Lund M, French J K, Johnson R N, Williams B F, White H D
Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand.
Eur Heart J. 2000 Feb;21(3):245-53. doi: 10.1053/euhj.1999.1745.
To describe the pattern of release of five myocardial proteins after elective cardioversion.
We measured serum levels of the myocardial proteins creatine kinase, creatine kinase MB mass, myoglobin, troponin T and troponin I serially from baseline to 24 h after 72 elective cardioversion attempts. The total energy used for attempted cardioversion was 408+/-318 J (range 50 to 1280 J). Maximal creatine kinase levels (median 232 IU x l(-1), interquartile range 91 to 1152 IU x l(-1)) occurred at 24 h and correlated with the total energy delivered (r=0.75, P<0.0001). The peak creatine kinase MB mass levels exceeded the discrimination level for myocardial injury (>/=5 microg x l(-1)) in seven patients (10%). The peak myoglobin levels were elevated (>85 microg x l(-1)) in 40 patients (56%) and correlated with the peak creatine kinase levels (r=0.83, P<0.0001). Troponin T reached the discrimination level (0.10 microg x l(-1)) in one patient with a serum creatinine level of 0.16 mmol x l(-1)and severe left ventricular impairment. Twelve patients had baseline troponin I levels above our prespecified discrimination level of 0.4 microg x l(-1)(range 0.4 to 3.1 microg x l(-1)), which did not increase after cardioversion. In two patients the levels rose from <0.4 microg x l(-1) to 0.5 microg x l(-1) and 0.6 microg x l(-1) respectively.
Troponin T levels do not rise after elective cardioversion. The minor increases in troponin I may reflect our choice of discrimination level. Cardiac troponins are useful in determining whether arrhythmias requiring emergency cardioversion are primary or secondary to myocardial infarction.
描述择期心脏复律后五种心肌蛋白的释放模式。
我们对72例择期心脏复律尝试从基线至复律后24小时连续测量心肌蛋白肌酸激酶、肌酸激酶同工酶质量、肌红蛋白、肌钙蛋白T和肌钙蛋白I的血清水平。心脏复律尝试所使用的总能量为408±318焦耳（范围50至1280焦耳）。肌酸激酶最高水平（中位数232国际单位×升⁻¹，四分位间距91至1152国际单位×升⁻¹）出现在24小时，且与输送的总能量相关（r = 0.75，P < 0.0001）。7例患者（10%）的肌酸激酶同工酶质量峰值水平超过心肌损伤的判别水平（≥5微克×升⁻¹）。40例患者（56%）的肌红蛋白峰值水平升高（>85微克×升⁻¹），且与肌酸激酶峰值水平相关（r = 0.83，P < 0.0001）。1例血清肌酐水平为0.16毫摩尔×升⁻¹且有严重左心室功能不全的患者肌钙蛋白T达到判别水平（0.10微克×升⁻¹）。12例患者的基线肌钙蛋白I水平高于我们预先设定的0.4微克×升⁻¹的判别水平（范围0.4至3.1微克×升⁻¹），心脏复律后未升高。2例患者的水平分别从<0.4微克×升⁻¹升至0.5微克×升⁻¹和0.6微克×升⁻¹。
择期心脏复律后肌钙蛋白T水平不升高。肌钙蛋白I的轻微升高可能反映了我们对判别水平的选择。心肌肌钙蛋白有助于确定需要紧急心脏复律的心律失常是原发性的还是继发于心肌梗死的。
