Fernández Angel L, García-Bengochea José B, Alvarez Julián, González Juanatey José R
Department of Cardiac Surgery, University Hospital of Santiago, 15706 Santiago de Compostela, Spain.
Interact Cardiovasc Thorac Surg. 2008 May;7(3):373-6; discussion 376-7. doi: 10.1510/icvts.2007.168302. Epub 2008 Feb 7.
The purpose of this study was to compare cardiac markers in the pericardial fluid and serum in order to evaluate preoperative myocardial injury. Thirty patients were divided into three groups. The first group (AVR; n=10) received an aortic valve replacement. The second group (SA; n=10) included patients with stable angina who underwent elective coronary artery bypass grafting (CABG). The third group (ACS; n=10) included patients with acute coronary syndrome who underwent urgent CABG. Pericardial fluid and venous samples were taken after opening the pericardium and 24 h postoperatively. Serum and pericardial concentration of troponin I (cTnI), creatine kinase (CK), its MB isoenzyme (CK-MB) and myoglobin were determined. Preoperative pericardial cTnI was significantly (P<0.01) higher than in serum in all groups. Preoperative pericardial CK, CK-MB and myoglobin were significantly (P<0.01) lower than in serum in groups AVR and SA. Preoperative pericardial and serum cTnI were significantly higher in the ACS than in AVR and SA groups (P<0.01). Postoperative pericardial concentration of all markers was significantly higher (P<0.01) than in serum in all groups. We conclude that preoperative pericardial accumulation of cTnI may reflect subclinical injury which may not be demonstrated by the usual laboratory tests.
本研究的目的是比较心包积液和血清中的心脏标志物，以评估术前心肌损伤。30例患者被分为三组。第一组（AVR组；n = 10）接受主动脉瓣置换术。第二组（SA组；n = 10）包括接受择期冠状动脉旁路移植术（CABG）的稳定型心绞痛患者。第三组（ACS组；n = 10）包括接受急诊CABG的急性冠状动脉综合征患者。心包打开后及术后24小时采集心包积液和静脉血样本。测定血清和心包中肌钙蛋白I（cTnI）、肌酸激酶（CK）及其MB同工酶（CK-MB）和肌红蛋白的浓度。所有组术前心包cTnI均显著高于血清（P<0.01）。AVR组和SA组术前心包CK、CK-MB和肌红蛋白显著低于血清（P<0.01）。ACS组术前心包和血清cTnI显著高于AVR组和SA组（P<0.01）。所有组术后心包中所有标志物的浓度均显著高于血清（P<0.01）。我们得出结论，术前心包cTnI的蓄积可能反映亚临床损伤，而常规实验室检查可能无法显示这种损伤。
