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Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
Published on: September 17, 2021
Troponin I and lactate from coronary sinus predict cardiac complications after myocardial revascularization
Francesco Onorati1, Lucia Cristodoro, Santo Caroleo
1Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy. frankono@libero.it
Insights
Elevated troponin I and lactate levels after myocardial revascularization predict cardiac complications. Early intraoperative monitoring can help prevent acute myocardial infarction and myocardial damage.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biochemistry
Background:
- Postoperative elevation of troponin I and lactate are associated with cardiac complications following myocardial revascularization.
- Early prediction of acute myocardial infarction (AMI) and myocardial damage is crucial after cardiac surgery.
Purpose of the Study:
- To evaluate the predictive value of troponin I and lactate levels for acute myocardial infarction (AMI) and myocardial damage after myocardial revascularization.
- To assess the utility of intraoperative and postoperative biochemical markers in predicting cardiac complications.
Main Methods:
- 183 patients undergoing isolated myocardial revascularization were prospectively studied.
- Troponin I and lactate levels were measured preoperatively, intraoperatively, and at 12, 24, 48, and 72 hours postoperatively.
- Receiver operating characteristic (ROC) curves were used to determine the predictive accuracy of troponin I and lactate for AMI and myocardial damage.
Main Results:
- Patients who developed AMI (3.2%) or myocardial damage (3.2%) had significantly higher troponin I and lactate levels at all measured time points.
- Coronary sinus troponin I demonstrated superior predictive accuracy for AMI (AUC 0.820) and myocardial damage (AUC 0.834) compared to lactate.
- Elevated troponin I and lactate were associated with longer intubation times, intensive care unit stays, hospital stays, and worse ventricular function.
Conclusions:
- Coronary sinus troponin I and lactate levels are valuable predictors of cardiac complications after myocardial revascularization.
- Routine intraoperative biochemical monitoring of troponin I and lactate should be implemented to facilitate preventative strategies and reduce myocardial damage.
Background:
Postoperative troponin I and lactate elevation are related to cardiac complications after myocardial revascularization. We sought to evaluate earlier predictive value for acute myocardial infarction (AMI) and myocardial damage of troponin I and lactate after myocardial revascularization.
Methods:
In all, 183 consecutive isolated myocardial revascularizations were prospectively enrolled in the study. Troponin I and lactate were sampled preoperatively and intraoperatively from the coronary sinus, and at 12, 24, 48, and 72 hours. Hospital outcome was recorded. Receiver operating curves for coronary sinus troponin I and lactate were constructed to differentiate patients with or without AMI and myocardial damage.
Results:
Acute myocardial infarction developed in 6 patients (3.2%), with higher troponin I and lactate at all time points (p < 0.05), longer intubation time (p = 0.003), intensive care unit stay (p = 0.001), hospital stay (p = 0.001), higher atrial fibrillation (p = 0.001), and worse ventricular function (p = 0.001). Myocardial damage developed in 6 patients (3.2%), showing higher troponin I at all time points (p < 0.001), higher intraoperative lactate (p = 0.04), longer intubation time (p = 0.005), and intensive care unit stay (p = 0.03). Receiver operating characteristic curves demonstrated coronary sinus troponin I greater than 0.94 microg/L (area under the curve [AUC] 0.820 +/- 0.075; sensitivity 90.0%, specificity 68.9%) as a better discriminator between patients with or without AMI than lactate level greater than 2.85 mmol/L (AUC 0.686 +/- 0.090; sensitivity 80.0%; specificity 72.9%); troponin I greater than 0.65 microg/L was a better discriminator between patients with or without myocardial damage (AUC 0.834 +/- 0.061; sensitivity 93.8%, specificity 71.5%), than lactate greater than 2.05 mmol/L (AUC 0.627 +/- 0.067; sensitivity 87.5%; specificity 70.7%).
Conclusions:
Coronary sinus troponin I and lactate are predictive for cardiac complications after myocardial revascularization. Intraoperative biochemical assays should be routinely performed to establish preventative strategies to reduce further myocardial damage.
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