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Cardiac enzymes after transmyocardial laser treatment with CO2 laser
O Tjomsland1, L Aaberge, S M Almdahl
1Feiring Heart Clinic, University of Oslo, Norway. mrisberg@ah.telia.no
Insights
Transmyocardial laser treatment (TML) increases cardiac enzymes post-surgery, with higher levels linked to adverse events. Enzyme levels also inversely correlate with ejection fraction changes after TML.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biochemistry
Background:
- Refractory angina pectoris (Canadian Cardiovascular Society Angina Score Class III & IV) poses a significant clinical challenge.
- Transmyocardial laser treatment (TML) is an alternative therapy for patients unsuitable for conventional revascularization.
- Understanding the biochemical and clinical sequelae of TML is crucial for patient management.
Purpose of the Study:
- To investigate postoperative serum cardiac enzyme levels following TML using CO2 laser.
- To assess the relationship between enzyme release and postoperative cardiac events.
- To evaluate the association between enzyme levels and changes in ejection fraction at 3-month follow-up.
Main Methods:
- A cohort of 49 patients with refractory angina underwent TML with CO2 laser.
- Serum levels of aspartate aminotranspherase (ASAT), alanine aminotranspherase (ALAT), and creatine kinase MB-isoenzymes (CK-MB) were monitored for 72 hours post-surgery.
- Left ventricular ejection fraction was assessed at baseline and 3 months postoperatively using multiple-gated acquisition ventriculography.
Main Results:
- A significant rise in serum markers of myocardial necrosis was observed 8 hours after TML.
- Increased enzyme levels between 8 and 24 hours post-surgery correlated with adverse cardiac events.
- Peak cardiac enzyme levels showed an inverse correlation with the change in ejection fraction from baseline to 3 months.
Conclusions:
- TML with CO2 laser results in a significant increase in serum cardiac enzymes starting 8 hours post-procedure.
- Elevated enzyme levels post-TML are associated with increased risk of postoperative cardiac adverse events.
- The magnitude of peak enzyme elevation after TML is inversely related to the improvement in ejection fraction observed at 3 months.
Objectives:
The aim of the present study was to examine postoperative serum levels of cardiac enzymes after transmyocardial laser treatment (TML) and to evaluate any associations between this release, postoperative cardiac events and change in ejection fraction after 3 months' follow-up.
Design:
Forty-nine patients with angina pectoris Canadian Cardiovascular Society Angina Score Class III & IV refractory to medical therapy and untreatable by coronary artery bypass or percutaneous transluminal angioplasty treated with CO2 laser were included. Inclusion criteria were age less than 75 years, left ventricular ejection fraction greater than or equal to 30% and myocardial regions with reversible ischemia. Serum levels of aspartate aminotranspherase (ASAT), alanine aminotranspherase (ALAT) and MB-isoenzymes of creatine kinase (CK-MB) were followed during the first 72 h after surgery. Ejection fractions were estimated by multiple-gated acquisition ventriculography at inclusion and 3 months postoperatively.
Results:
A significant increase in serum markers of myocardial necrosis was observed 8 h after surgery. A subsequent increase from 8 to 24 h after surgery was associated with the presence of postoperative cardiac adverse events. An inverse correlation was found between peak level of cardiac enzymes and change in ejection fraction from baseline to 3 months' follow-up.
Conclusions:
TML with CO2 laser is followed by a significant increase in serum levels of cardiac enzymes after 8 h. Further significant increases are associated with cardiac adverse events postoperatively. Peak enzyme values are inversely correlated with change in ejection fraction from baseline to 3 months' follow-up.