Goeddel Lee A, Zaky Ahmed, Aban Inmaculada, Steele Chad, George James F, Melby Spencer J, Dell'Italia Louis J
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Ala.
JTCVS Tech. 2023 Apr 14;19:86-92. doi: 10.1016/j.xjtc.2023.03.018. eCollection 2023 Jun.
Pericardial fluid biomarkers reflect the physiologic state of the myocardium. Previously, we showed a sustained increase in pericardial fluid biomarkers compared with blood in the 48 hours after cardiac surgery. We assess the feasibility of analyzing 9 common cardiac biomarkers from pericardial fluid collected during cardiac surgery and test a preliminary hypothesis of association between the most common biomarkers, troponin and brain natriuretic peptide, and length of stay after surgery.
We prospectively enrolled 30 patients aged 18 years or more undergoing coronary artery or valvular surgery. Patients with ventricular assist devices, atrial fibrillation surgery, thoracic aorta surgery, redo surgery, concomitant noncardiac surgery, and preoperative inotropic support were excluded. Before pericardial excision during surgery, a 1-cm pericardial incision was made to insert an 18-gauge catheter and collect 10 mL of pericardial fluid. Concentrations of 9 established biomarkers of cardiac injury or inflammation including brain natriuretic peptide and troponin were measured. Zero truncated Poisson regression adjusted for Society of Thoracic Surgery Preoperative Risk of Mortality tested for a preliminary association between pericardial fluid biomarkers and length of stay.
Pericardial fluid was collected and pericardial fluid biomarkers resulted for all patients. Adjusted for Society of Thoracic Surgery risk, brain natriuretic peptide, and troponin were associated with increased intensive care unit and overall hospital length of stay.
In 30 patients, pericardial fluid was obtained and analyzed for cardiac biomarkers. Adjusting for Society of Thoracic Surgery risk, pericardial fluid troponin and brain natriuretic peptide were preliminarily associated with increased length of stay. Further investigation is needed to validate this finding and to investigate the potential clinical utility of pericardial fluid biomarkers.
心包积液生物标志物可反映心肌的生理状态。此前，我们发现心脏手术后48小时内心包积液生物标志物水平相较于血液持续升高。我们评估了分析心脏手术期间收集的心包积液中9种常见心脏生物标志物的可行性，并检验了最常见的生物标志物肌钙蛋白和脑钠肽与术后住院时间之间关联的初步假设。
我们前瞻性纳入了30例年龄在18岁及以上接受冠状动脉或瓣膜手术的患者。排除使用心室辅助装置、房颤手术、胸主动脉手术、再次手术、同期非心脏手术以及术前使用正性肌力药物支持的患者。在手术过程中进行心包切除之前，做一个1厘米的心包切口，插入一根18号导管，收集10毫升心包积液。检测9种已确定的心脏损伤或炎症生物标志物的浓度，包括脑钠肽和肌钙蛋白。采用零截断泊松回归模型，并根据胸外科医师协会术前死亡风险进行调整，以检验心包积液生物标志物与住院时间之间的初步关联。
所有患者均收集到了心包积液并检测了心包积液生物标志物。根据胸外科医师协会风险进行调整后，脑钠肽和肌钙蛋白与重症监护病房住院时间和总体住院时间延长相关。
在30例患者中，获取了心包积液并分析了其中的心脏生物标志物。根据胸外科医师协会风险进行调整后，心包积液肌钙蛋白和脑钠肽与住院时间延长初步相关。需要进一步研究以验证这一发现，并探讨心包积液生物标志物的潜在临床应用价值。
