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Denessen EJ, Heuts S, Daemen JH, van Doorn WP, Vroemen WH, Sels JW, Segers P, Van‘t Hof AW, Maessen JG, Bekers O, Van Der Horst IC, Mingels AM. High-Sensitivity Cardiac Troponin I and T Kinetics Differ following Coronary Bypass Surgery: A Systematic Review and Meta-Analysis. Clin Chem 2022; 68:1564-1575. [DOI: 10.1093/clinchem/hvac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Cardiac troponin I and T are both used for diagnosing myocardial infarction (MI) after coronary artery bypass grafting (CABG), also known as type 5 MI (MI-5). Different MI-5 definitions have been formulated, using multiples of the 99th percentile upper reference limit (10×, 35×, or 70× URL), with or without supporting evidence. These definitions are arbitrarily chosen based on conventional assays and do not differentiate between troponin I and T. We therefore investigated the kinetics of high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) following CABG.
Methods
A systematic search was applied to MEDLINE and EMBASE databases including the search terms “coronary artery bypass grafting” AND “high-sensitivity cardiac troponin.” Studies reporting hs-cTnI or hs-cTnT on at least 2 different time points were included. Troponin concentrations were extracted and normalized to the assay-specific URL.
Results
For hs-cTnI and hs-cTnT, 17 (n = 1661 patients) and 15 studies (n = 2646 patients) were included, respectively. Preoperative hs-cTnI was 6.1× URL (95% confidence intervals: 4.9–7.2) and hs-cTnT 1.2× URL (0.9–1.4). Mean peak was reached 6–8 h postoperatively (126× URL, 99–153 and 45× URL, 29–61, respectively). Subanalysis of hs-cTnI illustrated assay-specific peak heights and kinetics, while subanalysis of surgical strategies revealed 3-fold higher hs-cTnI than hs-cTnT for on-pump CABG and 5-fold for off-pump CABG.
Conclusion
Postoperative hs-cTnI and hs-cTnT following CABG surpass most current diagnostic cutoff values. hs-cTnI was almost 3-fold higher than hs-cTnT, and appeared to be highly dependent on the assay used and surgical strategy. There is a need for assay-specific hs-cTnI and hs-cTnT cutoff values for accurate, timely identification of MI-5.
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Affiliation(s)
- Ellen J Denessen
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Jean H Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center , Heerlen , the Netherlands
| | - William P van Doorn
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Wim H Vroemen
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Jan-Willem Sels
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Department of Cardiology, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Arnoud W Van‘t Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Cardiology, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Department of Cardiology, Zuyderland Medical Center , Heerlen , the Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Iwan C Van Der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Alma M Mingels
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
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Heuts S, Denessen EJ, Daemen JH, Vroemen WH, Sels JW, Segers P, Bekers O, van ‘t Hof AW, Maessen JG, van der Horst IC, Mingels AM. Meta-Analysis Evaluating High-Sensitivity Cardiac Troponin T Kinetics after Coronary Artery Bypass Grafting in Relation to the Current Definitions of Myocardial Infarction. Am J Cardiol 2022; 163:25-31. [PMID: 34763830 DOI: 10.1016/j.amjcard.2021.09.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
Various definitions of myocardial infarction type 5 after coronary artery bypass grafting (CABG) have been proposed (myocardial infarction [MI-5], also known as peri-procedural MI), using different biomarkers and different and arbitrary cut-off values. This meta-analysis aims to determine the expected release of high-sensitivity cardiac troponin T (hs-cTnT) after CABG in general and after uncomplicated surgery and off-pump CABG in particular. A systematic search was applied to 3 databases. Studies on CABG as a single intervention and reporting on postoperative hs-cTnT concentrations on at least 2 different time points were included. All data on hs-cTnT concentrations were extracted, and mean concentrations at various points in time were stratified. Eventually, 15 studies were included, encompassing 2,646 patients. Preoperative hs-cTnT was 17 ng/L (95% confidence interval [CI] 13 to 20 ng/L). Hs-cTnT peaked at 6 to 8 hours postoperatively (628 ng/L, 95% CI 400 to 856 ng/L; 45x upper reference limit [URL]) and was still increased after 48 hours. In addition, peak hs-cTnT concentration was 614 ng/L (95% CI 282 to 947 ng/L) in patients with a definite uncomplicated postoperative course (i.e., without MI). For patients after off-pump CABG compared to on-pump CABG, the mean peak hs-cTnT concentration was 186 ng/L (95% CI 172 to 200 ng/L, 13 × URL) versus 629 ng/L (95% CI 529 to 726 ng/L, 45 × URL), respectively. In conclusion, postoperative hs-cTnT concentrations surpass most of the currently defined cut-off values for MI-5, even in perceived uncomplicated surgery, suggesting thorough reassessment. Hs-cTnT release differences following on-pump CABG versus off-pump CABG were observed, implying the need for different cut-off values for different surgical strategies.
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Bishawi M, Milano CA. Treatment of Perioperative Ischemia, Infarction, and Ventricular Failure in Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Masseli F, Masseli M, Dolscheid-Pommerich R, Stoffel-Wagner B, Schiller W. Comparison of Perioperative High-Sensitive Troponin T and Troponin I Assays in Cardiac Surgery. Heart Lung Circ 2021; 31:407-414. [PMID: 34511360 DOI: 10.1016/j.hlc.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/22/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Troponin measurements are among the standard parameters for monitoring perioperative myocardial ischaemia after cardiosurgical procedures. As high-sensitive assays continue to replace older analytic parameters with lower sensitivity, this study aimed to compare perioperative profiles of a high-sensitive troponin T assay (hsTnT, Roche Diagnostics, Mannheim, Germany) with a troponin I assay (sTnI, Siemens Healthcare Diagnostics, Eschborn, Germany). METHODS A total of 287 consecutive patients undergoing a typical spectrum of cardiac procedures from August 2017 to March 2018 monitored with the hsTnT assay were compared with a propensity-matched collective analysed with the sTnI assay. For side-by side comparison, the peak troponin (Tmax) values were scaled to a z-score distribution before comparison. RESULTS Despite absolute postoperative hsTnT and sTnI values differing by an order of magnitude, parameters could be scaled to a common distribution with kernel density curves overlapping 92%. Both parameters showed equal behaviour in subgroup analyses regarding relevant perioperative factors, such as type of procedure, cross-clamping time, and type of cardioplegic solution. However, there were some differences regarding pre-existing renal impairment between both parameters. In both groups, renal failure patients with chronic kidney disease stages IV or V as well as patients on haemodialysis exhibited a marked Tmax increase of >100% compared with normal kidney function (hsTnT, +121%; 2,383.5 vs 1,078.8 ng/L; p=0.0006; and sTnI, +149%; 27.3 ng/mL vs 11.0 ng/mL; p=0.009). However, in patients with moderately impaired renal function, those in the hsTnT group, but not in the sTnI cohort, showed significantly increased Tmax values (CKD stages II or III, 1,233.5 ng/L [+14%] and 1,314.1 ng/L [+22%] vs 1,078.8 ng/L; p=0.01 and p=0.03). In these patients, the postoperative interval until Tmax was reached was also significantly increased (14.4 and 19.0 hrs vs 12.4 hrs for chronic kidney disease stages II and III; p=0.0038 and p<0.001), indicating a higher rate of accumulation in the hsTnT parameter. CONCLUSION In the context of cardiac surgery, this study found that both parameters behaved in a similar manner under most relevant circumstances. Despite significant difference in the absolute serum concentration, hsTnT and sTnI can be scaled to virtually identical distributions. However, renal impairment did affect both parameters differently with troponin T but not troponin I, showing evidence of accumulation in moderately impaired renal disease.
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Affiliation(s)
- Franz Masseli
- Department of Cardiovascular Surgery, University Clinic Mainz, Mainz, Germany.
| | - Marc Masseli
- Department of Cardiac Surgery, University Clinic Bonn, Bonn, Germany
| | | | - Birgit Stoffel-Wagner
- Institute for Clinical Chemistry and Biochemistry, University Clinic Bonn, Bonn, Germany
| | - Wolfgang Schiller
- Department of Cardiovascular Surgery, University Clinic Mainz, Mainz, Germany
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Gu Y, Shan L, Liu B, Lv M, Chen X, Yan T, Shi Y, Chen J, Li Z, Zhang Y. Release Profile of Cardiac Troponin T and Risk Factors of Postoperative Myocardial Injury in Patients Undergoing CABG. Int J Gen Med 2021; 14:2541-2551. [PMID: 34163222 PMCID: PMC8214547 DOI: 10.2147/ijgm.s315691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac troponin T (cTnT) is currently one of the important indicators for clinical diagnosis of myocardial injury, which is inevitable in cardiac surgery, especially coronary artery bypass grafting (CABG). Describing the release profile of cTnT and finding out the risk factors of postoperative myocardial injury (PMI) are of great significance. The purposes of this study are to explore the release profile of cTnT in patients undergoing CABG and to search for independent risk factors of PMI. Methods In this retrospective study, clinical data of CABG patients were collected. The cTnT was measured at 24 hours before and 6, 12, 24, 48, 72, 96 and 120 hours after operation separately. The release profiles and peak time of cTnT in total cohort and sub-cohorts were observed. Independent risk factors of PMI were explored via univariate and multivariate logistic regression analyses. Results In total, 2084 patients were enrolled, including 998 patients in a cTnT group and 1086 patients in a high-sensitive cTnT (hs-cTnT) group. PMI was recognized in 797 patients. In both groups, cTnT showed a trend of rising first and then falling within 120 hours after operation. The peak cTnT appeared within 12–24 hours after operation, while the peak hs-cTnT occurred mostly within 24–48 hours after operation. Univariate logistic analysis showed that body mass index (BMI), New York Heart Association (NYHA) classification, coronary artery disease (CAD) classification, cerebrovascular disease, left ventricular ejection fraction, number of diseased vessels, valvular disease, intra-aortic balloon pump (IABP) implantation, chronic obstructive pulmonary disease, pulmonary hypertension, previous percutaneous coronary intervention (PCI), BMI, bypass graft number, cardiopulmonary bypass, and preoperative cTnT were related risk factors. Multivariate logistic regression analysis showed that NYHA classification, CAD classification, valvular disease, IABP implantation, pulmonary hypertension, previous PCI, bypass graft number, cardiopulmonary bypass, and preoperative cTnT were independent risk factors of PMI. Conclusion NYHA classification, CAD classification, valvular disease, IABP implantation, pulmonary hypertension, previous PCI, bypass graft number, cardiopulmonary bypass, and preoperative cTnT are independent risk factors of PMI in patients undergoing CABG.
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Affiliation(s)
- Yuying Gu
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Mengwei Lv
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xi Chen
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Tao Yan
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Shi
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiapeng Chen
- Xinglin College, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Nellipudi JA, Baker RA, Dykes L, Krieg BM, Bennetts JS. Prognostic Value of High-Sensitivity Troponin T After On-Pump Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2021; 30:1562-1569. [PMID: 33931302 DOI: 10.1016/j.hlc.2021.03.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION High-sensitivity troponin T (hs-TnT), as a single or serial measurement to predict postoperative mortality and morbidity, appears to be attractive due to its direct relationship in assessing myocardial damage and the widespread availability of hs-TnT testing. Therefore, this study aimed to identify any prognostic value of hs-TnT in predicting in-hospital outcomes after coronary artery bypass graft (CABG) surgery. METHOD We identified all consecutive patients who underwent on-pump CABG between July 2011 and December 2018. To evaluate the prognostic value of hs-TnT after CABG, we assessed the probability and odds ratio (OR) of adverse events concerning the maximum value of postoperative hs-TnT (measured within 24 hrs). TnT was routinely collected at 0, 6, 12 and 72 hours postoperatively. Values were categorised into intervals of 200 for analysis. A fully Bayesian logistic regression of the adverse event with the troponin T interval (0-200) as the reference level was used. A subgroup analysis was performed in patients with normal and elevated preoperative hs-TnT (< or ≥30 ng/L). The pre-specified primary outcome was a major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death within 30 days of operation for any cause, myocardial infection (MI), or stroke. RESULTS 1,318 people underwent on-pump CABG during this period. One hundred and twenty-three (123) (9.3%) experienced MACCE, 14 (1.1%) experienced death within 30 days, 105 (8.0%) experienced MI and 14 (1.1%) experienced stroke. Compared to the reference category (hs-TnT ≤200 ng/L) we found there was an increase in OR with increasing level of hs-TnT for MACCE (p<0.001), 30-day mortality (p=0.003), MI (p<0.001) and ICU stay >48 hours (p<0.001). However, there was no statistically significant association present between hs-TnT and stroke, readmission to the intensive care unit (ICU), return to theatre for bleeding, or new-onset renal dysfunction. CONCLUSION Peak hs-TnT level, greater than 400 ng/L, measured within 24 hours after CABG surgery is associated with MACCE, 30-day mortality, MI and ICU stay >48 hours. Prospectively designed trials, with clear prognostic and outcome variables, may provide further insight into the prognostic value of hs-TnT post-CABG.
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Affiliation(s)
- Jessy A Nellipudi
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Robert A Baker
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Lukah Dykes
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Health Analytics Research Collaborative, Health Translation South, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Bronwyn M Krieg
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jayme S Bennetts
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Deneer R, Boxtel AGMV, Boer AK, Hamad MAS, Riel NAWV, Scharnhorst V. Detecting patients with PMI post-CABG based on cardiac troponin-T profiles: A latent class mixed modeling approach. Clin Chim Acta 2020; 504:23-29. [PMID: 32001234 DOI: 10.1016/j.cca.2020.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG) is fraught with complexity since it is primarily based on a single cut-off value for cardiac troponin (cTn) that is exceeded in over 90% of CABG patients, including non-PMI patients. In this study we applied an unsupervised statistical modeling approach to uncover clinically relevant cTn release profiles post-CABG, including PMI, and used this to improve diagnostic accuracy of PMI. METHODS In 624 patients that underwent CABG, cTnT concentration was serially measured up to 24 h post aortic cross clamping. 2857 cTnT measurements were available to fit latent class linear mixed models (LCMMs). RESULTS Four classes were found, described by: normal, high, low and rising cTnT release profiles. With the clinical diagnosis of PMI as golden standard, the rising profile had a diagnostic accuracy of 97%, compared to 83% for an optimally chosen cut-off and 21% for the guideline recommended cut-off value. CONCLUSION Clinically relevant subgroups, including patients with PMI, can be uncovered using serially measured cTnT and a LCMM. The LCMM showed superior diagnostic accuracy of PMI. A rising cTnT profile is potentially a better criterion than a single cut-off value in diagnosing PMI post-CABG.
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Affiliation(s)
- Ruben Deneer
- Clinical Laboratory, Catharina Hospital Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands.
| | | | - Arjen-Kars Boer
- Clinical Laboratory, Catharina Hospital Eindhoven, The Netherlands
| | | | - Natal A W van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Department of Vascular Medicine, Amsterdam University Medical Centers, The Netherlands
| | - Volkher Scharnhorst
- Clinical Laboratory, Catharina Hospital Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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Chen XJ, Zhang W, Bian ZP, Wang ZM, Zhang J, Wu HF, Shao YF, Zhang JN, Zhao S. Cardiac Myosin-Binding Protein C Release Profile After Cardiac Surgery in Intensive Care Unit. Ann Thorac Surg 2019; 108:1195-1201. [PMID: 31034826 DOI: 10.1016/j.athoracsur.2019.03.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac surgical procedures produce iatrogenic myocardial cell injury with necrosis that result in an obligatory release of biomarkers. Cardiac myosin binding protein C (cMyBP-C) has recently emerged as a specific and sensitive biomarker in patients with acute myocardial injury. We therefore aimed to investigate the release profiles of cMyBP-C after cardiac surgical procedures. METHODS Enzyme-linked immunosorbent assay to detect blood cMyBP-C was established by using two monoclonal antibodies against N-terminus of human cMyBP-C. Consecutive patients undergoing cardiac operations (N = 151) were recruited in this study. Blood cMyBP-C was assayed preoperatively, at intensive care unit arrival (0 hour after the operation), at 2 to 48 hours, and before discharge. The characteristics and detailed surgical procedure were recorded. RESULTS The established immunoassay was capable of detecting human cMyBP-C (0 to 1000 ng/L). The released cMyBP-C peaked immediately after cardiac surgery (0 h), attaining 3.8-fold higher than before the operation, dropped abruptly within 24 hours, and stayed at a higher level until discharge. Postoperative cMyBP-C levels correlated positively with high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase, myoglobin, and creatine kinase MB isoenzyme. Different cardiac surgical procedures were characterized by different levels of release of cardiac biomarkers. Isolated off-pump coronary artery bypass grafting was associated with the smaller amount of cMyBP-C release, whereas valve replacement/plasty surgery produced higher release, in particular the multiple-valve surgery. Both cMyBP-C and hs-cTnT correlated with surgical techniques, postoperative intensive care unit stay, and hospital stay. CONCLUSIONS Circulating cMyBP-C is a promising novel biomarker for evaluating cardiac surgical trauma in patients undergoing a cardiac operation.
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Affiliation(s)
- Xiang-Jian Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi-Ping Bian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ze-Mu Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juan Zhang
- The Translational Platform of Jiangsu Province Hospital, Nanjing Bottests Biotechnology Co, Ltd, Nanjing, China
| | - Heng-Fang Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yong-Feng Shao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ji-Nan Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The Translational Platform of Jiangsu Province Hospital, Nanjing Bottests Biotechnology Co, Ltd, Nanjing, China
| | - Sheng Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Ge W, Gu C, Chen C, Chen W, Cang Z, Wang Y, Shi C, Zhang Y. High-sensitivity troponin T release profile in off-pump coronary artery bypass grafting patients with normal postoperative course. BMC Cardiovasc Disord 2018; 18:157. [PMID: 30064376 PMCID: PMC6069958 DOI: 10.1186/s12872-018-0893-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to investigate the high-sensitivity troponin T (hs-TnT) release profile in off-pump coronary artery bypass grafting (OPCABG) patients with normal postoperative course. METHODS From January 2015 to October 2016, 398 consecutive OPCABG patients who had normal postoperative courses were enrolled. Blood samples for hs-TnT were collected at several time points and the comparisons among different time points grouped by various factors were further analyzed. RESULTS There were 317 male and 81 female patients, with a median age of 64. For 66.1% of the patients, peak hs-TnT occurred at the 24th hour after OPCABG, regardless of the groups divided by different factors. In total, the hs-TnT values were much higher in male group (P = 0.035), in patients who need 5 or more bypass grafts (P = 0.035) and in patients with high-risk EuroSCORE II assessment (P = 0.013). However, we failed to find any significant differences between different age groups (P = 0.129) or among different coronary heart disease classifications (P = 0.191). CONCLUSIONS The hs-TnT values were affected by various factors and culminated around the first 24 h following OPCABG. It may provide some useful information for future clinical studies of myocardial biomarkers after OPCABG.
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Affiliation(s)
- Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, affiliated to Shanghai University of TCM, Shanghai, 200021, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chao Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Wangwang Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Zhengqiang Cang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Yuliang Wang
- Department of Hygiene Analysis and Detection School of Public Health Nanjing Medical University, Nanjing, 210029, China
| | - Chennan Shi
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China. .,Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
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