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Horcicka A, Fischer L, Weigand MA, Larmann J. [Cardiac biomarkers prior to noncardiac surgery]. DIE ANAESTHESIOLOGIE 2024; 73:365-375. [PMID: 38829520 DOI: 10.1007/s00101-024-01417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Cardiac biomarkers, such as high-sensitivity cardiac troponin (hs-cTn) and brain natriuretic peptide (BNP) or N‑terminal prohormone of brain natriuretic peptide (NT-proBNP) are measured perioperatively to improve the prognosis and risk prediction. The European Society of Cardiology (ESC), European Society of Anesthesiology and Intensive Care (ESAIC) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI) have recently published guidelines on the use of cardiac biomarkers prior to surgery. OBJECTIVE/RESEARCH QUESTION This article provides an overview of the available evidence on perioperative troponin and BNP/NT-proBNP measurements. Current guideline recommendations are presented and discussed. MATERIAL AND METHODS MEDLINE, Cochrane and google.scholar were searched for relevant keywords. Titles and abstracts of identified papers were checked for relevance and published results were summarized. Guideline recommendations from the ESC, ESAIC and DGAI are presented, compared and evaluated based on the available literature. In addition, the significance of new perioperative cardiac biomarkers is discussed based on the existing evidence. RESULTS The definitions, diagnosis and management of cardiovascular events in the perioperative context differ from those in the nonsurgical setting. The evidence for the measurement of hs-cTn and BNP/NT-proBNP is evaluated differently in the guidelines and the resulting recommendations are partly contradictory. In particular, recommendations for changes in perioperative management based on biomarker measurements diverge. The ESC guidelines propose an algorithm that uses preoperative biomarkers as the basis for additional cardiac investigations. In particular, invasive coronary angiography is recommended for patients with stable chronic coronary syndrome who have no preoperative cardiac symptoms but elevated biomarkers. In contrast, the ESAIC guidelines emphasize that the available evidence is not sufficient to use perioperative biomarker measurements as a basis for a change in perioperative management. DISCUSSION Treating physicians should coordinate interdisciplinary (surgery, anesthesiology, cardiology) recommendations for clinical practice based on the aforementioned guidelines. If cardiac biomarkers are routinely determined in high-risk patients, this should be done in accordance with the ESC algorithm.
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Affiliation(s)
- Anna Horcicka
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Lilli Fischer
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Markus A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Jan Larmann
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
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Bhende VV, Sharma TS, Trivedi BY, Kumar A, Parmar DM, Nerurkar P, Shah PM, Fumakiya NJ, Majmudar HP, Pathan SR. Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study. Health Sci Rep 2022; 5:e909. [PMID: 36320652 PMCID: PMC9617649 DOI: 10.1002/hsr2.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study. METHODS This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored. RESULTS The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively. CONCLUSIONS RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective.
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Affiliation(s)
- Vishal V. Bhende
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Tanishq S. Sharma
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Bhadra Y. Trivedi
- Department of Pediatric Cardiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Amit Kumar
- Department of Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Dushyant M. Parmar
- Department of Perfusion Technology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Paresh Nerurkar
- Department of Perfusion Technology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Prachi M. Shah
- Department of Perfusion Technology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Naresh J. Fumakiya
- Department of Echocardiography, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Hardil P. Majmudar
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Sohilkhan R. Pathan
- Clinical Research Coordinator, Central Research Services (Crs), Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
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Fang S, Yang W, Zhang K, Peng C. Gandouling Mitigates CuSO 4-Induced Heart Injury in Rats. Animals (Basel) 2022; 12:2703. [PMID: 36230444 PMCID: PMC9559265 DOI: 10.3390/ani12192703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
We assessed the protective effects of Gandouling (GDL) on copper sulfate (CuSO4)-induced heart injuries in Sprague−Dawley rats, which were randomly divided into the control, CuSO4, GDL + CuSO4 and penicillamine + CuSO4 groups. The rats received intragastric GDL (400 mg/kg body weight) once per day for 42 consecutive days after 56 days of CuSO4 exposure, and penicillamine was used as a positive control. The levels of plasma inflammatory cytokines (IMA, hFABP, cTn-I and BNP) were determined using the enzyme-linked immunosorbent assay. The histopathological symptoms were evaluated using hematoxylin and eosin staining and transmission electron microscopy. To determine the underlying mechanism, Western blotting was conducted for the detection of the heme oxygenase 1 (HO-1) expression. The results revealed that GDL supplementation alleviated the histopathological symptoms of the rat heart tissue, promoted Cu excretion to attenuate impairment, and significantly decreased inflammatory cytokine levels in the plasma (p < 0.01). In addition, GDL increased the HO-1 expression in the rat hepatic tissue. The protective effect of GDL on the heart was superior to that of penicillamine. Overall, these findings indicate that GDL alleviates hepatic heart injury after a Cu overaccumulation challenge, and GDL supplements can be beneficial for patients with Wilson’s disease.
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Affiliation(s)
- Shuzhen Fang
- University Hospital, Anhui Agricultural University, 130 Changjiang Road West, Shushan District, Hefei 230036, China
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Meishan Road, Shushan District, Hefei 230031, China
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Meishan Road, Shushan District, Hefei 230031, China
| | - Kangyi Zhang
- School of Tea and Food Science & Technology, Anhui Agricultural University, 130 Changjiang Road West, Shushan District, Hefei 230036, China
| | - Chuanyi Peng
- School of Tea and Food Science & Technology, Anhui Agricultural University, 130 Changjiang Road West, Shushan District, Hefei 230036, China
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Goel H, Melot J, Krinock MD, Kumar A, Nadar SK, Lip GYH. Heart-type fatty acid-binding protein: an overlooked cardiac biomarker. Ann Med 2020; 52:444-461. [PMID: 32697102 PMCID: PMC7877932 DOI: 10.1080/07853890.2020.1800075] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cardiac troponins (cTn) are currently the standard of care for the diagnosis of acute coronary syndromes (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). However, their plasma kinetics necessitate a prolonged ED stay or overnight hospital admission, especially in those presenting early after CP onset. Moreover, ruling out ACS in low-risk patients requires prolonged ED observation or overnight hospital admission to allow serial measurements of c-Tn, adding cost. Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury with putative advantages over cTn. Being present in abundance in the myocellular cytoplasm, it is released rapidly (<1 h) after the onset of myocardial injury and could potentially play an important role in both earlier diagnosis of high-risk patients presenting early after CP onset, as well as in risk-stratifying low-risk patients rapidly. Like cTn, H-FABP also has a potential role as a prognostic marker in other conditions where the myocardial injury occurs, such as acute congestive heart failure (CHF) and acute pulmonary embolism (PE). This review provides an overview of the evidence examining the role of H-FABP in early diagnosis and risk stratification of patients with CP and in non-ACS conditions associated with myocardial injury. Key messages Heart-type fatty acid-binding protein is a biomarker that is elevated early in myocardial injury The routine use in the emergency department complements the use of troponins in ruling out acute coronary syndromes in patients presenting early with chest pain It also is useful in risk stratifying patients with other conditions such as heart failure and acute pulmonary embolism.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, USA.,Luis Katz School of Medicine, Temple University, Philadelphia, USA
| | - Joshua Melot
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, USA
| | - Matthew D Krinock
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, USA
| | - Ashish Kumar
- Department of Medicine, Wellspan York Hospital, York, PA, USA
| | - Sunil K Nadar
- Department of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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5
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Kurth MJ, McBride WT, McLean G, Watt J, Domanska A, Lamont JV, Maguire D, Fitzgerald P, Ruddock MW. Acute kidney injury risk in orthopaedic trauma patients pre and post surgery using a biomarker algorithm and clinical risk score. Sci Rep 2020; 10:20005. [PMID: 33203963 PMCID: PMC7673130 DOI: 10.1038/s41598-020-76929-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
Acute kidney injury (AKI) after major trauma is associated with increased mortality. The aim of this study was to assess if measurement of blood biomarkers in combination with clinical characteristics could be used to develop a tool to assist clinicians in identifying which orthopaedic trauma patients are at risk of AKI. This is a prospective study of 237 orthopaedic trauma patients who were consecutively scheduled for open reduction and internal fixation of their fracture between May 2012 and August 2013. Clinical characteristics were recorded, and 28 biomarkers were analysed in patient blood samples. Post operatively a combination of H-FABP, sTNFR1 and MK had the highest predictive ability to identify patients at risk of developing AKI (AUROC 0.885). Three clinical characteristics; age, dementia and hypertension were identified in the orthopaedic trauma patients as potential risks for the development of AKI. Combining biomarker data with clinical characteristics allowed us to develop a proactive AKI clinical tool, which grouped patients into four risk categories that were associated with a clinical management regime that impacted patient care, management, length of hospital stay, and efficient use of hospital resources.
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Affiliation(s)
- Mary Jo Kurth
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - William T McBride
- Department of Cardiac Anaesthesia, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Gavin McLean
- Trauma and Orthopaedics, Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon, BT63 5QQ, Northern Ireland, UK
| | - Joanne Watt
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Anna Domanska
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - John V Lamont
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Daniel Maguire
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Peter Fitzgerald
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Mark W Ruddock
- Randox Laboratories Ltd, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK.
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Using the SYNTAX score to predict myocardial injury early after on-pump coronary artery bypass surgery: a single-centre experience analysis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:76-82. [PMID: 32728369 PMCID: PMC7379221 DOI: 10.5114/kitp.2020.97263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/25/2020] [Indexed: 12/02/2022]
Abstract
Introduction Marked isolated elevation of cardiac biomarkers (CK-MB, cardiac troponin I, heart-type fatty acid binding protein, hFABP) within 48 hours after coronary artery bypass surgery (CABG), even in the absence of electrocardiographic/angiographic evidence of myocardial infarction (MI), indicates prognostically significant cardiac procedural myocardial injury. There are no data exploring the relationship between the complexity of coronary atherosclerotic burden and early post-CABG myocardial injury. Aim To analyse correlations and predictive strength of the SYNTAX score (SS) for early myocardial injury after on-pump CABG. Material and methods One hundred and twenty consecutive patients undergoing CABG were included in the analysis. We obtained data on demographics, medical history, cardiovascular risk factors and echocardiography. Cardiac biomarkers were assessed at 6 hours after CABG. Multivariate linear regression analysis was performed to evaluate independent variables correlated with cardiac biomarkers. Results The most significant predictor for myocardial injury was SS, strongly correlated with the rise of all cardiac biomarkers (p < 0.001). Hypertension and creatinine clearance were associated with cTnI and hFABP. Diabetes was corelated with hFABP. In a multivariate analysis including all significant predictors, SS remained an independent predictor for myocardial injury, strongly associated with hFABP (p < 0.001, OR = 5.79, 95% CI: 3.59–7.98), cTnI (p < 0.001, OR = 6.49, 95% CI: 4.78–8.20), but not with CK-MB (95% CI: 0.61–1.07). Conclusions Defining myocardial injury as elevation of cardiac biomarkers between normal values and the cut-off for MI has a tremendous clinical significance as patients maintain high negative prognostic rates. SS could be used to predict post-operative rise of cardiac biomarkers, the correlation between SS and myocardial injury being very solid.
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7
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Wei J, Liu J, Zhang L, Zhu Y, Li X, Zhou G, Zhao Y, Sun Z, Zhou X. Endosulfan induces cardiotoxicity through apoptosis via unbalance of pro-survival and mitochondrial-mediated apoptotic pathways. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 727:138790. [PMID: 32344260 DOI: 10.1016/j.scitotenv.2020.138790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Although the associations between endosulfan and adverse cardiovascular health have been reported, the toxic effects and underlying mechanism of endosulfan on the heart are not well understood. In this study, we examined the cardiotoxicity induced by endosulfan using Wistar rats and human cardiomyocytes (AC16) cells. Wistar rats were divided into control group (received corn oil alone) and three concentrations of endosulfan groups (1, 5 and 10 mg/kg·bw) by gavage. The AC16 cells were treated with three various concentrations (0, 1.25, 5, and 20 μg/mL) of endosulfan. The results showed that endosulfan induced cytotoxicity through damaging myocardial structure, decreasing the viability of cardiomyocytes, and elevating the serum levels of cardiac troponin I, heart fatty acid binding protein, aspartate aminotransferase, and reactive oxygen species (p < 0.05). Moreover, measurement of mitochondrial function showed that endosulfan could significantly decrease adenosine triphosphate levels and cytochrome c oxidase IV expression in AC16 cells (p < 0.05). In addition, endosulfan obviously inhibited Bcl-2 expression, activated the expressions of cytochrome c/Caspase-9/Caspase-3 signaling pathway, and induced the apoptosis of AC16 cells (p < 0.05). Furthermore, endosulfan significantly increased the expression of Bim, and inhibited the expressions of PI3K/Akt/FoxO3a signaling pathways in cardiomyocytes (p < 0.05). These results suggest that endosulfan may induce cardiotoxicity by inducing myocardial apoptosis resulting from activation of mitochondria-mediated apoptosis pathway and inhibition of pro-survival signaling pathways, which might be helpful in elucidating the mechanism of cardiac dysfunction induced by endosulfan.
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Affiliation(s)
- Jialiu Wei
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
| | - Jianhui Liu
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Lianshuang Zhang
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Yupeng Zhu
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Xiangyang Li
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Guiqing Zhou
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Yanzhi Zhao
- Yanjing Medical College, Capital Medical University, Beijing, China.
| | - Zhiwei Sun
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Xianqing Zhou
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China.
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Kavsak PA, Whitlock R, Thiessen-Philbrook H, Parikh CR. Perioperative heart-type fatty acid binding protein concentration cutoffs for the identification of severe acute kidney injury in patients undergoing cardiac surgery. Clin Chem Lab Med 2018; 57:e8-e10. [PMID: 30044762 DOI: 10.1515/cclm-2018-0547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/04/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Peter A Kavsak
- Juravinski Hospital and Cancer Centre, 711 Concession Street, Hamilton, ON L8V 1C3, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Population Health Research Institute and Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Heather Thiessen-Philbrook
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Jo MS, Lee J, Kim SY, Kwon HJ, Lee HK, Park DJ, Kim Y. Comparison between creatine kinase MB, heart-type fatty acid-binding protein, and cardiac troponin T for detecting myocardial ischemic injury after cardiac surgery. Clin Chim Acta 2018; 488:174-178. [PMID: 30389460 DOI: 10.1016/j.cca.2018.10.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Heart-type fatty acid-binding protein (H-FABP) is a cytoplasmic protein and is released form necrotic cardiac myocytes, as well as ischemic cardiac myocytes. In this study, we compared creatine kinase MB (CK-MB), H-FABP, and cardiac troponin T (cTnT) after coronary artery bypass grafting (CABG), heart valve surgery, or septal defect surgery to evaluate the difference in detecting myocardial injury between three markers. METHODS A total of 69 patients (CABG, 32; valve surgery, 27; and septal defect surgery, 10) were prospectively enrolled. Blood samples were taken at specific intervals. RESULTS Mean amount (AUC0-72h) of CK-MB and cTnT released for 72 h in the patients with valve surgery were 2446 h·ng/ml and 93.2 h·ng/ml, which were significantly larger than those in the patients with CABG or septal defect surgery (p < .05). Mean amount (AUC0-72h) of H-FABP released for 72 h in the patients with CABG was 1939 h·ng/ml, which was significantly larger than that in the patients with septal defect surgery (700.1 h·ng/ml) (p < .05). CONCLUSION H-FABP would be a more useful marker for detecting myocardial ischemic injury than CK-MB and cTnT. CK-MB and cTnT would be more sensitive to myocardial injury with surgical trauma than with ischemic injury in the patients with cardiac surgery.
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Affiliation(s)
- Min Seop Jo
- Department of Thoracic and Cardiovascular surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Jehoon Lee
- Department of Laboratory Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Soo-Young Kim
- Department of Laboratory Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Hi Jeong Kwon
- Department of Laboratory Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Hae Kyung Lee
- Department of Laboratory Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Dong Jin Park
- Department of Laboratory Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Yeongsic Kim
- Department of Laboratory Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea.
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Kavsak PA, Ainsworth C, Arnold DM, Scott T, Clark L, Ivica J, Mackett K, Whitlock R, Worster A. The potential role of a turbidimetric heart-type fatty acid-binding protein assay to aid in the interpretation of persistently elevated, non-changing, cardiac troponin I concentrations. Clin Biochem 2018; 58:53-59. [DOI: 10.1016/j.clinbiochem.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/25/2018] [Accepted: 05/07/2018] [Indexed: 01/02/2023]
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11
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Beysel S, Kizilgul M, Ozbek M, Caliskan M, Kan S, Apaydin M, Ozcelik O, Cakal E. Heart-type fatty acid binding protein levels in elderly diabetics without known cardiovascular disease. Clin Interv Aging 2017; 12:2063-2068. [PMID: 29255351 PMCID: PMC5722006 DOI: 10.2147/cia.s137247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Cardiovascular disease (CVD) is reported to be higher in elderly diabetics. Serum heart-type fatty acid binding protein (H-FABP) is a serum marker of myocardial ischemia. We aimed to investigate the association between serum H-FABP level and conventional cardiovascular risk factors, inflammatory markers and subclinical atherosclerosis in elderly diabetics without overt CVD. Patients and methods A total of 50 elderly diabetic patients without overt CVD and 30 age-, sex- and body mass index (BMI)-matched healthy controls were enrolled. Anthropometric and biochemical parameters, serum H-FABP, high-sensitivity C-reactive protein (hs-CRP), fibrinogen and carotid intima-media thickness (CIMT) were measured. Logistic regression analyses (adjustments for age, sex, hypertension, smoking, diabetes, BMI, blood pressure, lipid, blood glucose, hemoglobin A1c, hs-CRP and fibrinogen) were performed to evaluate the association between H-FABP and cardiovascular risk factors and atherosclerosis indices. Results Serum fibrinogen (421.50±85.52 mg/dL vs 319.17±30.77 mg/dL, p=0.023), CIMT (0.70±0.12 mm vs 0.59±0.06 mm, p<0.001) and hs-CRP (5.72±4.50 mg/dL vs 1.60±0.72 mg/dL, p<0.001) were significantly higher in diabetic patients than controls. The mean serum H-FABP level did not differ between groups (1571.79±604.60 ng/mL vs 1500.25±463.35 ng/mL, p=0.905). H-FABP was positively correlated with fibrinogen (r2=0.473, p<0.001), hs-CRP (r2=0.323, p=0.003) and CIMT (r2=0.467, p<0.001). After full adjustments, the serum H-FABP level was independently associated with an increase in the fibrinogen level (odds ratio [OR] =4.21, 95% confidence level [CI] =1.49–11.90). Conclusion Serum H-FABP was similar in the elderly diabetic patients without known CVD when compared with the nondiabetic control group. H-FABP does not possess a high diagnostic value as a cardiovascular marker when used alone; however, it may add supplementary information in patients with a high fibrinogen level.
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Affiliation(s)
- Selvihan Beysel
- Department of Endocrinology and Metabolism, Eskisehir State Hospital, Eskisehir.,Department of Medical Biology, Baskent University, Ankara
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, Kilis State Hospital, Kilis
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara
| | - Mustafa Caliskan
- Department of Endocrinology and Metabolism, Düzce Ataturk State Hospital, Duzce
| | - Seyfullah Kan
- Department of Endocrinology and Metabolism, Denizli State Hospital, Denizlim
| | - Mahmut Apaydin
- Department of Endocrinology and Metabolism, Yozgat State Hospital, Yozgat
| | - Ozgur Ozcelik
- Department of Endocrinology and Metabolism, Igdir State Hospital, Igdir, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara
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12
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Low platelet activity predicts 30 days mortality in patients undergoing heart surgery. Blood Coagul Fibrinolysis 2016; 27:199-204. [PMID: 26366827 DOI: 10.1097/mbc.0000000000000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival.
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Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-Cardiac-Output Syndrome After Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 31:291-308. [PMID: 27671216 DOI: 10.1053/j.jvca.2016.05.029] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia.
| | - Sergey M Efremov
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Mikhail Y Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Evgeny V Fominskiy
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Alexander M Karaskov
- Department of Cardiac Surgery, Research Institute of Circulation Pathology, Novosibirsk, Russia
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Saddic LA, Chang TW, Sigurdsson MI, Heydarpour M, Raby BA, Shernan SK, Aranki SF, Body SC, Muehlschlegel JD. Integrated microRNA and mRNA responses to acute human left ventricular ischemia. Physiol Genomics 2015; 47:455-62. [PMID: 26175501 DOI: 10.1152/physiolgenomics.00049.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/08/2015] [Indexed: 12/22/2022] Open
Abstract
MicroRNAs (miRNAs) play a significant role in ischemic heart disease. Animal models of left ventricular (LV) ischemia demonstrate a unique miRNA profile; however, these models have limitations in describing human disease. In this study, we performed next-generation miRNA and mRNA sequencing on LV tissue from nine patients undergoing cardiac surgery with cardiopulmonary bypass and cardioplegic arrest. Samples were obtained immediately after aortic cross clamping (baseline) and before aortic cross clamp removal (postischemic). Of 1,237 identified miRNAs, 21 were differentially expressed between baseline and postischemic LV samples including the upregulated miRNAs miR-339-5p and miR-483-3p and the downregulated miRNA miR-139-5p. Target prediction analysis of these miRNAs was integrated with mRNA expression from the same LV samples to identify anticorrelated miRNA-mRNA pairs. Gene enrichment studies of candidate mRNA targets demonstrated an association with cardiovascular disease, cell death, and metabolism. Therapeutics that intervene on these miRNAs and their downstream targets may lead to novel mechanisms of mitigating the damage caused by ischemic insults on the human heart.
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Affiliation(s)
- Louis A Saddic
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tzuu-Wang Chang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin I Sigurdsson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin A Raby
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sary F Aranki
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon C Body
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;
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Perioperative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery. Kidney Int 2015; 88:576-83. [PMID: 25830762 PMCID: PMC4556547 DOI: 10.1038/ki.2015.104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 01/20/2023]
Abstract
Acute Kidney Injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Since heart fatty acid binding protein (H-FABP) is a myocardial protein that detects cardiac injury, we sought to determine if plasma H-FABP was associated with AKI in the TRIBE-AKI cohort; a multi-center cohort of 1219 patients at high risk for AKI who underwent cardiac surgery. The primary outcomes of interest were any AKI (Acute Kidney Injury Network (AKIN) stage 1 or higher) and severe AKI (AKIN stage 2 or higher). The secondary outcome was long-term mortality after discharge. Patients who developed AKI had higher levels of H-FABP pre- and post-operatively than patients who did not have AKI. In analyses adjusted for known AKI risk factors, first post-operative log(H-FABP) was associated with severe AKI (adjusted OR 5.39 [95% CI, 2.87-10.11] per unit increase), while pre-operative log(H-FABP) was associated with any AKI (2.07 [1.48-2.89]) and mortality (1.67 [1.17-2.37]). These relationships persisted after adjustment for change in serum creatinine (for first postoperative log(H-FABP)) and biomarkers of cardiac and kidney injury, including brain natriuretic peptide, cardiac troponin-I, interleukin-18, liver fatty acid binding protein, kidney injury molecule-1, and neutrophil gelatinase associated lipocalin. Thus, peri-operative plasma H-FABP levels may be used for risk-stratification of AKI and mortality following cardiac surgery.
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GNAS gene variants affect β-blocker-related survival after coronary artery bypass grafting. Anesthesiology 2014; 120:1109-1117. [PMID: 24755784 DOI: 10.1097/aln.0000000000000189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac overexpression of the β-adrenoreceptor (βAR)-coupled stimulatory G-protein subunit Gαs enhances inotropic responses to adrenergic stimulation and improves survival in mice under βAR blockade. The authors recently identified three common haplotypes in the GNAS gene encoding Gαs, with the greatest Gαs protein expression and signal transduction in haplotype *3 carriers and less in haplotype *2 and *1 carriers. The authors tested the hypothesis that these GNAS variants result in altered mortality in patients after coronary artery bypass graft surgery, particularly in those receiving βAR blockade. METHODS This prospective analysis included 1,627 European ancestry patients undergoing primary coronary artery bypass graft surgery. Patients were genotyped for two GNAS haplotype tagging single-nucleotide polymorphisms defining three major haplotypes. Up to 5-yr all-cause mortality was estimated using a Cox proportional hazard model; hazard ratios and 95% CIs were calculated while adjusting for demographics, clinical covariates, and the new EuroSCORE II. RESULTS Univariate analysis revealed haplotype-dependent 5-yr mortality rates (*1/*1: 18.9%, *2/*1: 13.7%, *2/*2: 9.3%, *3/*1: 10.6%, *3/*2: 9.1%, and *3/*3: 9.6%; P = 0.0006). After adjustment for other predictors of death, homozygote haplotype *1 carriers showed a doubled risk for death (hazard ratio, 2.2; 95% CI, 1.2 to 3.8; P = 0.006). Considering only patients receiving βAR blockers (n = 1,267), the adjusted risk of death even tripled (hazard ratio, 3.0; 95% CI, 1.5 to 6.1; P = 0.002). CONCLUSIONS GNAS haplotypes independently associate with an increased risk of death after primary coronary artery bypass graft surgery. These results are most pronounced in patients receiving βAR blockers, strengthening the rationale for personalized treatment, to decrease medication side effects and improve outcomes.
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Walder B, Robin X, Rebetez MML, Copin JC, Gasche Y, Sanchez JC, Turck N. The prognostic significance of the serum biomarker heart-fatty acidic binding protein in comparison with s100b in severe traumatic brain injury. J Neurotrauma 2014; 30:1631-7. [PMID: 23590685 DOI: 10.1089/neu.2012.2791] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The outcome after severe traumatic brain injury (TBI) is largely unfavorable, with approximately two thirds of patients suffering from severe disabilities or dying during the first 6 months. Existing predictive models displayed only limited utility for outcome prediction in individual patients. Time courses of heart-fatty acidic binding protein (H-FABP) and their association with outcome were investigated and compared with S100b. Forty-nine consecutive patients with severe TBI (sTBI; Head component of the Abbreviated Injury Scale [HAIS] >3) with mono and multiple trauma were enrolled in this study. Enzyme-linked immunosorbent assay measured blood concentrations of H-FABP and S100b at 6, 12, 24, and 48 h after TBI. Outcome measures were conscious state at 14 days (Glasgow Coma Scale), disability (Glasgow Outcome Scale Extended; GOSE), and mortality at 3 months. Univariate logistic regression analysis and receiver operating characteristic curves analysis were carried out. Maximal H-FABP and S100b concentrations were observed at 6 h after TBI (34.4±34.0 and 0.64±0.99 ng/mL, respectively). Patients with multi-trauma had significantly higher H-FABP concentrations at 24 and 48 h (22.6±25.6 and 12.4±18.2 ng/mL, respectively), compared to patients with mono trauma (6.9±5.1 and 3.7±4.2 ng/mL, respectively). In the first 48 h, H-FABP and S100b were inversely correlated with the GOSE at 3 months; H-FABP at 48 h predicted mortality with 75% sensitivity and 93% specificity. Early blood levels of H-FABP after sTBI have prognostic significance for survival and disability.
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Affiliation(s)
- Bernhard Walder
- 1 Division of Anaesthesiology, University Hospitals of Geneva , Geneva, Switzerland
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18
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Carmona P, Mateo E, Montoro A, Alós L, Coret M, Errando CL, Llagunes J, De Andrés J. [Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery]. ACTA ACUST UNITED AC 2014; 62:3-9. [PMID: 24746360 DOI: 10.1016/j.redar.2014.02.011] [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: 01/21/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND GOAL OF STUDY Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein » (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. MATERIALS AND METHODS A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. RESULTS Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL). CONCLUSION This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.
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Affiliation(s)
- P Carmona
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Mateo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - A Montoro
- Servicio de Análisis Clínicos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Alós
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Coret
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Llagunes
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J De Andrés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Glatz JFC, Renneberg R. Added value of H-FABP as plasma biomarker for the early evaluation of suspected acute coronary syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.13.87] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Early troponin T and prediction of potentially correctable in-hospital complications after coronary artery bypass grafting surgery. PLoS One 2013; 8:e74241. [PMID: 24040214 PMCID: PMC3765291 DOI: 10.1371/journal.pone.0074241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/31/2013] [Indexed: 11/19/2022] Open
Abstract
Background Peak levels of troponin T (TnT) reliably predict morbidity and mortality after cardiac surgery. However, the therapeutic window to manage CABG-related in-hospital complications may close before the peak is reached. We investigated whether early TnT levels correlate as well with complications after coronary artery bypass grafting (CABG) surgery. Methods A 12 month consecutive series of patients undergoing elective isolated CABG procedures (mini-extra-corporeal circuit, Cardioplegic arrest) was analyzed. Logistic regression modeling was used to investigate whether TnT levels 6 to 8 hours after surgery were independently associated with in-hospital complications (either post-operative myocardial infarction, stroke, new-onset renal insufficiency, intensive care unit (ICU) readmission, prolonged ICU stay (>48 hours), prolonged need for vasopressors (>24 hours), resuscitation or death). Results A total of 290 patients, including 36 patients with complications, was analyzed. Early TnT levels (odds ratio (OR): 6.8, 95% confidence interval (CI): 2.2-21.4, P=.001), logistic EuroSCORE (OR: 1.2, 95%CI: 1.0-1.3, P=.007) and the need for vasopressors during the first 6 postoperative hours (OR: 2.7, 95%CI: 1.0-7.1, P=.05) were independently associated with the risk of complications. With consideration of vasopressor use during the first 6 postoperative hours, the sum of specificity (0.958) and sensitivity (0.417) of TnT for subsequent complications was highest at a TnT cut-off value of 0.8 ng/mL. Conclusion Early TnT levels may be useful to guide ICU management of CABG patients. They predict clinically relevant complications within a potential therapeutic window, particularly in patients requiring vasopressors during the first postoperative hours, although with only moderate sensitivity.
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Rader F, Pujara AC, Pattakos G, Rajeswaran J, Li L, Castel L, Chung MK, Gillinov AM, Costantini O, Van Wagoner DR, Blackstone EH. Perioperative heart-type fatty acid binding protein levels in atrial fibrillation after cardiac surgery. Heart Rhythm 2013; 10:153-7. [PMID: 23041578 PMCID: PMC3687792 DOI: 10.1016/j.hrthm.2012.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is common and associated with poor outcomes. Perioperative ischemia can alter arrhythmic substrate. OBJECTIVE To demonstrate an association between perioperative measurements of heart-type fatty acid binding protein (HT-FABP), a sensitive marker of ischemic myocardial injury. METHODS Blood samples from 63 inpatients undergoing coronary artery bypass surgery, valve surgery, or both were obtained before and up to 4 days after surgery. Continuous telemetry monitoring was used to detect POAF. Fifty-nine patients had at least 3 HT-FABP measurements. The relationship of enzyme-linked immunosorbent assay-measured HT-FABP with POAF was assessed by using joint logistic regression adjusted for age and surgery type. RESULTS Thirty-five patients (55%) developed POAF; these were, on average, older (69.3±10 years vs 60±11 years; P = .0019), with a higher prevalence of heart failure (43% vs 17%; P = .034), chronic obstructive lung disease (26% vs 4%; P = .017), preoperative calcium channel blocker use (29% vs 7%; P = .031), and more likely to undergo combined surgery (21% vs 11%, P = .049). The joint age- and coronary artery bypass surgery-adjusted model revealed that postoperative but not preoperative HT-FABP levels predicted POAF (coefficient 1.9±0.87; P = .03). Longer bypass time, prior infarction, and worse renal function were all associated with higher postoperative HT-FABP. CONCLUSIONS A greater rise of HT-FABP is associated with atrial fibrillation after cardiac surgery, suggesting that ischemic myocardial damage is a contributing underlying mechanism. Interventions that decrease perioperative ischemic injury may also decrease the occurrence of POAF.
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Affiliation(s)
- Florian Rader
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, California 90048, USA.
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22
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Looso M, Michel CS, Konzer A, Bruckskotten M, Borchardt T, Krüger M, Braun T. Spiked-in Pulsed in Vivo Labeling Identifies a New Member of the CCN Family in Regenerating Newt Hearts. J Proteome Res 2012; 11:4693-704. [DOI: 10.1021/pr300521p] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mario Looso
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
| | - Christian S. Michel
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
| | - Anne Konzer
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
| | - Marc Bruckskotten
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
| | - Thilo Borchardt
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
| | - Marcus Krüger
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
| | - Thomas Braun
- Max-Planck-Institute for Heart and Lung Research, Ludwigstr. 43, 61231 Bad
Nauheim, Germany
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Zhang ZC, Dai HW, Yu YH, Yang JD, Hu CB. Usefulness of heart-type fatty acid-binding protein in patients with severe sepsis. J Crit Care 2012; 27:415.e13-8. [PMID: 22386224 DOI: 10.1016/j.jcrc.2012.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/06/2012] [Accepted: 01/16/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the value of heart-type fatty acid-binding protein (hFABP) as a novel clinical biomarker in patients with severe sepsis. METHODS Serum concentrations of hFABP and traditional cardiac biomarkers including cardiac troponin I, creatine kinase-MB, and B-type natriuretic peptides levels were measured within 6 hours after admission in 93 severe septic patients. The value of hFABP for the diagnosis of sepsis-related myocardial dysfunction (SRMD) and for the prediction of 28-day mortality was evaluated by receiver operating characteristics curve analysis. The prognostic value of elevated hFABP was subsequently confirmed by multivariate Cox proportional hazards analysis and Kaplan-Meier survival analysis. RESULTS Heart-type fatty acid-binding protein was elevated (≥ 4.5 ng/mL) in 58 (62.4%) patients; patients with elevated hFABP appeared more likely to have SRMD (84.5% vs 31.4%, P < .001) and have higher prevalence of 28-day death (37.9% vs 8.6%, P = .002). Heart-type fatty acid-binding protein offered superior value over conventional biomarkers in both diagnosis of SRMD (area under the curve, 0.767; P < .001) and prediction of 28-day death (area under the curve, 0.805; P < .001). CONCLUSIONS Serum hFABP is frequently elevated among patients with severe sepsis and appears to be associated with SRMD. Elevated hFABP independently predicts 28-day mortality in severe sepsis.
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Affiliation(s)
- Zhao-cai Zhang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, China.
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Hinchcliff M, Huang CC, Ishida W, Fang F, Lee J, Jafari N, Wilkes M, Bhattacharyya S, Leof E, Varga J. Imatinib mesylate causes genome-wide transcriptional changes in systemic sclerosis fibroblasts in vitro. Clin Exp Rheumatol 2012; 30:S86-96. [PMID: 22691216 PMCID: PMC3860597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is a heterogeneous multifactorial disease dominated by progressive skin and internal organ fibrosis that is driven in part by transforming growth factor-beta (TGF-β). An important downstream target of TGF-β is the Abelson (c-Abl) tyrosine kinase, and its inhibition by imatinib mesylate (Gleevec) attenuates fibrosis in mice. Here we examined the effect of c-Abl activation and blockade in explanted healthy control and SSc fibroblasts. METHODS Skin biopsies and explanted fibroblasts from healthy subjects and patients with SSc were studied. Changes in genome-wide expression patterns in imatinib-treated control and SSc fibroblasts were analysed by DNA microarray. RESULTS Treatment of control fibroblasts with TGF-β resulted in activation of c-Abl and stimulation of fibrotic gene expression that was prevented by imatinib. Moreover, imatinib reduced basal collagen gene expression in SSc but not control fibroblasts. No significant differences in tissue levels of c-Abl and phospho-c-Abl were detected between SSc and control skin biopsies. In vitro, imatinib induced dramatic changes in the expression of genes involved in fibrosis, cardiovascular disease, inflammation, and lipid and cholesterol metabolism. Remarkably, of the 587-imatinib-responsive genes, 91% showed significant change in SSc fibroblasts, but only 12% in control fibroblasts. CONCLUSIONS c-Abl plays a key role in fibrotic responses. Imatinib treatment results in dramatic changes in gene expression in SSc fibroblasts but has only modest effects in control fibroblasts. These data provide novel insights into the mechanisms underlying the antifibrotic effect of imatinib in SSc.
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Sbarouni E, Georgiadou P, Koutelou M, Constantinos M, Chaidaroglou A, Degiannis D, Voudris V. Heart type fatty acid binding protein in relation to pharmacologic scintigraphy in coronary artery disease. Clin Chem Lab Med 2011; 50:387-90. [PMID: 22022983 DOI: 10.1515/cclm.2011.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 09/26/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heart-type fatty acid-binding protein (H-FABP) is a marker of myocardial necrosis, but whether it increases during myocardial ischemia is not known. This study investigated whether serum levels of H-FABP change during adenosine stress testing and nuclear imaging in patients with stable coronary artery disease. METHODS Thirty stable patients with established coronary artery disease on their medications were studied. Sampling was performed before the stress test, at the end of adenosine infusion, as well as 1, 2 and 3 h after the completion of the infusion. RESULTS No difference in H-FABP serum levels were found at the five pre-specified time points in the overall group (p=0.99); furthermore, there was no significant difference regardless of the test result--positive (p=1) or negative (p=0.98). CONCLUSIONS It is concluded that H-FABP does not change significantly during pharmacologic stress testing in patients with known coronary artery disease and there is no difference whether there is inducible ischemia or not.
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Affiliation(s)
- Eftihia Sbarouni
- 2 nd Department of Cardiology, Onassis Cardiac Surgery Center, 356 Syngrou Avenue, 17674 Athens, Greece.
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Rade JJ, Hogue CW. Do we really need another biomarker to diagnose myocardial infarction after coronary artery bypass graft surgery? Anesth Analg 2010; 111:1086-7. [PMID: 20971957 DOI: 10.1213/ane.0b013e3181f4db4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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