Hasegawa Tomomi, Yoshimura Naoki, Oka Shigeteru, Ootaki Yoshio, Toyoda Yoshiya, Yamaguchi Masahiro
Department of Cardiothoracic Surgery, Kobe Children's Hospital, Kobe, Japan.
J Thorac Cardiovasc Surg. 2004 Jun;127(6):1697-702. doi: 10.1016/j.jtcvs.2004.02.006.
Perioperative myocardial damage is a major determinant of postoperative cardiac dysfunction for congenital heart disease. Heart fatty acid-binding protein is reported to be a rapid marker of perioperative myocardial damage that peaks earlier than creatine kinase isoenzyme MB or cardiac troponin T in adults. The objective of this study was to assess the suitability of using serum concentrations of heart fatty acid-binding protein for evaluation of perioperative myocardial damage in pediatric cardiac surgery.
After institutional review board approval and informed consent, 100 children undergoing open procedures for congenital heart disease were prospectively enrolled in the study. Mean age at operation was 4.9 +/- 0.4 years. Serum concentrations of heart fatty acid-binding protein, creatine kinase isoenzyme MB, and cardiac troponin T were measured serially before operation and at 0, 1, 2, 3, and 6 hours after aortic declamping. Relationships between serum peak level of heart fatty acid-binding protein and intraoperative and postoperative clinical variables were evaluated.
Serum heart fatty acid-binding protein reached its peak level at 1 hour after declamping in 95 patients (95%), which was significantly earlier (P <.01) than serum creatine kinase isoenzyme MB or cardiac troponin T. In addition, serum heart fatty acid-binding protein level immediately after declamping correlated strongly with serum peak heart fatty acid-binding protein level (r = 0.91, P <.01). The serum peak level of heart fatty acid-binding protein correlated with those of creatine kinase isoenzyme MB (r = 0.77, P <.01) and cardiac troponin T (r = 0.80, P <.01). In the forward stepwise multiple regression analysis, age (P <.0001), aortic crossclamp time (P <.0001), the presence of a ventriculotomy (P <.001), and the lowest hematocrit level during cardiopulmonary bypass (P <.05) were significant intraoperative variables that influenced the release of heart fatty acid-binding protein. There were significant relationships between serum peak heart fatty acid-binding protein level and postoperative inotropic support, duration of intubation, and intensive care unit stay (P <.01 for each).
Heart fatty acid-binding protein is a rapid marker for assessment of myocardial damage and clinical outcome in pediatric cardiac surgery. In particular, serum heart fatty acid-binding protein level immediately after aortic declamping may be a potentially useful prognostic indicator of myocardial damage as well as clinical outcome in pediatric cardiac surgery.
围手术期心肌损伤是先天性心脏病术后心脏功能障碍的主要决定因素。据报道，心脏脂肪酸结合蛋白是围手术期心肌损伤的快速标志物，在成人中其峰值出现时间早于肌酸激酶同工酶MB或心肌肌钙蛋白T。本研究的目的是评估使用血清心脏脂肪酸结合蛋白浓度评估小儿心脏手术围手术期心肌损伤的适用性。
经机构审查委员会批准并获得知情同意后，前瞻性纳入100例接受先天性心脏病开放手术的儿童。手术时的平均年龄为4.9±0.4岁。在手术前以及主动脉钳夹后0、1、2、3和6小时连续测量血清心脏脂肪酸结合蛋白、肌酸激酶同工酶MB和心肌肌钙蛋白T的浓度。评估心脏脂肪酸结合蛋白血清峰值水平与术中和术后临床变量之间的关系。
95例患者（95%）的血清心脏脂肪酸结合蛋白在钳夹后1小时达到峰值水平，这明显早于血清肌酸激酶同工酶MB或心肌肌钙蛋白T（P<0.01）。此外，钳夹后即刻的血清心脏脂肪酸结合蛋白水平与血清心脏脂肪酸结合蛋白峰值水平密切相关（r = 0.91，P<0.01）。心脏脂肪酸结合蛋白血清峰值水平与肌酸激酶同工酶MB（r = 0.77，P<0.01）和心肌肌钙蛋白T（r = 0.80，P<0.01）的水平相关。在向前逐步多元回归分析中，年龄（P<0.0001）、主动脉阻断时间（P<0.0001）、心室切开术的存在（P<0.001）以及体外循环期间的最低血细胞比容水平（P<0.05）是影响心脏脂肪酸结合蛋白释放的重要术中变量。血清心脏脂肪酸结合蛋白峰值水平与术后强心支持、插管持续时间和重症监护病房停留时间之间存在显著关系（每项P<0.01）。
心脏脂肪酸结合蛋白是评估小儿心脏手术中心肌损伤和临床结局的快速标志物。特别是，主动脉钳夹后即刻的血清心脏脂肪酸结合蛋白水平可能是小儿心脏手术中心肌损伤以及临床结局的潜在有用预后指标。
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