心脏直视手术成年患者围手术期冠状窦源性血清心肌肌钙蛋白I、肌酸激酶同工酶MB、乳酸、丙酮酸及乳酸与丙酮酸比值的短期预后价值

Short-term prognostic value of perioperative coronary sinus-derived-serum cardiac troponin-I, creatine kinase-MB, lactate, pyruvate, and lactate-pyruvate ratio in adult patients undergoing open heart surgery.

作者信息

Chowdhury Ujjwal Kumar, Sheil Avneesh, Kapoor Poonam Malhotra, Narang Rajiv, Gharde Parag, Malik Vishwas, Kalaivani Mani, Chaudhury Arindam

机构信息

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

出版信息

Ann Card Anaesth. 2016 Jul-Sep;19(3):439-53. doi: 10.4103/0971-9784.185526.

DOI:10.4103/0971-9784.185526

PMID:27397448

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4971972/

Abstract

OBJECTIVES

To investigate the release pattern of different cardiac metabolites and biomarkers directly from the coronary sinus (CS) and to establish the diagnostic discrimination limits of each marker protein and metabolites to evaluate perioperative myocardial injury in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).

PATIENTS AND METHODS

Sixty-eight patients undergoing first mitral and/or aortic valve replacements with/without coronary artery bypass grafting and Bentall procedure under CPB and blood cardioplegic arrest were studied. All cardiac metabolites and biomarkers were measured in serial CS-derived blood samples at pre-CPB, immediate post aortic declamping, 10 minutes post-CPB and 12 hrs post-CPB.

RESULTS

Receiver operating characteristic curve analysis of cardiac biomarkers indicated lactate-pyruvate ratio as the superior diagnostic discriminator of myocardial injury with an optimal "cut-off" value >10.8 immediately after aortic declamping (AUC, 0.92; 95% CI: 0.85-0.98). Lactate was the second best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2mmol/l at immediately after aortic declamping (AUC, 0.89; 95% CI: 0.80-0.96). Cardiac troponin-I was the third best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2.1ng/ml at immediately after aortic declamping (AUC, 0.88; 95% CI: 0.80-0.95). Creatine kinase-MB was the fourth best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >58 log units/ml prior to decanulation (AUC, 0.85; 95% CI: 0.78-0.94).

CONCLUSIONS

Measurable cardiac damage exists in all patients undergoing cardiac surgery under cardioplegic arrest. The degree of myocardial injury is more in patients with poor ventricular function and those requiring longer aortic clamp time. CS-derived lactate-pyruvate ratio, lactate, cTn-I served as superior diagnostic discriminators of peri-operative myocardial damage.

摘要

目的

直接研究不同心脏代谢产物和生物标志物从冠状窦（CS）的释放模式，并确定每种标记蛋白和代谢产物的诊断鉴别界限，以评估体外循环（CPB）下心内手术患者围手术期心肌损伤情况。

患者和方法

对68例在CPB和冷血心脏停搏下进行首次二尖瓣和/或主动脉瓣置换术（伴或不伴冠状动脉搭桥术及Bentall手术）的患者进行研究。在CPB前、主动脉开放后即刻、CPB后10分钟和CPB后12小时，对一系列源自CS的血样进行所有心脏代谢产物和生物标志物的测量。

结果

心脏生物标志物的受试者工作特征曲线分析表明，乳酸 - 丙酮酸比值是心肌损伤的最佳诊断鉴别指标，在主动脉开放后即刻最佳“截断”值>10.8（AUC，0.92；95%CI：0.85 - 0.98）。乳酸是心肌损伤的第二佳诊断鉴别指标，在主动脉开放后即刻最佳“截断”值>2mmol/l（AUC，0.89；95%CI：0.80 - 0.96）。心肌肌钙蛋白I是心肌损伤的第三佳诊断鉴别指标，在主动脉开放后即刻最佳“截断”值>2.1ng/ml（AUC，0.88；95%CI：0.80 - 0.95）。肌酸激酶 - MB是心肌损伤的第四佳诊断鉴别指标，在拔除插管前最佳“截断”值>58 log单位/ml（AUC，0.85；95%CI：0.78 - 0.94）。