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. 1998 Oct;80(4):341–348. doi: 10.1136/hrt.80.4.341

Intraoperative release of troponin T in coronary venous and arterial blood and its relation to recovery of left ventricular function and oxidative metabolism following coronary artery surgery

T Koh 1, J Hooper 1, M Kemp 1, F Ferdinand 1, D Gibson 1, J Pepper 1
PMCID: PMC1728823  PMID: 9875109

Abstract

Objective—To investigate the intraoperative release of troponin T during uncomplicated coronary artery surgery and to determine its relation to ischaemic time and to recovery of left ventricular function and oxidative metabolism.
Design—A prospective observational study.
Setting—Cardiac surgical unit in a tertiary referral centre.
Methods—Troponin T, creatine kinase, and lactate were analysed from arterial and coronary sinus samples taken before operation, and 1, 4, 6, 10, 20, 35, and 45 minutes after cross clamp release. Net myocardial troponin T release and lactate extraction were derived from their respective arteriovenous differences. Haemodynamic measurements were made using a thermodilution pulmonary artery catheter.
Patients—45 patients, mean (SD) age 62 (9) years, with two or three vessel coronary artery disease and chronic stable angina undergoing routine coronary artery surgery.
Results—Before operation, troponin T concentrations were not raised, but within one minute of cross clamp release they increased progressively in both coronary sinus and arterial blood for the entire 45 minutes of reperfusion studied. Coronary sinus troponin T concentrations were consistently higher than arterial concentrations at all time points (p < 0.001), indicating net troponin T release by the myocardium. Peak net troponin T release and area under the curve of net troponin T release correlated closely with ischaemic time (r = 0.58 and r = 0.61, p < 0.0001 for both). Area under the curve of arterial troponin T concentration was also significantly correlated with ischaemic time (r = 0.44, p < 0.01). Patients with cross clamp times longer than 72 minutes (upper quartile for ischaemic time) had greater troponin T release, delayed reversion to lactate extraction, and lower left ventricular stroke work index three hours after surgery, compared with patients who had short (< 50 minutes, lower quartile) and intermediate (51-71 minutes, interquartile) cross clamp times. Peak net troponin T release and area under the curve of arterial troponin T concentration were inversely correlated with left ventricular stroke work index three hours after surgery (r = −0.57, r = −0.38, p < 0.01).
Conclusions—Troponin T concentrations increased in every patient after cross clamp release, and were consistently higher in coronary sinus blood than in arterial blood, indicating net myocardial release of troponin T during the period of reperfusion. Intraoperative net troponin T release has functional significance, as it is closely related to ischaemic time and reflects delayed recovery of left ventricular function and oxidative metabolism; therefore, its measurement may contribute to the perioperative assessment of myocardial injury sustained during coronary artery surgery.

 Keywords: coronary artery surgery;  troponin T;  intraoperative assessment;  myocardial injury

Full Text

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Figure 1  .

Figure 1  

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Troponin T concentration in coronary sinus and arterial blood. Troponin T concentrations in both were raised within one minute of cross clamp release and increased progressively. Coronary sinus concentrations were consistently higher than arterial: *p < 0.001 between coronary sinus and arterial concentrations. Data are expressed as median and interquartile (25th and 75th centile) range.

Figure 2  .

Figure 2  

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Creatine kinase MB activity in coronary sinus and arterial blood. Coronary sinus concentrations were higher than arterial at all time points: *p < 0.001 between coronary sinus and arterial concentration. Data are expressed as median and interquartile (25th and 75th centile) range.

Figure 3  .

Figure 3  

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Relation between peak net release of troponin T (coronary sinus-arterial, CS-A difference) and ischaemic time, showing a close correlation.

Figure 4  .

Figure 4  

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Relation between area under the curve (AUC) of net troponin T release and ischaemic time, showing that they are closely correlated.

Figure 5  .

Figure 5  

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Relation between area under the curve (AUC) of arterial troponin T concentration and ischaemic time, showing a significant correlation.

Figure 6  .

Figure 6  

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Lactate extraction in groups A, B, and C showing lower lactate production at four minutes in groups A and B v group C, and earlier reversion from production to extraction in group A at 35 minutes after cross clamp release: *p < 0.05 between group A and B v group C; **p < 0.05 between group A v group C. Data are means; error bars = SEM.

Figure 7  .

Figure 7  

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Relation between left ventricular stroke work index at three hours and peak net release of troponin T (coronary sinus-arterial, CS-A difference), showing a significant inverse correlation.

Figure 8  .

Figure 8  

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Relation between left ventricular stroke work index at three hours and area under the curve (AUC) of arterial troponin T concentration, showing significant inverse correlation.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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