经静脉植入自动心脏复律除颤器过程中心肌损伤的检测

Detection of myocardial injury during transvenous implantation of automatic cardioverter-defibrillators.

作者信息

Hurst T M, Hinrichs M, Breidenbach C, Katz N, Waldecker B

机构信息

Department of Cardiology, University of Giessen, Germany.

出版信息

J Am Coll Cardiol. 1999 Aug;34(2):402-8. doi: 10.1016/s0735-1097(99)00194-1.

DOI:10.1016/s0735-1097(99)00194-1

PMID:10440152

Abstract

OBJECTIVES

The present study was designed to assess the extent of myocardial injury in patients undergoing transvenous implantation of an automatic implantable cardioverter-defibrillator (ICD) using cardiac troponin I (cTNI), which is a highly specific marker of structural cardiac injury.

BACKGROUND

During ICD implantation, repetitive induction and termination of ventricular fibrillation (VF) via endocardial direct current shocks is required to demonstrate the correct function of the device. Transthoracic electrical shocks can cause myocardial cell injury.

METHODS

Measurements of total creatine kinase (CK), CK-MB, myoglobin, cardiac troponin T (cTNT) and cTNI were obtained before and after ICD implantation in 49 consecutive patients. Blood samples were drawn before and 2, 4, 8, and 24 h after implantation.

RESULTS

Elevations of CK, CK-MB, myoglobin, cTNT and cTNI above cut-off level were found in 25%, 6%, 76%, 37% and 14% of patients, respectively, with peak cTNI concentrations ranging from 1.7 to 5.5 ng/ml. Cumulative defibrillation energy (DFE), mean DFE, cumulative VF time, number of shocks as well as prior myocardial infarction (MI) were found to be significantly related to a rise of cTNI. Mean DFE > or = 18 J and a recent MI were identified as strong risk factors for cTNI rise.

CONCLUSIONS

During transvenous ICD implantation myocardial injury as assessed by cTNI rise occurs in about 14% of the patients. Peak cTNI concentrations are only minimally elevated reflecting subtle myocardial cell damage. Patients with a recent MI and a mean DFE > or = 18 J seem to be prone to cTNI rise.

摘要

目的

本研究旨在使用心肌肌钙蛋白I（cTNI）评估接受自动植入式心脏复律除颤器（ICD）经静脉植入的患者心肌损伤程度，cTNI是心脏结构损伤的高度特异性标志物。

背景

在ICD植入过程中，需要通过心内膜直流电电击反复诱发和终止室颤（VF）以证明设备功能正常。经胸电击可导致心肌细胞损伤。

方法

对49例连续患者在ICD植入前后进行总肌酸激酶（CK）、CK-MB、肌红蛋白、心肌肌钙蛋白T（cTNT）和cTNI测量。在植入前以及植入后2、4、8和24小时采集血样。

结果

分别有25%、6%、76%、37%和14%的患者CK、CK-MB、肌红蛋白、cTNT和cTNI升高超过临界水平，cTNI峰值浓度范围为1.7至5.5 ng/ml。发现累积除颤能量（DFE）、平均DFE、累积VF时间、电击次数以及既往心肌梗死（MI）与cTNI升高显著相关。平均DFE≥18 J和近期MI被确定为cTNI升高的强危险因素。