High-sensitivity Cardiac Troponin T is More Helpful in Detecting Peri-operative Myocardial Injury and Apoptosis During Coronary Artery Bypass Graft Surgery

Overview

Journal Cardiovasc J Afr

Specialty Cardiology & Vascular Diseases

Date 2015 Jul 28

PMID 26212819

Citations 7

Authors

Emel Fatma Kocak

Cengiz Kocak

Ahmet Aksoy

Ozden Ozben Isiklar

Raziye Akcilar

Ibrahim Fevzi Ozdomanic

Cevher Unsal

Merve Celenk

Irfan Altuntas

Affiliations

Soon will be listed here.

Abstract

Aim: To determine whether there is a correlation between cardiac markers and peri-operative myocardial injury (PMI) and apoptosis in coronary artery bypass graft (CABG) surgery and to compare the efficacy of cardiac markers to detect PMI.

Methods: The study population consisted of 37 patients (24 male, 13 female, mean age 63.4 ± 8.9 years) undergoing elective CABG. Arterial and coronary sinus blood samples were collected just before aortic cross-clamping (pre-ACC) and after aortic declamping (post-ACC). Creatine kinase-MB isoenzyme (CK-MB) activity, and high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB isoenzyme mass (CK-MB mass) and cardiac troponin I (cTnI) concentrations were measured in blood samples. Myocardial injury and apoptosis were examined in atrial biopsies.

Results: CABG caused PMI and apoptosis in all cases. Concentrations and net releases of cardiac markers significantly increased after aortic declamping (p < 0.001 for CK-MB and CK-MB mass, p < 0.01 for cTnI, p < 0.05 for hs-cTnT). A positive correlation was found between apoptotic index (r = 0.611, p < 0.001 for cTnI; r = 0.806, p < 0.001 for hs-cTnT), myocardial injury score (r = 0.544, p < 0.001 for cTnI; r = 0.719, p < 0.001 for hs-cTnT) and cTnI and hs-cTnT values in the post-ACC period. A positive correlation was found between apoptotic index (r = 0.507, p < 0.001), myocardial injury score (r = 0.416, p = 0.010) and net release of hs-cTnT. Furthermore, a positive correlation was found between aortic cross-clamp (ACC) time (r = 0.448, p = 0.007), cardiopulmonary bypass (CPB) time (r = 0.342, p = 0.047) and net release of hs-cTnT.

Conclusion: Although both cTnI and hs-cTnT may be specific and efficacious markers of myocardial apoptosis and injury occurring during CABG with CPB, hs-cTnT may be a more useful marker than cTnI to detect peri-operative myocardial apoptosis and injury.

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References

Takeda S, Nakanishi K, Ikezaki H, Kim C, Sakamoto A, Tanaka K . Cardiac marker responses to coronary artery bypass graft surgery with cardiopulmonary bypass and aortic cross-clamping. J Cardiothorac Vasc Anesth. 2002; 16(4):421-5. DOI: 10.1053/jcan.2002.125150. View

Yeh C, Wang Y, Wu Y, Chu J, Lin P . Continuous tepid blood cardioplegia can preserve coronary endothelium and ameliorate the occurrence of cardiomyocyte apoptosis. Chest. 2003; 123(5):1647-54. DOI: 10.1378/chest.123.5.1647. View

Nigam P . Biochemical markers of myocardial injury. Indian J Clin Biochem. 2012; 22(1):10-7. PMC: 3454263. DOI: 10.1007/BF02912874. View

Peivandi A, Dahm M, Opfermann U, Peetz D, Doerr F, Loos A . Comparison of cardiac troponin I versus T and creatine kinase MB after coronary artery bypass grafting in patients with and without perioperative myocardial infarction. Herz. 2004; 29(7):658-64. DOI: 10.1007/s00059-004-2543-y. View

Thielmann M, Massoudy P, Marggraf G, Knipp S, Schmermund A, Piotrowski J . Role of troponin I, myoglobin, and creatine kinase for the detection of early graft failure following coronary artery bypass grafting. Eur J Cardiothorac Surg. 2004; 26(1):102-9. DOI: 10.1016/j.ejcts.2004.03.015. View

Nagele P, Brown F, Gage B, Gibson D, Miller J, Jaffe A . High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery. Am Heart J. 2013; 166(2):325-332.e1. PMC: 3728677. DOI: 10.1016/j.ahj.2013.04.018. View

Poulsen T, Andersen L, Steinbruchel D, Gotze J, Jorgensen O, Olsen N . Two large preoperative doses of erythropoietin do not reduce the systemic inflammatory response to cardiac surgery. J Cardiothorac Vasc Anesth. 2008; 23(3):316-23. DOI: 10.1053/j.jvca.2008.08.018. View

Malik V, Kale S, Chowdhury U, Ramakrishnan L, Chauhan S, Kiran U . Myocardial injury in coronary artery bypass grafting: On-pump versus off-pump comparison by measuring heart-type fatty-acid-binding protein release. Tex Heart Inst J. 2006; 33(3):321-7. PMC: 1592275. View

Kovacevic R, Majkic-Singh N, Ignjatovic S, Otasevic P, Obrenovic R, Paris M . Troponin T levels in detection of perioperative myocardial infarction after coronary artery bypass surgery. Clin Lab. 2004; 50(7-8):437-45. View

10.

Di Stefano S, Casquero E, Bustamante R, Gualis J, Carrascal Y, Bustamante J . Plasma troponins as markers of myocardial damage during cardiac surgery with extracorporeal circulation. Tohoku J Exp Med. 2007; 213(1):63-9. DOI: 10.1620/tjem.213.63. View

11.

Ramlawi B, Feng J, Mieno S, Szabo C, Zsengeller Z, Clements R . Indices of apoptosis activation after blood cardioplegia and cardiopulmonary bypass. Circulation. 2006; 114(1 Suppl):I257-63. DOI: 10.1161/CIRCULATIONAHA.105.000828. View

12.

Preeshagul I, Gharbaran R, Jeong K, Abdel-Razek A, Lee L, Elman E . Potential biomarkers for predicting outcomes in CABG cardiothoracic surgeries. J Cardiothorac Surg. 2013; 8:176. PMC: 3726492. DOI: 10.1186/1749-8090-8-176. View

13.

Jaffe A, Babuin L, Apple F . Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006; 48(1):1-11. DOI: 10.1016/j.jacc.2006.02.056. View

14.

Bignami E, Landoni G, Crescenzi G, Gonfalini M, Bruno G, Pappalardo F . Role of cardiac biomarkers (troponin I and CK-MB) as predictors of quality of life and long-term outcome after cardiac surgery. Ann Card Anaesth. 2009; 12(1):22-6. DOI: 10.4103/0971-9784.45009. View

15.

Ruifrok W, Westenbrink B, de Boer R, den Hamer I, Erasmus M, Mungroop H . Apoptosis during CABG surgery with the use of cardiopulmonary bypass is prominent in ventricular but not in atrial myocardium. Neth Heart J. 2010; 18(5):236-42. PMC: 2871743. DOI: 10.1007/BF03091769. View

16.

Qing M, Klosterhalfen B, Sigler M, Schumacher K, Duchateau J, Messmer B . Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shock. 2001; 15(5):372-7. DOI: 10.1097/00024382-200115050-00007. View

17.

Bleier J, Vorderwinkler K, Falkensammer J, Mair P, Dapunt O, Puschendorf B . Different intracellular compartmentations of cardiac troponins and myosin heavy chains: a causal connection to their different early release after myocardial damage. Clin Chem. 1998; 44(9):1912-8. View

18.

Fischer U, Cox Jr C, Laine G, Mehlhorn U, Bloch W, Allen S . Induction of cardioplegic arrest immediately activates the myocardial apoptosis signal pathway. Am J Physiol Heart Circ Physiol. 2006; 292(3):H1630-3. DOI: 10.1152/ajpheart.00006.2005. View

19.

Ong S, Lim S, Li S . Reliability and validity of a Chinese version's health-related quality of life questionnaire for hepatitis B patients. Value Health. 2009; 13(2):324-7. DOI: 10.1111/j.1524-4733.2009.00615.x. View

20.

Yau T, Weisel R, Mickle D, Komeda M, Ivanov J, Carson S . Alternative techniques of cardioplegia. Circulation. 1992; 86(5 Suppl):II377-84. View