Cardiac troponin I release after open heart surgery: a marker of myocardial protection?

Vermès, Emmanuelle; Mesguich, Martine; Houël, Rémi; Soustelle, Céline; Besnerais, P. Le; Hillion, Marie-Line; Loisance, D

doi:10.1016/s0003-4975(00)02152-4

Cited by 39 publications

(23 citation statements)

References 15 publications

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“…However, the patients in our study undergoing coronary surgery had enzyme increases, which were consistently greater than in those patients undergoing valve surgery, despite that aortic valve stenosis with severe hypertrophy increased the levels of markers of ischemia. According to Winter et al (1995), CK and CK-MB were increased and, over the time course of the procedure, occurred slightly before the changes in the values of TnT and I (Vermes et al 2000); the rise starting around the 5th sample (18 hrs post-procedure) and being maintained elevated at the 6th sample (42 hrs post-procedure). It is clear that the classical markers have considerable diagnostic validity but, also, diagnosis of peri-operative infarct can benefit from newer technologies.…”

Section: Discussionmentioning

confidence: 97%

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Stefano¹,

Casquero²,

Bustamante

et al. 2007

Tohoku J. Exp. Med.

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All types of cardiac surgery involve considerable injury to the myocardium. However, it is difficult to differentiate, in the immediate postoperative state, between ischemic alterations associated with the cardiac surgery itself and the pathological alterations of a peri-operative myocardial infarction. The diagnosis of damaged myocardium, classically performed with the enzymatic markers creatine kinase (CK) and its muscle fraction (CK-MB), has become more precise with the option of measuring cardiac troponins T and I. We measured these markers in 58 patients undergoing elective cardiac surgery with extra-corporeal circulation (ECC). The patients included 37 cases undergoing valve surgery, 14 for coronary revascularization, 6 for mixed procedures, and 1 for closure of an inter-atrial communication. The markers were measured in plasma at baseline (at anesthesia initiation), 5 min post-ECC commencement, following aorta de-clamping, during the surgical closure, and 6, 18 and 42 hrs after surgery. All the markers were increased significantly relative to the baseline values. Troponin I, CK and CK-MB values peaked between 6 and 18 hrs after surgery, troponin T between 18 and 42 hrs, and myoglobin at the surgical closure. The values of all markers were higher in patients undergoing coronary surgery compared to those in patients undergoing valve surgery. In the evaluation of myocardial damage after surgery, the measurement of classical markers such as CK and myoglobin remain valid, but other markers such as troponins provide significant additional diagnostic benefit and, thus, need to be included in the routine biochemical measurements for monitoring myocardial damage associated with the surgical procedure.Peri-operative myocardial damage; injury markers; troponin; creatine kinase; myoglobin

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Section: Discussionmentioning

confidence: 97%

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Stefano¹,

Casquero²,

Bustamante

et al. 2007

Tohoku J. Exp. Med.

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“…Vermes et al showed that cTnI could be a marker of myocardial ischemia after open heart surgery. 16 Lasocki et al have shown that the cTnI concentration measured 20 h after the end of surgery is an independent predictor of in-hospital death after cardiac surgery, and elevated concentrations of cTnI were associated with both a cardiac cause of death and major postoperative complications. 17 In our study, the plasma levels of cTnI in the control group significantly stepped up during CPB and reached their peak at 4 h after surgery, indicating obvious myocardial injury in patients undergoing MVR surgery.…”

Section: Discussionmentioning

confidence: 99%

Effect of Limb Ischemic Preconditioning on Myocardial Injury in Patients Undergoing Mitral Valve Replacement Surgery - A Randomized Controlled Trial -

Gui

et al. 2011

Circ J

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“…The primary concern is systemic inflammatory response (SIRS) due to release of cytokines 5 . It has been suggested that CTnI specificity to detect myocardial injury may be greater than that of Cardiac troponin T (CTnT) 6 . The aim of this prospective randomized study was to evaluate the myocardial protection in Off-pump CABG group by the estimation of CTnI release and also to compare between Off-pump and On-pump CABG group and their short-term in-hospital outcome.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of myocardial protection in off-pump vs on-pump coronary bypass surgery by troponin I estimation

Badruzzaman

Hossain

Adhikary

et al. 2011

Bangladesh Med Res Counc Bull

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Background: This prospective non-randomized clinical study was done to compare Off-pump and Onpump myocardial revascularization by Troponin I release in patients undergoing first elective coronary artery bypass graft used to evaluate myocardial injury. Methods: One hundred an twenty patients were non-randomly assigned to a Off-pump or On-pump myocardial revascularization group. Cardiac Troponin I (CTnI) were measured in serial venous blood samples drawn preoperatively in both groups. In On-pump group after aortic unclamping at 12 and 24 hours and in Off-pump group after the last distal anastomosis at 12 and 24 hours. Results: The total amount of CTnI release were significantly higher in On-pump group than in Off-pump group. In On-pump group it was 2.1±1.9 (mean±SD) ng/ml vs in Off-pump group it was 1.0±1.7 (mean±SD) ng/ml at 12 hours and in On-pump group it was 1.6±1.6 (mean±SD) ng/ml vs in Off-pump group it was .9±1.6 (mean±SD) ng/ml at 24 hours (P<0.0001 for the pattern). Conclusion: The lower release of CTnI in the Off-pump myocardial revascularization group indicates that the arrested heart coronary revascularization group causes more damage to the heart due to cardiopulmonary bypass than Off-pump myocardial revascularization group.

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Cardiac troponin I release after open heart surgery: a marker of myocardial protection?

Cited by 39 publications

References 15 publications

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Effect of Limb Ischemic Preconditioning on Myocardial Injury in Patients Undergoing Mitral Valve Replacement Surgery - A Randomized Controlled Trial -

Evaluation of myocardial protection in off-pump vs on-pump coronary bypass surgery by troponin I estimation

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