1
|
Yang C, Zheng P, Li L, Zhang Q, Luo Z, Shi Z, Zhao S, Li Q. Machine learning-based model development for predicting risk factors of prolonged intra-aortic balloon pump therapy in patients with coronary artery bypass grafting. J Cardiothorac Surg 2024; 19:383. [PMID: 38926828 PMCID: PMC11201335 DOI: 10.1186/s13019-024-02830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Machine learning algorithms are frequently used to clinical risk prediction. Our study was designed to predict risk factors of prolonged intra-aortic balloon pump (IABP) use in patients with coronary artery bypass grafting (CABG) through developing machine learning-based models. Patients who received perioperative IABP therapy were divided into two groups based on their length of IABP implantation longer than the 75th percentile for the whole cohort: normal (≤ 10 days) and prolonged (> 10 days) groups. Seven machine learning-based models were created and evaluated, and then the Shapley Additive exPlanations (SHAP) method was employed to further illustrate the influence of the features on model. In our study, a total of 143 patients were included, comprising 56 cases (38.16%) in the prolonged group. The logistic regression model was considered the final prediction model according to its most excellent performance. Furthermore, feature important analysis identified left ventricular end-systolic or diastolic diameter, preoperative IABP use, diabetes, and cardiac troponin T as the top five risk variables for prolonged IABP implantation in patients. The SHAP analysis further explained the features attributed to the model. Machine learning models were successfully developed and used to predict risk variables of prolonged IABP implantation in patients with CABG. This may help early identification for prolonged IABP use and initiate clinical interventions.
Collapse
Affiliation(s)
- Changqing Yang
- Department of Emergency, The Sixth Affiliated Hospital of Nantong University, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China
- Department of Emergency, Yancheng Third People's Hospital, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China
| | - Peng Zheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Luo Li
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Soochow University, 899 Pinghai Road, Suzhou, Jiangsu, 215123, China
| | - Qian Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Zhouyu Luo
- Department of Emergency, The Sixth Affiliated Hospital of Nantong University, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China
- Department of Emergency, Yancheng Third People's Hospital, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China
| | - Zhan Shi
- Department of Cardiovascular Surgery, The Sixth Affiliated Hospital of Nantong University, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China.
- Department of Cardiovascular Surgery, Yancheng Third People's Hospital, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China.
| | - Sheng Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Quanye Li
- Department of Emergency, The Sixth Affiliated Hospital of Nantong University, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China.
- Department of Emergency, Yancheng Third People's Hospital, 2 Xinduxi Road, Yancheng, Jiangsu, 224000, China.
| |
Collapse
|
2
|
Cheng XF, Wang K, Zhang HT, Zhang H, Jiang XY, Lu LC, Chen C, Cheng YQ, Wang DJ, Li K. Risk factors for postoperative myocardial injury-related cardiogenic shock in patients undergoing cardiac surgery. J Cardiothorac Surg 2023; 18:220. [PMID: 37415183 DOI: 10.1186/s13019-023-02312-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/28/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Myocardial injury-related cardiogenic shock (MICS) is significantly associated with poor outcomes in patients after cardiac surgery. Herein, we aimed to investigate the risk factor for postoperative MICS. METHODS We performed a case-control study on 792 patients undergoing cardiac surgery from 2016 to 2019, including 172 patients with postoperative MICS and 620 age- and sex-matched controls. MICS was defined as composite criteria: a cardiac index of < 2.2 L/m2/min, arterial lactate levels of > 5 mmol/L at the end of the surgery, a vasoactive-inotropic score of > 40 at the end of the surgery, and a cardiac troponin T (cTnT) level of > 0.8 µg/L on postoperative day 1 (POD1) with an increase of > 10% on POD 2. RESULTS A total of 4671 patients who underwent cardiac surgery in our hospital between 2016 and 2019 were included; of these, 172 (3.68%) had MICS and the remaining 4499 did not. For investigating the risk factors, we selected 620 age- and sex-matched controls. In the univariate analysis, MICS was significantly associated with death (P < 0.05), extracorporeal membrane oxygenation (P < 0.05), continuous renal replacement therapy (P < 0.01), and ventricular arrhythmias (P < 0.05). Multivariable logistic regression analysis revealed that diabetes mellitus (OR:8.11, 95% CI: 3.52-18.66, P < 0.05) and a cardiopulmonary bypass (CPB) time of > 2 h (OR: 3.16, 95% CI: 1.94-5.15, P < 0.05) were associated with postoperative MICS. Moreover, long-time administration of preoperative calcium channel blocker (CCB) was associated with a less incidence of MICS (OR: 0.11, 95% CI: 0.05-0.27, P < 0.05). CONCLUSIONS Postoperative MICS is significantly associated with poor outcomes. Diabetes mellitus and long CPB time are associated with MICS. Preoperative CCB administration is associated with less incidence of MICS.
Collapse
Affiliation(s)
- Xiao-Feng Cheng
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Kuo Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Hai-Tao Zhang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - He Zhang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Xin-Yi Jiang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Li-Chong Lu
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Cheng Chen
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Yong-Qing Cheng
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, 210008, China
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Number 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Number 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Number 321 Zhongshan Road, Nanjing, 210008, China.
| | - Kai Li
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, 210008, China.
| |
Collapse
|
3
|
Zhou S, Diehl R, Sessler DI, Liang C, Mascha EJ, Soltesz EG, Duncan AE. Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis. Anesth Analg 2022; 134:1260-1269. [PMID: 35110515 DOI: 10.1213/ane.0000000000005850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Myocardial injury after coronary artery bypass grafting (CABG) is defined as troponin concentrations >10 times 99th percentile upper reference limit (URL) according to the Fourth Universal Definition. However, troponin concentrations after non-CABG cardiac surgery which indicate greater-than-expected myocardial injury and increased risk for complications remain unclear. Our goal was to assess procedure-specific relationships between troponin T and a composite outcome of low cardiac output syndrome and in-hospital mortality in cardiac surgical patients. METHODS Patients having cardiac surgery between January 2010 and December 2017 were categorized into 4 groups by procedure: (1) CABG; (2) mitral valve repair; (3) aortic valve repair/replacement (AVR); (4) mitral valve replacement (MVR) or CABG + valve surgeries. Exclusion criteria were elevated preoperative troponin T, preoperative kidney failure, circulatory arrest, or preoperative/planned mechanical circulatory support. Logistic regression was used to assess the association between troponin T and composite outcome, both overall and by procedure, including assessment of the interaction between procedure and troponin T on outcome. RESULTS Among 10,253 patients, 37 (0.4%) died and 393 (3.8%) developed the primary outcome. Troponin T concentrations differed by procedure (P < .001). Compared to CABG, AVR had 0.53 (99.2% confidence interval [CI], 0.50-0.56; unadjusted P < .001) times lower troponin T concentrations, while MVR/CABG + valve were 1.54 (99.2% CI, 1.45-1.62, unadjusted P < .001) times higher. There were linear relationships between log2 troponin T concentration and log odds mortality/low cardiac output syndrome. The (unadjusted) relationships were parallel for various types of surgery (interaction P = .59), but at different levels of the outcome. CONCLUSIONS The relative increase in odds for mortality/low cardiac output syndrome per a similar increase in troponin T concentrations did not differ among cardiac surgical procedures, but the absolute troponin T concentrations did. Troponin concentrations should thus be interpreted in context of surgical procedure.
Collapse
Affiliation(s)
- Shan Zhou
- From the Department of Cardiothoracic Anesthesiology
| | - Rachel Diehl
- From the Department of Cardiothoracic Anesthesiology
| | | | - Chen Liang
- Department of Outcomes Research.,Department of Quantitative Health Sciences
| | - Edward J Mascha
- Department of Outcomes Research.,Department of Quantitative Health Sciences
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Andra E Duncan
- From the Department of Cardiothoracic Anesthesiology.,Department of Outcomes Research
| |
Collapse
|
4
|
Li Y, Zhang Y, Zhou X, Lei X, Li X, Wei L. Dynamic observation of 5-fluorouracil-induced myocardial injury and mitochondrial autophagy in aging rats. Exp Ther Med 2021; 22:1451. [PMID: 34721693 PMCID: PMC8549097 DOI: 10.3892/etm.2021.10886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
Patients treated with 5-fluorouracil (5-FU) can develop rare but potentially severe cardiac effects, including cardiomyopathy, angina pectoris, heart failure and cardiogenic shock. The specific pathologies and underlying mechanisms are yet to be fully understood. The results of previous studies have indicated that mitochondrial autophagy is widely detected in many angiocardiopathies. In the present study, the dynamic changes in the homeostasis of mitochondrial injury and autophagy were observed in rats treated with 5-FU for different durations. A corresponding control group and a 5-FU model group were established in groups of Sprague-Dawley rats aged 2 and 18 months, and the myocardial enzyme levels were determined at different time points. At 2 weeks post-model establishment, cardiac ultrasound and myocardial histological staining were performed, cardiomyocyte apoptosis and myocardial mitochondrial function were assessed, and mitochondrial ultrastructure was examined. In addition, the expression levels of autophagy-related proteins were evaluated in the 18-month-old rats on days 7 and 14 of 5-FU administration. The experimental results demonstrated that 5-FU induced an elevation in the levels of myocardial enzymes, as well as changes in the cardiac structure and function, and that these changes were more prominent over longer drug durations. In addition, 5-FU decreased the levels of myocardial mitochondrial ATP and mitochondrial membrane potential, and aggravated myocardial fibrosis and cardiomyocyte apoptosis compared with those observed in the untreated control group, treated with the same volume of saline as 5-FU in the 5-FU group. These injuries were particularly evident in aging rats. Notably, 5-FU increased the expression levels of myocardial mitochondrial autophagy-related proteins, and electron microscopy revealed a more severe autophagic state in the model groups compared with that in the control groups. In conclusion, 5-FU induced myocardial mitochondrial damage, the degree of which was more severe in aging rats compared with that in young rats. The mitochondrial autophagy induced by 5-FU was excessive, and the degree of autophagy was aggravated with increased 5-FU administration time.
Collapse
Affiliation(s)
- Yuanyang Li
- School of Graduate Studies, Tianjin University of Traditional Chinese Medicine, Tianjin 301677, P.R. China.,Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin 300121, P.R. China
| | - Yufan Zhang
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin 300121, P.R. China.,School of Graduate Studies, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Xiangzhong Zhou
- Department of Cardiology, Tianjin Da Gang Hospital, Tianjin 300270, P.R. China
| | - Xianghong Lei
- Department of Ultrasound, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin 300121, P.R. China
| | - Xinhang Li
- School of Graduate Studies, Tianjin University of Traditional Chinese Medicine, Tianjin 301677, P.R. China.,Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin 300121, P.R. China
| | - Liping Wei
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin 300121, P.R. China
| |
Collapse
|
5
|
Bøtker HE. The Future of Cardioprotection-Pointing Toward Patients at Elevated Risk as the Target Populations. J Cardiovasc Pharmacol Ther 2020; 25:487-493. [PMID: 32597205 DOI: 10.1177/1074248420937871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Translation of the cardioprotective effect by pharmacological and mechanical conditioning therapies into improvement of clinical outcome for the patients has been disappointing. Confounding factors like comorbidity and comedications may explain some of the loss in translation. However, the substantial improvement of outcome in disease states involving ischemia-reperfusion injury, that is, planned cardiac surgery, elective percutaneous coronary intervention, and even primary percutaneous coronary intervention for ST-segment myocardial infarction (STEMI), is the most plausible explanation for the missed demonstration of a clinical benefit. Remote ischemic conditioning has demonstrated consistent cardioprotective effect in experimental and in clinical proof-of-concept studies. As an adjunctive cardioprotective treatment beyond reperfusion, remote ischemic conditioning should address target populations at risk of extensive tissue damage, including patients who experience complications, which may induce profound myocardial ischemia in relation to cardiac surgery or elective percutaneous coronary intervention. Moreover, patients with STEMI and predictable impaired clinical outcome due to delayed hospital admission, high Killip class, cardiogenic shock, and cardiac arrest remain target groups. For high-risk patients, daily remote ischemic conditioning or the corollary of blood flow-restricted exercise may be alternative cardioprotective options during postoperative and post-myocardial infarct rehabilitation.
Collapse
Affiliation(s)
- Hans Erik Bøtker
- Department of Cardiology, 11297Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
6
|
Nam K, Shin KW, Kim TK, Kim KH, Kim KB, Jeon Y, Cho YJ. Prognostic value of high-sensitivity troponin I after cardiac surgery according to preoperative renal function. Medicine (Baltimore) 2020; 99:e20040. [PMID: 32443309 PMCID: PMC7253774 DOI: 10.1097/md.0000000000020040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac troponin levels can be elevated without myocardial injury in patients with renal impairment. However, the prognostic value of elevated troponin levels after cardiac surgery has not been well evaluated in patients with renal impairment. We evaluated the relationship between postoperative troponin levels and mortality following cardiac surgery according to preoperative renal function.Among 3661 patients underwent cardiac surgery between March 2005 and December 2015, 1909 patients were analyzed after excluding those with insufficient laboratory data, preoperative myocardial infarction, underwent Cox-Maze or redo surgery, or with a follow-up period <30 days. The primary outcome was risk of 30-day mortality according to elevated postoperative high-sensitivity cardiac troponin I (hs-cTnI) levels in varying degrees of renal function. Secondary outcomes included long-term cardiac-cause and all-cause mortality during the median follow-up of 52 months.After adjustment for risk factors, elevated peak postoperative hs-cTnI was associated with 30-day mortality [adjusted odds ratio 1.028, 95% confidence interval (CI) 1.013-1.043, P < .001], long-term cardiac-cause [adjusted hazard ratio (HR) 1.013, 95% CI 1.009-1.017, P < .001] and all-cause mortality (adjusted HR 1.013, 95% CI 1.009-1.016, P < .001), in patients with preoperative normal renal function [estimated glomerular filtration rate (eGFR) ≥60 ml/minute/1.73 m]. However, in patients with renal impairment (eGFR < 60 ml/minute/1.73 m), hs-cTnI levels were not associated with mortality following cardiac surgery.Elevated hs-cTnI levels following cardiac surgery did not predict short- and long-term mortality in patients with preoperative renal impairment.
Collapse
Affiliation(s)
- Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Kyung Won Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| |
Collapse
|
7
|
Pan T, Long GF, Chen C, Zhang HT, Wang JX, Ahaskar A, Chen HB, Wang DJ. Heparin-binding protein measurement improves the prediction of myocardial injury-related cardiogenic shock. BMC Cardiovasc Disord 2020; 20:124. [PMID: 32156261 PMCID: PMC7065315 DOI: 10.1186/s12872-020-01406-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcomes in patients with postoperative myocardial injury-related cardiogenic shock (MIRCS). We aimed to evaluate and validate HBP as a prognostic biomarker for postoperative MIRCS. Methods We performed a case-control study in 792 patients undergoing cardiac surgery from January 1, 2016, to August 1, 2019, including 172 patients with postoperative MIRCS and 620 age- and sex-matched controls. The association between HBP and MIRCS was determined by multivariate logistic regression analysis. Receiver operating characteristic curves (ROCs) with area under the curve (AUC) were performed to calculate the cut-off value, sensitivity and specificity. The association between HBP and cardiac troponin T (cTnT) was determined by multivariable linear regression analysis. Blood samples were drawn from the coronary sinus and arterial line of the cardiopulmonary bypass (CPB) before aortic cross-clamping (time point 1) and 5 min after aortic declamping (time point 2). Results Before aortic cross-clamping, coronary sinus HBP (HBPCS1) showed no differences between the two groups. However, after declamping, the MIRCS group had a significantly higher sinus HBP level (HBPCS2) than did the control group. HBPCS2 predicted MIRCS with an AUC of 0.85 (95% CI: 0.81–0.89, cut-off: 220 ng/ml, sensitivity: 92% and specificity: 70%). After adjusting for confounding factors, we found that HBP was an independent risk factor for MIRCS (OR: 7.65, 95% CI: 4.86–12.06, P < 0.01) and was positively associated with cTnT (β > 0, P < 0.01). Conclusions Elevated levels of coronary sinus HBP were useful biomarkers for predicting MIRCS after cardiac surgery.
Collapse
Affiliation(s)
- Tuo Pan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Guang-Feng Long
- Department of clinical laboratory, Children's Hospital of Nanjing Medical University, Nanjing, 210008, Jiangsu, China
| | - Cheng Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Hai-Tao Zhang
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jun-Xia Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Anshu Ahaskar
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Hong-Bing Chen
- Department of clinical laboratory, Children's Hospital of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Tanihata J, Nishioka N, Inoue T, Bando K, Minamisawa S. Urinary Titin Is Increased in Patients After Cardiac Surgery. Front Cardiovasc Med 2019; 6:7. [PMID: 30800662 PMCID: PMC6375839 DOI: 10.3389/fcvm.2019.00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Few non-invasive biomarkers have been used to detect myocardial injury in patients with heart diseases. Recently, the N-terminal fragment (N-titin) of titin, a giant sarcomeric protein, which is involved in muscular passive tension and viscoelasticity, has been reported to detect muscle damage in patients with cardiomyopathy as well as in patients with skeletal muscle dystrophy and in healthy volunteers with endurance exercise. In the present study, we evaluated whether urinary N-titin is changed during a perioperative period and whether its increase reflects myocardial damage. Materials and Methods: In 18 patients who underwent cardiac surgery, blood and urine samples were obtained before and after surgery. We measured the urinary levels of N-titin with a highly sensitive ELISA system. Results: Urinary N-titin to creatinine (N-titin/Cr) was significantly increased in all patients postoperatively (43.3 ± 39.5 pmol/mg/dL on the day of operation) and remained significantly high for at least 4 days postoperatively. Urinary N-titin/Cr was positively correlated with serum cardiac troponin T (r = 0.36, p = 0.0006, n = 90) but not creatine kinase-MB (CK-MB). We also found that urinary N-titin/Cr in patients after a coronary artery bypass grafting operation was higher by day 2 postoperatively than in patients following open cardiac surgeries. Conclusion: The cleaved N-titin was significantly increased in urine after cardiac surgery. Urinary N-titin may be useful for detecting the risk of latent postoperative cardiac damage.
Collapse
Affiliation(s)
- Jun Tanihata
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Naritomo Nishioka
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Inoue
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Susumu Minamisawa
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
van Beek DEC, van der Horst ICC, de Geus AF, Mariani MA, Scheeren TWL. Albumin, a marker for post-operative myocardial damage in cardiac surgery. J Crit Care 2018; 47:55-60. [PMID: 29925051 DOI: 10.1016/j.jcrc.2018.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Low serum albumin (SA) is a prognostic factor for poor outcome after cardiac surgery. The aim of this study was to estimate the association between pre-operative SA, early post-operative SA and postoperative myocardial injury. METHODS This single center cohort study included adult patients undergoing cardiac surgery during 4 consecutive years. Postoperative myocardial damage was defined by calculating the area under the curve (AUC) of troponin (Tn) values during the first 72 h after surgery and its association with SA analyzed using linear regression and with multivariable linear regression to account for patient related and procedural confounders. The association between SA and the secondary outcomes (peri-operative myocardial infarction [PMI], requiring ventilation >24 h, rhythm disturbances, 30-day mortality) was studied using (multivariable) log binomial regression analysis. RESULTS In total 2757 patients were included. The mean pre-operative SA was 29 ± 13 g/l and the mean post-operative SA was 26 ± 6 g/l. Post-operative SA levels (on average 26 min after surgery) were inversely associated with postoperative myocardial damage in both univariable analysis (regression coefficient - 0.019, 95%CI -0.022/-0.015, p < 0.005) and after adjustment for patient related and surgical confounders (regression coefficient - 0.014 [95% CI -0.020/-0.008], p < 0.0005). CONCLUSIONS Post-operative albumin levels were significantly correlated with the amount of postoperative myocardial damage in patients undergoing cardiac surgery independent of typical confounders.
Collapse
Affiliation(s)
- Dianne E C van Beek
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Iwan C C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, the Netherlands
| | - A Fred de Geus
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thomas W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
11
|
Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release. Anesthesiology 2017; 127:918-933. [DOI: 10.1097/aln.0000000000001873] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
12
|
Gawdat K, Legere S, Wong C, Myers T, Marshall JS, Hassan A, Brunt KR, Kienesberger PC, Pulinilkunnil T, Legare JF. Changes in Circulating Monocyte Subsets (CD16 Expression) and Neutrophil-to-Lymphocyte Ratio Observed in Patients Undergoing Cardiac Surgery. Front Cardiovasc Med 2017; 4:12. [PMID: 28361055 PMCID: PMC5350132 DOI: 10.3389/fcvm.2017.00012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/27/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The characteristics of circulating inflammatory cells (leukocytes) in patients undergoing heart surgery remains poorly understood. Recently, neutrophil-to-lymphocyte ratio (NLR) and specific monocyte subsets (based on CD14/CD16 expression) have been suggested as markers of inflammation and predictors of outcomes. The present study aims to characterize the influence cardiac surgery with cardiopulmonary bypass has on specific circulating leukocytes. METHODS All enrolled patients had blood samples taken pre- (0 days), early post- (5 days), and late post- (90 days) surgery. Complete blood counts were performed and whole leukocyte isolations were obtained from blood samples and analyzed with flow cytometry. Fluorophore-linked antibodies (CD45, CD11b, CD14, and CD16) were added to the blood cell isolations and later assessed by flow cytometry. RESULTS Seventeen patients were enrolled and samples obtained at 0, 5, and 90 days. We demonstrated a significant increase in NLR (2.2-fold; p = 0.0028) and CD16 mean fluorescence index (MFI-measure fluorescence intensity shift of CD16 in a gated cell population) early at day 5 (2.0-fold; p = 0.0051). Both NLR and CD16 MFI levels generally returned to normal by day 90. There was a significant positive correlation between NLR and CD16 MFI (r2 = 0.29; p = 0.0064). Adverse cardiovascular event (AE) was defined as prolonged length of hospitalization or readmission to hospital for cardiac reasons after discharge was seen in 59% of patients (no deaths occurred). In an unadjusted analysis of AE, we identified NLR as a likely predictor of AE, which meant that patients developing AE had a significantly higher baseline NLR (p = 0.0065), something that was not observed with CD16 MFI (p = 0.2541). CONCLUSION Cardiac surgery is associated with a significant increase in NLR and CD16 MFI (non-classical monocytes) early after surgery corresponding to the early inflammatory phase after surgery. Furthermore, we have, for the first time, identified a significant correlation between NLR and CD16 MFI. While the mechanism for this relationship remains unclear, our findings support the use of a simple test of NLR as a biomarker of inflammation for predicting outcomes in cardiac surgery patients.
Collapse
Affiliation(s)
- Kareem Gawdat
- Department of Pathology, Dalhousie University , Halifax, NS , Canada
| | - Stephanie Legere
- Department of Microbiology and Immunology, Dalhousie University , Halifax, NS , Canada
| | - Chloe Wong
- Department of Pathology, Dalhousie University , Halifax, NS , Canada
| | - Tanya Myers
- Department of Pathology, Dalhousie University , Halifax, NS , Canada
| | - Jean Sylvia Marshall
- Department of Microbiology and Immunology, Dalhousie University , Halifax, NS , Canada
| | - Ansar Hassan
- New Brunswick Heart Centre, Saint John, NB, Canada; Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Keith R Brunt
- Dalhousie Medicine New Brunswick , Saint John, NB , Canada
| | | | | | - Jean-Francois Legare
- Department of Pathology, Dalhousie University, Halifax, NS, Canada; New Brunswick Heart Centre, Saint John, NB, Canada; Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| |
Collapse
|