Peivandi A A, Dahm M, Hake U, Hafner G, Opfermann U T, Loos A H, Tzanova I, Oelert H
Department for Cardiothoracic-Surgery, Johannes Gutenberg-University Hospital, Mainz, Germany.
Thorac Cardiovasc Surg. 2001 Jun;49(3):137-43. doi: 10.1055/s-2001-14289.
Cardiac troponin I (cTnI) has been shown to be a specific marker for myocardial injury in cardiac surgery. The object of this prospective study was to determine the patterns and kinetic and diagnostic value of cTnI, cardiac troponin T (cTnT), and creatine kinase MB (CKMB) activity after minimally invasive coronary revascularization using an octopus device on the beating heart (OPCAB).
48 patients (33 male/15 female, mean age 68.3 +/- 8.7 years) underwent their first elective OPCAB surgery with median sternotomy without mortality. The mean number of grafts was 2.0 +/- 0.8 per patient. Preoperative mean ejection fraction was 56.6 % +/- 14.9%. CTnI and T levels, total creatine kinase (CK) and CK-MB activity in the serum were measured before operation, at arrival at the ICU, and 6, 12, 24, 48 and 120 hours afterward. Serial 12-lead ECGs were recorded preoperatively and at days 1, 2 and 5. The relationship between perioperative data and postoperative cTnI and cTnT levels and CKMB were statistically identified for all variables.
The best cutoff value for cTnI was 8.35 micrograms/l. The patients were grouped by the ECG findings and maximal slopes of cTnI postoperatively (group I: unchanged ECG and cTnI < 8.35 micrograms/l, n = 38; group II: unchanged ECG and cTnI > 8.35 micrograms/l n = 6; group III: Q-wave in ECG and cTnI > 8.35 micrograms/l, n = 4). Baseline serum concentrations of cTnI were in the normal range, and significantly increased after surgery with a peak 24h after the operation. Maximal slopes of cTnI ranged in group II between 9.1 and 18.0 micrograms/l, and in group III between 35.9 and 88.8 micrograms/l. There was strong concordance between maximum cTnI, cTnT (p < 0.0001) and CK-MB levels (p = 0.003). First cTnI levels immediately post-op correlated with the maximum cTnI levels during the postoperative course (p = 0.009).
CTnI after minimal invasive surgery shows a characteristic pattern with a maximum at 24h after the operation. The measurement of postoperative biochemical marker concentrations, specially cTnI, reflects myocardial injury incurred during the procedure. It is an accurate method for confirming or excluding a perioperative myocardial injury diagnosis after OPCAB surgery.
心肌肌钙蛋白I（cTnI）已被证明是心脏手术中心肌损伤的特异性标志物。这项前瞻性研究的目的是确定在跳动心脏上使用章鱼装置进行微创冠状动脉血运重建术（OPCAB）后，cTnI、心肌肌钙蛋白T（cTnT）和肌酸激酶MB（CKMB）活性的变化模式、动力学及诊断价值。
48例患者（33例男性/15例女性，平均年龄68.3±8.7岁）接受了首次择期OPCAB手术，采用正中胸骨切开术，无死亡病例。每位患者平均移植血管数为2.0±0.8根。术前平均射血分数为56.6%±14.9%。在手术前、抵达重症监护病房时以及术后6、12、24、48和120小时测量血清中的cTnI和T水平、总肌酸激酶（CK）和CK-MB活性。术前及术后第1、2和5天记录连续12导联心电图。对所有变量进行统计学分析，确定围手术期数据与术后cTnI、cTnT水平及CKMB之间的关系。
cTnI的最佳临界值为8.35微克/升。根据术后心电图表现和cTnI的最大斜率对患者进行分组（I组：心电图无变化且cTnI<8.35微克/升，n = 38；II组：心电图无变化且cTnI>8.35微克/升，n = 6；III组：心电图出现Q波且cTnI>8.35微克/升，n = 4）。cTnI的基线血清浓度在正常范围内，术后显著升高，术后24小时达到峰值。II组cTnI的最大斜率在9.1至18.0微克/升之间，III组在35.9至88.8微克/升之间。cTnI最大值与cTnT（p<0.0001）和CK-MB水平（p = 0.003）之间存在高度一致性。术后即刻的首次cTnI水平与术后过程中的最大cTnI水平相关（p = 0.009）。
微创手术后cTnI呈现出术后24小时达到最大值的特征性模式。术后生化标志物浓度的测定，特别是cTnI，反映了手术过程中发生的心肌损伤。它是确认或排除OPCAB手术后围手术期心肌损伤诊断的准确方法。
