Short-term prognostic value of perioperative coronary sinus-derived-serum cardiac troponin-I, creatine kinase-MB, lactate, pyruvate, and lactate-pyruvate ratio in adult patients undergoing open heart surgery

Abstract

Objectives:To investigate the release pattern of different cardiac metabolites and biomarkers directly from the coronary sinus (CS) and to establish the diagnostic discrimination limits of each marker protein and metabolites to evaluate perioperative myocardial injury in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).Patients and Methods:Sixty-eight patients undergoing first mitral and/or aortic valve replacements with/without coronary artery bypass grafting and Bentall procedure under CPB and blood cardioplegic arrest were studied. All cardiac metabolites and biomarkers were measured in serial CS-derived blood samples at pre-CPB, immediate post aortic declamping, 10 minutes post-CPB and 12 hrs post-CPB.Results:Receiver operating characteristic curve analysis of cardiac biomarkers indicated lactate-pyruvate ratio as the superior diagnostic discriminator of myocardial injury with an optimal “cut-off” value >10.8 immediately after aortic declamping (AUC, 0.92; 95% CI: 0.85-0.98). Lactate was the second best diagnostic discriminator of myocardial injury with an optimal “cut-off” value >2mmol/l at immediately after aortic declamping (AUC, 0.89; 95% CI: 0.80-0.96). Cardiac troponin-I was the third best diagnostic discriminator of myocardial injury with an optimal “cut-off” value >2.1ng/ml at immediately after aortic declamping (AUC, 0.88; 95% CI: 0.80-0.95). Creatine kinase-MB was the fourth best diagnostic discriminator of myocardial injury with an optimal “cut-off” value >58 log units/ml prior to decanulation (AUC, 0.85; 95% CI: 0.78-0.94).Conclusions:Measurable cardiac damage exists in all patients undergoing cardiac surgery under cardioplegic arrest. The degree of myocardial injury is more in patients with poor ventricular function and those requiring longer aortic clamp time. CS-derived lactate-pyruvate ratio, lactate, cTn-I served as superior diagnostic discriminators of peri-operative myocardial damage.

The Incidence, Risk Factors, and Outcomes of Hyperlactatemia after Heart Transplantation

“…During cardiac surgery, lactate is measured from the coronary sinus after reperfusion of the heart over time, Chowdhury, et al reported that lactate increased as myocardial damage strengthened. 15) This suggests that lactate accumulates in the heart as a result of the slow progression of myocardial injury, despite being stored in cooled cardiac preservation solution. Lactate then flows throughout the body after reperfusion, and HL is observed in arterial blood.…”

Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

“…Close hemodynamic, clinical, and biomarker-based monitoring continued from the perioperative to the intensive care setting provides early mobilization in a safe manner postcardiac surgery. [ 26 27 28 ]…”

Development of ultra‐high‐performance supercritical fluid chromatography‐mass spectrometry assays to analyze potential biomarkers in sweat

“…These metabolic waste products are produced through glycolysis and provide indicators for anaerobic cell metabolism. The lactate/pyruvate ratio (L/P) has previously been used as an indicator for several ischemic-related medical conditions including acute liver failure [11], myocardial injury [12], and traumatic brain injury [13]. Soetens et al most recently demonstrated the use of these non-invasive inflammatory biomarkers as a potential indicator of pressure-induced tissue damage using the analytical assay described in this paper to detect and quantify levels of lactate and pyruvate collected from sweat and sebum samples [14].…”