Madrid A H, del Rey J M, Rubí J, Ortega J, González Rebollo J M, Seara J G, Ripoll E, Moro C
Arrhythmia Unit and Clinical Biochemistry Department, Ramón y Cajal Hospital, Department of Medicine, Alcalá University. Madrid, Spain.
Am Heart J. 1998 Dec;136(6):948-55. doi: 10.1016/s0002-8703(98)70148-6.
We designed this study to determine the value of serum levels of several cardiac markers in patients who underwent radiofrequency ablation and to establish the utility of cardiac troponin I (cTnI). After radiofrequency ablation there is always a small localized endomyocardial necrosis. The volume of the necrosis may be estimated by the rise of several biochemical marker levels, classically creatinine kinase (CK) and CK-MB. cTnI is a newly available biochemical marker with a high cardiac specificity.
We analyzed the data from 51 patients who underwent radiofrequency ablation and from 16 control patients who underwent an electrophysiologic study without ablation. The levels of CK, CK-MB mass, cTnI, and myoglobin were compared with clinical findings, ST-T wave abnormalities, and the presence of arrhythmias. The study shows that there is a higher release of cTnI compared with the standard markers CK, CK-MB, and myoglobin. A pathologic value of cTnI was found in 92% of the patients of the ablation group. CK-MB had a lower sensitivity (63%). The area under the receiver operating characteristic curve for cTnI was 0.9375, significantly superior to the other biochemical markers (P <.05). We found a moderate level of correlation between the number of radiofrequency pulses and cardiac cTnI release (r = 0.69, P <.0001).
The serum level of cTnI detects the minor myocardial damage produced by radiofrequency ablation. This would be useful information to have in patients who might have the potential for other ischemic events. The other biochemical or ablation parameters usually reported, including the radiofrequency ablation parameters, have no good correlation with the size of the myocardial necrosis. Therefore we suggest that monitoring of cTnI is the best way to detect and quantify the size of myocardial necrosis created by radiofrequency ablation.
我们开展这项研究以确定接受射频消融术患者的几种心脏标志物血清水平的价值，并确立心肌肌钙蛋白I（cTnI）的效用。射频消融术后总会存在小范围局限性心内膜心肌坏死。坏死体积可通过几种生化标志物水平的升高来估计，传统上是肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）。cTnI是一种新可用的具有高心脏特异性的生化标志物。
我们分析了51例接受射频消融术患者以及16例接受非消融性电生理检查的对照患者的数据。将CK、CK-MB质量、cTnI和肌红蛋白水平与临床表现、ST-T波异常及心律失常的存在情况进行比较。研究表明，与标准标志物CK、CK-MB和肌红蛋白相比，cTnI的释放量更高。在消融组92%的患者中发现cTnI具有病理学意义的值。CK-MB的敏感性较低（63%）。cTnI的受试者工作特征曲线下面积为0.9375，显著优于其他生化标志物（P<.05）。我们发现射频脉冲数量与心脏cTnI释放之间存在中等程度的相关性（r = 0.69，P<.0001）。
cTnI血清水平可检测出射频消融术造成的轻微心肌损伤。对于可能有其他缺血性事件风险的患者而言，这将是有用的信息。通常报道的其他生化或消融参数，包括射频消融参数，与心肌坏死大小均无良好相关性。因此我们建议，监测cTnI是检测和量化射频消融术造成的心肌坏死大小的最佳方法。
