clinical Governance, The Cardiothoracic Centre, Liverpool, UK
| | - TJ Hine
- Department of Clinical Biochemistry, The Royal Liverpool and Broad Green University Hospital, UK
| | - RH Stables
- Department of Cardiology, The Cardiothoracic Centre, Liverpool, UK
| | - BM Fabri
- Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool, UK
| | - DR Ramsdale
- Department of Cardiology, The Cardiothoracic Centre, Liverpool, UK
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Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol 2006; 48:1-11. [PMID: 16814641 DOI: 10.1016/j.jacc.2006.02.056] [Citation(s) in RCA: 396] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 02/02/2006] [Accepted: 02/16/2006] [Indexed: 12/14/2022]
Abstract
The use of biomarkers to aid diagnosis and treatment is increasing rapidly as genomics and proteomics help us expand the number of markers we can use and as an improved understanding of the pathophysiology of cardiac disease guides their use. However, as with all rapidly expanding fields, there is the risk of excessive enthusiasm unless we are circumspect about the data that guide the clinical use of these new tools. This review focuses first on how to use troponin, which at present is the best validated of the new markers, and will hopefully provide insight into how to use this biomarker more productively by distinguishing subsets of patients and by providing an understanding of the meaning of elevations in various clinical situations. The review then discusses the use as well as the knowledge gaps associated with emerging biomarkers such as B-type natriuretic peptide and C-reactive protein, which are increasingly moving toward more productive clinical use. Finally, it reflects on some of the large number of markers that are still in development.
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Affiliation(s)
- Allan S Jaffe
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic and Medical School, Rochester, Minnesota 55905, USA.
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Dyke CM, Smedira NG, Koster A, Aronson S, McCarthy HL, Kirshner R, Lincoff AM, Spiess BD. A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: The EVOLUTION-ON study. J Thorac Cardiovasc Surg 2006; 131:533-9. [PMID: 16515902 DOI: 10.1016/j.jtcvs.2005.09.057] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 10/06/2005] [Accepted: 10/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Unfractionated heparin and its antidote, protamine sulfate, allow for rapid and reversible anticoagulation during cardiac surgery with cardiopulmonary bypass, yet limitations exist, including a variable dose-response, dependence on a cofactor for anticoagulant effect, and antigenic potential. This trial was performed to evaluate the safety and efficacy of bivalirudin as an alternative to heparin with protamine reversal in on-pump cardiac surgery. METHODS We conducted a randomized, open-label, multicenter trial comparing heparin with protamine reversal to bivalirudin in patients undergoing cardiac surgery with cardiopulmonary bypass. The primary objective was to demonstrate comparable rates of in-hospital procedural success defined as freedom from death, Q-wave myocardial infarction, stroke, or repeat revascularization. Twenty-one institutions enrolled 101 patients randomized to bivalirudin and 49 patients to heparin treatment. RESULTS The primary end point of procedural success was not significantly different between the bivalirudin arm and the heparin/protamine arms at 7 days, 30 days, or 12 weeks' follow-up. Adequate anticoagulation was achieved in all patients. Secondary end points including mortality, 24-hour blood loss, overall incidence of transfusions, and duration of surgery were similar between the two arms. CONCLUSIONS Bivalirudin is a safe and effective anticoagulant for patients undergoing a wide range of cardiac surgical procedures with cardiopulmonary bypass. Procedural success rates with bivalirudin were similar to rates in patients receiving heparin anticoagulation, with no difference in mortality. Avoidance of blood stasis and attention to the intraoperative medical management of patients is critical for successful use of bivalirudin during cardiopulmonary bypass.
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Affiliation(s)
- Cornelius M Dyke
- Carolina Cardiovascular and Thoracic Surgery Associates, Gaston Memorial Hospital, Gastonia, NC 28056, USA.
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Thielmann M, Massoudy P, Neuhäuser M, Knipp S, Kamler M, Piotrowski J, Mann K, Jakob H. Prognostic Value of Preoperative Cardiac Troponin I in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery. Chest 2005. [DOI: 10.1016/s0012-3692(15)52926-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Thielmann M, Massoudy P, Schmermund A, Neuhäuser M, Marggraf G, Kamler M, Herold U, Aleksic I, Mann K, Haude M, Heusch G, Erbel R, Jakob H. Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery. Eur Heart J 2005; 26:2440-7. [PMID: 16087649 DOI: 10.1093/eurheartj/ehi437] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIMS The rise of markers for myocardial injury indicates early graft-related or non-graft-related perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG). A diagnostic discrimination between these two situations may enable adequate therapeutic measures, limiting myocardial damage, and improving outcome. METHODS AND RESULTS In a prospective study, 94 among 3308 consecutive CABG patients underwent acute reangiography because of evidence of PMI. Of these 94 patients, 56 had graft-related PMI (group 1), 38 patients had non-graft-related PMI (group 2), and 95 patients without evidence of PMI and angiographically patent grafts served as control (group 3). Cardiac troponin I (cTnI), creatine kinase (CK), and its MB fraction were determined. CTnI, but not CK/CK-MB levels were significantly higher in group 1 than in groups 2 and 3 at 12 and 24 h after aortic unclamping (P<0.0001). Receiver operating characteristic and multivariable logistic regression analyses indicated cTnI as the best discriminator between PMI 'in general' and 'inherent' release of cTnI after CABG with a cut-off value of 10.5 ng/mL and between graft-related and non-graft-related PMI with a cut-off value of 35.5 ng/mL. CONCLUSION Perioperative cTnI elevation after CABG separates among patients with graft-related, non-graft-related, and without PMI, however, not earlier than 12 h after surgery.
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Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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