Carmona P, Mateo E, Montoro A, Alós L, Coret M, Errando C L, Llagunes J, De Andrés J
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
Rev Esp Anestesiol Reanim. 2015 Jan;62(1):3-9. doi: 10.1016/j.redar.2014.02.011. Epub 2014 Apr 18.
Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein » (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers.
A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded.
Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL).
This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.
术后心肌梗死是心脏手术严重且常见的并发症。然而，在此背景下进行诊断有时具有挑战性。我们试图评估新型生物标志物“心脏型脂肪酸结合蛋白”（h-FABP）与传统生物标志物相比，在非体外循环冠状动脉搭桥术患者心肌损伤早期检测中的动力学及诊断准确性。
对连续17例在2个月内接受非体外循环冠状动脉搭桥术的患者进行了一项前瞻性研究。在基线（T1）、冠状动脉搭桥术后即刻（T2）、入住重症监护病房时（T3）以及术后4小时（T4）、8小时（T5）、24小时（T6）和48小时（T7）采集血样，用于检测心肌缺血损伤生物标志物（h-FABP、肌钙蛋白、肌酸激酶[CK]和CK-MB）。记录根据心电图、超声心动图和血流动力学标准定义的围手术期缺血并发症。
肌钙蛋白在T4时出现较早的生物标志物血浆峰值（2.9±5.2 ng/mL），h-FABP在T5时出现（37.9±55.5 ng/mL）。CK和CK-MB的最大值出现较晚，均在T6时（分别为741±779和37±51 U/L）。h-FABP的优化截断值为19 ng/mL，对围手术期缺血损伤诊断的敏感性和特异性分别为77%和75%，h-FABP的ROC曲线下面积为0.83（95%CI 0.6 - 1.0），而肌钙蛋白为0.63（95%CI 0.33 - 0.83）。h-FABP的这个截断值平均在T2时达到（T2时h-FABP的平均值：18.9±21.5 ng/mL）。
这是第一项评估h-FABP生物标志物在围手术期非体外循环冠状动脉搭桥术中动力学的研究，所确定的截断值有助于在此背景下更早地检测心肌缺血。
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