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Structural myocardial changes after coronary artery surgery
F Eberhardt1, U Mehlhorn, K Larosé
1University of Cologne, University of Halle, Germany. frank.eberhardt@medinf.mu-luebeck.de
European Journal of Clinical Investigation
|December 15, 2000
Summary
Coronary artery bypass grafting (CABG) using cold crystalloid cardioplegia causes myocardial stunning. Structural changes like increased HSP-70i and ICAM-1 indicate stunning post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Molecular Biology
Background:
- Postoperative myocardial stunning is a known complication after coronary artery bypass grafting (CABG).
- The role of cold crystalloid cardioplegia in inducing myocardial changes requires further investigation.
Purpose of the Study:
- To investigate the presence and extent of clinical, structural, and histochemical evidence of myocardial stunning in patients undergoing CABG with cold crystalloid cardioplegia.
- To identify potential structural markers for myocardial stunning in a clinical setting.
Main Methods:
- Left ventricular biopsies from 10 CABG patients were collected before and after cardiopulmonary bypass (CPB).
- Biopsies were immunostained for heat-shock protein 70 (HSP-70i), intercellular adhesion molecule-1 (ICAM-1), and actin.
- Adenosine triphosphate (ATP) levels and coronary sinus lactate production were measured.
Main Results:
- Post-CPB biopsies showed increased HSP-70i and ICAM-1 expression, and disrupted actin patterns, unlike pre-CPB samples.
- ATP levels decreased significantly post-CPB, with increased lactate production observed.
- While echocardiography showed no functional decline, inotropic support was needed to maintain cardiac output.
Conclusions:
- Clinical and structural evidence of myocardial stunning was observed after CABG using cold crystalloid cardioplegia.
- Elevated HSP-70i and ICAM-1 expression, along with altered actin structure, may serve as reliable markers for identifying myocardial stunning.