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Cardiac troponin I and creatine kinase-MB release after different cardiac surgeries
Florinda Mastro1, Pietro Guida, Giuseppe Scrascia
1Division of Cardiac Surgery, Department of Emergency and Organ Transplant (D.E.T.O.), University of Bari, Bari, Italy.
Insights
Cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) levels vary after heart surgery. Mitral valve surgery shows the highest and longest elevations in these cardiac injury markers.
Area of Science:
- Cardiology
- Biomarkers
- Cardiac Surgery
Background:
- Cardiac biomarkers like cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) are crucial for diagnosing myocardial injury.
- Understanding their release patterns after different cardiac surgeries is essential for accurate interpretation.
Purpose of the Study:
- To compare the postoperative release patterns of cTnI and CK-MB following various cardiac surgical procedures.
- To identify procedural differences influencing myocardial injury biomarker levels.
Main Methods:
- A study involving 200 adult patients undergoing cardiopulmonary bypass for cardiac surgery (CABG, valve, thoracic aorta, combined).
- Serial measurements of cTnI and CK-MB were performed postoperatively until day 5.
- Multivariate analysis was used to assess factors influencing biomarker levels.
Main Results:
- Peak cTnI and CK-MB levels were typically observed within 18 hours post-surgery, correlating with bypass and cross-clamp times.
- Mitral valve surgery resulted in significantly higher cTnI and CK-MB levels and longer elevations compared to other procedures.
- Thoracic aorta surgery showed lower biomarker elevations than CABG and combined surgeries.
Conclusions:
- The release kinetics of cTnI and CK-MB are significantly influenced by the type of cardiac surgery performed.
- Mitral valve surgery is associated with the most pronounced and prolonged elevation of these myocardial injury markers.
- Further research is needed to clarify the determinants and prognostic implications of these biomarker differences, especially after valve surgery.
Aims:
To conduct a comparative study of cardiac troponin I (cTnI) and MB isoenzyme of serum creatine kinase (CK-MB) after different cardiac surgeries.
Methods:
Consecutive cardiac operations under cardiopulmonary bypass (200 adults, 144 men, 68 ± 11 years): 67 coronary artery bypass graft (CABG), 27 aortic valve surgery, 21 mitral valve surgery, 11 thoracic aorta surgery, and 74 combined surgery. Postoperative cTnI and CK-MB were measured on admission to the ICU and at fixed time until the fifth postoperative day.
Results:
Peak values of cTnI (median 5.8 ng/ml; interquartile range 3.6-11.9) and CK-MB (29.0 ng/ml; 15.6-60.4) were reached mainly within 18 h after the end of surgery (85% of cTnI and 95% of CK-MB highest determinations) without differences among groups. Cardiopulmonary bypass and cross-clamp time significantly correlated with markers' peak values. At multivariate analysis, mitral valve surgery showed greater cTnI, CK-MB, and their cumulative area under the curve than other isolated procedures. Thoracic aorta surgery showed lower cumulative area under the curve for both markers than CABG and combined surgery. Mitral valve surgery had significant later reduction of both markers in comparison with other procedures. No patient in mitral valve surgery group reached cTnI values in the normal laboratory range within 5 postoperative days.
Conclusion:
Release pattern of cTnI and CK-MB after heart surgery depends on the type of procedure. Mitral valve surgery was characterized by highest and longest elevation of postoperative markers' concentration. Determinants of differences in myocardial injury biomarkers and their prognostic value after valve surgery should be accurately assessed.
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