Purpose: Recent advances in technology has made it possible to use markers other than the "gold standard" creatine kinase MB fraction, such as troponin-T (Tn-T), and troponin-I (Tn-I) that are cardiospecific for the detection of minor myocardial damage. We compared Tn-T, Tn-I and the hemodynamics of the patients undergoing cardiopulmonary bypass surgery. Methods: Thirty five patients who underwent open heart surgery using cardiopulmonary bypass were included in this study. Blood Tn-T and and Tn-I were measured by immunoassay. Based on their 12 hour Tn-T levels, the patients were divided into groups, A: Tn-T<5 (n=24), B:>5(n=6), C:>10(n=5). Tn-T and Tn-I levels were compared with the hemodynamic data within the group. Results: When 12 hour levels of Tn-T and Tn-I were compared in groups A and B, the levels correlated with the extent of myocardial damage. Group C had patients with known myocardial damage (atrial fibrillation-1, acute MI-2, cardiogenic shock-1). The 12 hour Tn-T and Tn-I levels are shown in the table along with the hemodynamic support data. Group C patients had more ventilator and inotropic supports as expected. Conclusions: Our results, from a small group of patients, clearly indicate that Tn-T predicts the extent of myocardial injury preoperatively more accurately, and in most cases, Tn-T and Tn-I measurements are specific and sensitive enough to determine the myocardial injury perioperatively. But high Tn-I seen in some patients perioperatively that are not supported by the need for hemodynamic support is of great concern. Clinical Implications: Lately the use of cardiospecific proteins such as Tn-T and Tn-I to detect myocardial injury has increased and the results are quite accurate and specific. But under certain situations, caution should be exercised in relying on these markers in the diagnosis of myocardial infarction. Group Tn-T (ng/ml) pre-op 12 h Tn-I (ng/ml) pre-op 12 h Vent use, hrs IABP hrs Inotropic hrs Last CI A 0.6 + 0.2 2.7 + 0.60.4 + 0.24.6 + 1.015 + 6.7 0 12 + 9 3.4 + 0.8 B 1.0 + 0.2 6.7 + 0.81.1 + 0.48.5 + 3 32 + 8 0 16 + 8 2.9 + 1.1 C 14.2 + 3 41 + 11 3.5 + 1.0 28 + 10 85 + 20 14 134 + 403.5 + 0.5.
|Original language||English (US)|
|Issue number||4 SUPPL.|
|State||Published - Oct 1 1998|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine