Objective: To evaluate the importance of cardiac troponin-I serum levels in the preoperative period of patients suffering from left coronary branch obstruction but without prior cardiac events.Method: The cardiac troponin-I serum levels of 115 patients with obstructive coronary disease were analyzed. The ages of the patients varied between 32 and 81 years old with a mean age and standard deviation of 59.7 ? 10.5 years. The patients were divided into two groups: Group A, 41 patients suffering from left coronary branch obstruction with the degree of obstruction varying between 20% to subtotal occlusion (about 60%) and Group B, 74 patients without left coronary branch obstruction. All the patients were submitted to catheterism and no evidence of previous acute myocardial infarction (AMI) was identified. Chemoluminescence was utilized to measure the cardiac troponin-I level using the Sanofi-Pasteur Access apparatus, with values of less than 0.l nanograms per milliliter (ng/ml) considered normal. Results: No association was evidenced between the degree of left coronary branch obstruction and troponin-Icserum levels (P= 0.4617), however the average serum levels of troponin-I, in Groups A and B were 0.3841 ng/mL and 0.1711 ng/mL respectively (P=0.0324 Mann-Whitney test; OR = 4.44 95% CI 1.60 -12.31). Conclusions: The patients of Group A have 3.44 times higher chance of presenting with myocardial injury as identified by increased cardiac troponin-I levels than Group B, independent of the degree of left coronary branch obstruction. The sensitivity of clinical suspicion of myonecrosis was relatively low (31.7%), but the specificity was high (90.5%). However the clinical importance of the documentation of myonecrosis in a determined percentage of patients with branch injury without electrocardiographic evidence is stressed. Thus, patients with left coronary branch obstruction should be quickly submitted to operative procedures, in order to avoid worsening of the myonecrosis. However the clinical importance of the documentation of myonecrosis in a determined percentage of patients with branch injury without electrocardiographic evidence is stressed. Thus, patients with left coronary branch obstruction should be quickly submitted to operative procedures in order to avoid worsening of the myonecrosis. Descriptors: Troponin I. Biological markers. Coronary disease. Myocardial ischemia. Myocardial infarction. Importância da troponina-I cardíaca nos portadores de obstrução no tronco da artéria coronária esquerda sem evento cardíaco prévioImportance of cardiac troponin-I in the preoperative period of patients without prior cardiac events but suffering from left coronary branch obstruction BRAILE, DM ET AL -Importance of cardiac troponin-I in the preoperative period of patients without prior cardiac events but suffering from left coronary branch obstruction Braz
RBCCV 44205-760 Impacto da troponina I cardíaca sérica na evolução tardia de pacientes submetidos a ressincronização com estimulação biventricular: seguimento de até 59 mesesImpact of serum troponin I in the long-term evolution of patients submitted to resynchronization with biventricular stimulation: follow-up of up to 59 months Abstract Objective: To analyze the evolution and prognostic influence of the cardiac troponin I serum levels in patients with congestive heart failure (CHF) submitted to interventricular resynchronization (VR) over a 59-month follow-up period.Method: Thirty-three patients with idiopathic dilated myocardiopathy in NYHA functional classes III and IV were submitted to VR. The pre-and post-operative quality of life (QoL) was analyzed using the Minnesota Code and the left ventricle function was assessed by echocardiography. The cardiac troponin I levels were compared in 23 patients utilizing the Fisher exact test to analyze the correlation with death and the Kaplan-Meier curve was used to analyze the survival rate.Results: The QoL was better after VR with a median of 73 points in the pre-operative period and 36 in the postoperative period (p-value < 0.0001). The left ventricle diastolic diameter (LVDD) reduced from 65 mm in the preoperative period to 60 mm in the postoperative period (p-value = 0.0014) with an increase in the ejection fraction from 37 to 47% (p-value = 0.0004). In 15 patients with normal cardiac troponin I levels, no deaths occurred and of the 8 patients with high levels, six died (p-value = 0.0003). The actuarial survival curve showed a survival rate of 47.1 ± 13.3% at the end of 59 months.Conclusion: VR in patients with CHF improves the QoL and echocardiographic parameters (ejection fraction and LVDD). It is a good alternative for functional class III and IV patients. The serum levels of cardiac troponin I are predictors of risk to life. Descriptors: Troponin. Arrhythmia. Heart failure, congestive. Pacemaker, artificial. Descritores: Troponina. Arritmia. Insuficiência cardíaca congestiva. Marca-passo artificial.
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