Ischaemic preconditioning reduces troponin T release in patients undergoing coronary artery bypass surgery.

Jenkins, David P.; Pugsley, W; Alkhulaifi, Abdulaziz; Kemp, Michael; Hooper, James; Yellon, Derek M.

doi:10.1136/hrt.77.4.314

Cited by 215 publications

(124 citation statements)

References 22 publications

(4 reference statements)

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“…Some experimental studies have investigated the effect of ischemic preconditioning on necrosis markers and the potential clinical interpretation [36][37][38]. Basically, in MI patients undergoing myocardial revascularization ischemic preconditioning was reported to reduce periprocedural cTn concentrations and to delay myocardial necrosis [36]. To date, our study is the first to suggest that in vivo ischemic preconditioning might prevent exacerbation of myocardial necrosis at the onset of a new acute event.…”

Section: Discussionmentioning

confidence: 65%

“…The condition of patients with a history of ACS could reflect the experimental model of MI developing tolerance to prolonged ischemic insult, namely ischemic preconditioning when the myocardium has been previously exposed to brief periods of ischemia and reperfusion [35]. Some experimental studies have investigated the effect of ischemic preconditioning on necrosis markers and the potential clinical interpretation [36][37][38]. Basically, in MI patients undergoing myocardial revascularization ischemic preconditioning was reported to reduce periprocedural cTn concentrations and to delay myocardial necrosis [36].…”

Section: Discussionmentioning

confidence: 99%

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New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Ferraro

Biganzoli

Marano

et al. 2013

Clinical Biochemistry

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Objectives: ST-elevation and non-ST-elevation myocardial infarction (STEMI, NSTEMI) are considered two distinct pathophysiologic entities. We evaluated cardiac troponin I (cTnI) release in STEMI and NSTEMI using a "contemporary" (CV > 10 to 20% at the 99th percentile concentration) cTnI assay for patients undergoing early percutaneous coronary intervention (PCI).Design and methods: 856 patients with suspected acute coronary syndrome consecutively admitted to the Emergency Department of the Maggiore Hospital of Novara (225 STEMI and 135 NSTEMI) were selected according to: 1) early (≤4 h from admission) and successful PCI; and 2) cTnI measurements at ED presentation and within 24 h. The influence of the MI type on cTnI concentrations at baseline and after PCI as well as the velocity of cTnI [cTnI V = absolute increase (after log conversion of cTnI measurements) / delay between the two measurements] was studied by multiple regression analysis, adjusting for patient parameters.Results: A statistically significant interaction between MI type and time from symptoms was reported on cTnI concentrations (p b 0.0001): STEMI and NSTEMI differed for cTnI releases at admission and after revascularization. Higher cTnI V in STEMI was detectable in patients admitted within 6 h from symptoms. Baseline cTnI concentrations were lower in patients with a history of coronary artery disease (CAD) and increased with aging (p b 0.0001). In the elderly (>75 years), the cTnI V was significantly increased.Conclusion: STEMI and NSTEMI patients have different patterns and dynamics of cTnI release influenced by the interaction with time from symptoms, by aging and history of CAD.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Ferraro

Biganzoli

Marano

et al. 2013

Clinical Biochemistry

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“…This endogenous protection mechanism occurred in all animal species studied 9 , and some authors also suggested its existence in man 10,11 . In 1986, Murry et al 8 were the first to report this phenomenon in a canine model.…”

Section: Groupmentioning

confidence: 99%

Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases

Pêgo-Fernandes¹,

Jatene²,

Gentil³

et al. 2001

Arq. Bras. Cardiol.

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Objective -To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. Methods -In the control group (18 patients)Despite theoretical criticism of the technique of intermittent crossclamping of the aorta with hypothermia at 32ºC, the simplicity of the procedure and its good clinical results have led several surgeons to use it, particularly in myocardial revascularization surgery 1,2 .In Brazil, Jatene et al 3 have been using it since 1969, with good clinical results. A few randomized studies 4,5 comparing the efficacy of intermittent crossclamping of the aorta with the use of cardioplegic solutions exist, but none of them conclude that one method is superior to the others.One question about the technique is that the repetition of ischemic episodes, which are individually reversible, may cause cumulative damage resulting in necrosis. Reimer et al 6 disproved this concept by showing experimentally that intermittent reperfusion avoids cumulative metabolic deficit and myocardial ischemia with cell death and that the first episode of ischemia reduces the consumption of high energy phosphates in subsequent episodes. Other studies 7 have shown that short periods of ischemia do not induce irreversible cellular damage and that they do not result in cumulative metabolic, structural, and functional deficits. It has also been reported that, paradoxically, short periods of ischemia increase the tolerance of the heart instead of making it more vulnerable to subsequent ischemic episodes. This induction of tolerance to ischemia is called ischemic preconditioning 8 .The objective of this study was to assess the influence of ischemic preconditioning on myocardial protection obtained with intermittent crossclamping of the aorta in patients undergoing myocardial revascularization.

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“…The prognostic implication of the elevation of intraoperative cTn I was considered by JENKINS et al [15], when he proposed that the demonstration of the increase of cTn I is a consequence of myocardial lesion. GREENSON et al [16] reported that the peak of cTn I demonstrates the risk of cardiac events in a significantly better manner than the peak of CKMB, in patients submitted to CABG.…”

Section: Commentsmentioning

confidence: 99%

Prognostic implications of myocardial creatine kinase and cardiac troponin in coronary artery bypass surgery

Taniguchi¹,

Pěgo‐Fernandes²,

Jatene³

et al. 2003

Rev Bras Cir Cardiovasc

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Objectives: To evaluate the prognostic implications of myocardial creatine kinase and troponin I (cTn I) in blood samples from the coronary sinus of patients submitted to coronary artery bypass surgery both with and without ischemic preconditioning.Methods: From October 1998 to May 1999, 35 patients with coronary artery disease who were submitted to coronary artery bypass surgery were studied. Samples containing creatine kinase and cTn I were obtained from the great cardiac vein during surgery at the onset of cardiopulmonary bypass, at the end of the first anastomosis, and at the end of cardiopulmonary bypass. In May 2002, 29 patients were evaluated in regards to the angina functional class, congestive heart failure, number of hospitalizations, myocardial infarction and death. There were 15 patients in the Preconditioned group and 14 in the Control group. Each group was subdivided into patients with and without cardiovascular symptoms. Results:The Control and Preconditioned groups were not significantly different in relation to frequency of cardiovascular symptoms. There were progressive increases of the creatine kinase and cTn I levels at different Interval s of the study. The cTn I in the Preconditioned group was 1.21 ± 0.64 ng/mL and 3.19 ± 3.21 ng/mL in the Control group (p<0.05). The Control group with symptoms had the highest level for cTn I of 5.07 ± 3.69 ng/mL, significantly higher than all other groups (p<0.05).Conclusions: The Preconditioned group had the lowest level of cTn I. The cTn I may be a marker for late evolution in patients submitted to coronary artery bypass surgery.Descriptors: Myocardial revascularization. Myocardial ischemic preconditioning. Myocardial ischemia, physiology. Troponin. Cardiovasc 2003; 18(3): 210-216 Rev Bras Cir

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Ischaemic preconditioning reduces troponin T release in patients undergoing coronary artery bypass surgery.

Cited by 215 publications

References 22 publications

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases

Prognostic implications of myocardial creatine kinase and cardiac troponin in coronary artery bypass surgery

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