冠状动脉旁路移植术后围手术期心肌梗死的早期诊断：应用生物标志物和心脏磁共振成像的研究。

Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: a study using biomarkers and cardiac magnetic resonance imaging.

机构信息

Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom.

出版信息

Ann Thorac Surg. 2011 Dec;92(6):2046-53. doi: 10.1016/j.athoracsur.2011.05.019. Epub 2011 Oct 1.

DOI:10.1016/j.athoracsur.2011.05.019

PMID:21962261

Abstract

BACKGROUND

Myocardial injury related to coronary artery bypass grafting (CABG) is poorly characterized, and understanding the characteristic release of biomarkers associated with revascularization injury might provide novel therapeutic opportunities. This study characterized early changes in biomarkers after revascularization injury during on-pump CABG.

METHODS

This prospective study comprised 28 patients undergoing on-pump CABG and late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMRI) who underwent measurements of cardiac troponin I (cTnI), creatine kinase-MB, and inflammatory markers (C-reactive protein, serum amyloid A, myeloperoxidase, interleukin 6, tumor necrosis factor-α, matrix metalloproteinase 9a, monocyte chemotactic protein-1, plasminogen activator inhibitor-1a) at baseline, at 1, 6, 12, and 24 hours, and at 1 week (inflammatory markers only) post-CABG. Biomarker results at 1 hour were studied for a relationship to new myocardial infarction as defined by CMRI-LGE, and the diagnostic utility of combining positive biomarkers was assessed.

RESULTS

All patients had an uneventful recovery, but 9 showed a new myocardial infarction demonstrated by new areas of hyperenhancement on CMR. Peak cTnI at 24 hours (ρ = 0.66, p < 0.001) and CK-MB (ρ = 0.66, p < 0.001) correlated with the amount of new LGE. At 1 hour, 3 biomarkers--cTnI, interleukin 6, and tumor necrosis factor-α--were significantly elevated in patients with vs those without new LGE. Receiver operating curve analysis showed cTnI was the most accurate at detecting new LGE at 1 hour: a cutoff of cTnI exceeding 5 μg/L at 1 hour had 67% sensitivity and 79% specificity for detecting new LGE.

CONCLUSIONS

Unexpected CABG-related myocardial injury occurs in a significant proportion of patients. A cTnI test at 1 hour after CABG could potentially differentiate patients with significant revascularization injury.

摘要

背景

与冠状动脉旁路移植术（CABG）相关的心肌损伤特征较差，了解与再血管化损伤相关的生物标志物的特征性释放可能提供新的治疗机会。本研究对体外循环 CABG 期间再血管化损伤后生物标志物的早期变化进行了特征描述。

方法

这项前瞻性研究纳入了 28 例行体外循环 CABG 并接受晚期钆增强（LGE）心脏磁共振成像（CMRI）的患者，这些患者在 CABG 前、1 小时、6 小时、12 小时和 24 小时以及 1 周（仅炎症标志物）时进行了心脏肌钙蛋白 I（cTnI）、肌酸激酶-MB 和炎症标志物（C 反应蛋白、血清淀粉样蛋白 A、髓过氧化物酶、白细胞介素 6、肿瘤坏死因子-α、基质金属蛋白酶 9a、单核细胞趋化蛋白-1、纤溶酶原激活物抑制剂-1a）的测量。研究了 1 小时时的生物标志物结果与 CMRI-LGE 定义的新发心肌梗死之间的关系，并评估了联合阳性生物标志物的诊断效用。

结果

所有患者均顺利康复，但 9 例患者的 CMR 显示新出现的心肌梗死，有新的强化区域。24 小时时的峰值 cTnI（ρ=0.66，p<0.001）和 CK-MB（ρ=0.66，p<0.001）与新 LGE 的量相关。在 1 小时时，与无新 LGE 的患者相比，cTnI、白细胞介素 6 和肿瘤坏死因子-α 3 种生物标志物的水平显著升高。接受者操作特征曲线分析显示，在 1 小时时，cTnI 检测新 LGE 的准确性最高：cTnI 在 1 小时时超过 5μg/L 的截断值检测新 LGE 的敏感性为 67%，特异性为 79%。