Cardiac troponin I as an early marker of myocardial damage after coronary bypass surgery

Jacquet, Luc‐Marie; Noirhomme, Philippe; Khoury, Gébrine El; Goenen, Martin; Philippe, Marianne; Col, Jacques; Dion, Robert

doi:10.1016/s1010-7940(98)00032-3

Cited by 55 publications

(35 citation statements)

References 13 publications

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“…Thus, in this group, the 24-hour postoperative value averaged 4.4 g/L, which compares favorably with the value of 5.2 g/L reported at the same time point by Sadony and coworkers 30 in patients classified as having minor myocardial damage. Likewise, the peak value observed (at 6 hours postoperatively) in our series (5.8 g/L) is much lower than the cutoff value (13.4 g/L) shown by Jacquet and associates 31 to significantly separate those patients with an uneventful recovery from those with ischemia/infarction.…”

Section: Ii-342contrasting

confidence: 72%

Evidence for Preconditioning by Isoflurane in Coronary Artery Bypass Graft Surgery

Belhomme¹,

Peynet²,

Louzy³

et al. 1999

Circulation

206

106

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Background-Experimentally, isoflurane, a commonly used volatile anesthetic agent, mimics the cardioprotective effects of ischemic preconditioning via a mechanism that could involve the activation of protein kinase C. The present study was designed to assess the clinical relevance of this observation in patients undergoing elective CABG. Methods and Results-Twenty patients were included in the study. In 10 of them, preconditioning was elicited after the onset of cardiopulmonary bypass via a 5-minute exposure to isoflurane (2.5 minimum alveolar concentration), followed by a 10-minute washout before aortic cross-clamping and cardioplegic arrest. Ten case-matched control patients underwent an equivalent period (15 minutes) of prearrest isoflurane-free bypass. Outcome measurements included troponin I and creatine kinase-MB isoenzyme (until the third postoperative day) levels and the activity of ecto-5Ј-nucleotidase, which contributes to adenosine production and is considered to be a reporter of protein kinase C activation, as assessed in right atrial biopsy samples taken before bypass and at the end of the preconditioning protocol (or after 15 minutes of bypass in control patients Key Words: ischemia Ⅲ bypass Ⅲ anesthesia I schemic preconditioning is recognized as one of the most effective means of reducing cellular necrosis. As such, its implementation during cardiac surgery might be clinically relevant, particularly in high-risk patients in whom any additional myocardial ischemic injury induced with cardiopulmonary bypass and superimposed cardioplegic arrest can adversely affect postoperative outcome. Because in this setting it is particularly desirable to avoid an ischemic-type preconditioning stimulus, 1-3 extensive research is targeted toward identifying the pharmacological mediators of the preconditioning phenomenon in an attempt to exploit them therapeutically.There is compelling evidence that the preconditioning signal activates various membrane receptors, which triggers a signaling pathway leading to the activation of several kinases, 4 in particular, protein kinase C (PKC), 5 and the subsequent opening of ATP-dependent potassium channels, possibly at the mitochondrial level. 6,7 How opening of these channels elicits cardioprotection is not yet established but might involve the limitation of calcium influx, better control of cellular volume, or both. This scheme provides a framework for rationalizing interventions targeted at mimicking preconditioning and, in this perspective, makes logical the use, among other drugs, of potassium channel openers.Within this class of drugs, only nicorandil is currently available for human use. However, aside from the fact that nicorandil cannot be administered intravenously, this compound has marked nitrovasodilatory properties, which can be Circulation is available at http://www.circulationaha.org II-340by guest on May 10, 2018http://circ.ahajournals.org/ Downloaded from of concern. Alternatively, isoflurane is a volatile anesthetic agent that has been reported in animal mo...

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Section: Ii-342contrasting

confidence: 72%

Evidence for Preconditioning by Isoflurane in Coronary Artery Bypass Graft Surgery

Belhomme¹,

Peynet²,

Louzy³

et al. 1999

Circulation

206

106

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“…As a consequence, it is difficult to differentiate, in the immediate post-operative state, between ischemic alterations associated with the cardiac surgery itself and the pathological alterations of a perioperative myocardial infarction (Force et al 1990). The troponins, being specific markers of myocardial damage (Etievent et al 1995;Jacquet et al 1998), could be used to monitor surgeryassociated ischemia.…”

Section: Discussionmentioning

confidence: 99%

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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“…Numerous clinical studies could already demonstrate, that a significant rise of cardiac biomarkers like cTnI [11,12], troponin T [15,21] or Myo [21,21] as well as cardiac enzymes like CK and creatine kinase isoenzyme MB [21,22] [11] and 10.0 ng/ml [12,24] at 8 -12 h and 11.6 ng/ml at 24 h [11] after CABG. However, this is the first study to find a discriminating marker for the differentiation between early graft failure and non-graft-related PMI after CABG.…”

Section: Discussionmentioning

confidence: 99%

Role of troponin I, myoglobin, and creatine kinase for the detection of early graft failure following coronary artery bypass grafting1

Thielmann

Massoudy

Marggraf

et al. 2004

European Journal of Cardio-Thoracic Surgery

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Cardiac troponin I as an early marker of myocardial damage after coronary bypass surgery

Abstract: As soon as 6 h postoperatively, cTnI and CK-MB by mass assay were able to separate those patients with an uneventful recovery from those with significant ischemia. This is particularly useful in frequent cases when the ECG is difficult to interpret.

Cited by 55 publications

References 13 publications

Evidence for Preconditioning by Isoflurane in Coronary Artery Bypass Graft Surgery

Evidence for Preconditioning by Isoflurane in Coronary Artery Bypass Graft Surgery

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

Role of troponin I, myoglobin, and creatine kinase for the detection of early graft failure following coronary artery bypass grafting1

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