Abstract
Measurement of cardiac markers is an index of care standard in the assessment and diagnosis of cardiovascualr disease. Two of the major cardiac markers are Creatine Kinase isoenzyme CK-MB and Troponin T, which are extensively used in the diagnosis of heart disease. The release of Troponin T and creatine kinase isoenzyme (CK-MB) was investigated in 50 coronary artery bypass surgery patients. Measurement of plasma samples was carried out at five different time points, namely before surgery, 1,6,12,24 hours after surgery. The results indicated that CK-MB level were increased by a factor more than four times compared with the upper limit of baseline (befor surgery). Troponin T concentration showed more than six fold over the upper limit of baseline (before surgert) at 1,6,12,24 hours after surgery. In order to assess the significance of the length of the surgical procedure on the release of Troponin T and CK-MB, the surgery patient were divided into two groups according to the length of the surgical procedure: group I was selected on the basis that the surgical procedure they underwent lasted above 90 minutes and group II with a surgical procedure below 90 minutes. Both Troponin T and CK-MB showed a significant increase in-group I compared to group II. To investigate the likelihood that this effect is party due to myocardial infarction during surgery, the patients were divided into two groups: Group A with some sings of myocardial infarction on Q wave of ECG and group B without any change. The results showed approximately a two-fold increase of these markers in-group A compared to group B. Since these markers reach into blood following damage to myocardial their increase in patients with time course surgery of more than 90 minutes and those with a probability of MI during operation, indicating that these patient fall into a high risk group of repeat (MI) after surgery.
Key words: Creatine Kinase isoenzyme(CK-MB), Troponin T, Artery bypass surgery
Full Text
The Full Text of this article is available as a PDF (897.1 KB).
Glossary
- (CK-MB)
Creatine Kinase isoenzyme
- T(CTNT)
Cardiac Troponin
References
- 1.Higgins, S., Turner, A. and Wood, J. (1999) Biochemistry for the medical science. Chest pain. Editor: Thomas Devlin. Logman. p. 13–17.
- 2.Ooi D.S., Isotalo P.A., Veinot J.P. Correlation of ante mortem serum creatine kinase, Creatine kinase- MB, Troponin I, and troponin T with cardiac pathology. Clin. Chem. 2000;46:338–44. [PubMed] [Google Scholar]
- 3.Lehot J., Durand P.G., Badtin O. Isoenzyme in the diagnosis of myocardial infection after myocardial revascularization surgery. Ann. Fr. Anesth. Reanim. 1998;7:370–6. doi: 10.1016/s0750-7658(88)80052-2. [DOI] [PubMed] [Google Scholar]
- 4.Jain U. Myocardial during reoperation for coronary artery bypass surgery. J. Cardiotheorac. 1995;9:389–94. doi: 10.1016/s1053-0770(05)80092-8. [DOI] [PubMed] [Google Scholar]
- 5.Durfi, M. and Coworkers. (1998) Clinical data of Biochemistry: Editor. by Mordam. J. p. 324–332.
- 6.Wernovsky G. Follow-up studies after the arterial switch operation. J. Thorac. Cardiovasc. Surg. 1998;115:481–2. doi: 10.1016/s0022-5223(98)70301-0. [DOI] [PubMed] [Google Scholar]
- 7.Immer F.F., Stocker F., Seiler A.M., Pfammatter J.P., Printzen G. Troponin I for prediction of early postoperative course after pediatric cardiac surgery. J. Am. Coll. Cardiol. 1999;33:1719–23. doi: 10.1016/S0735-1097(99)00061-3. [DOI] [PubMed] [Google Scholar]
- 8.Hirsch R., Dent C. L., Wood M.K., Huddeston C.B. Patterns and potential value of cardiac troponin I elevation after pediatric cardiac operations. Ann. Thorac. Sur. 1998;65:1394–9. doi: 10.1016/S0003-4975(98)00228-8. [DOI] [PubMed] [Google Scholar]
- 9.Kessler-lcekson G., Birk E., Schlesinger H., Vidne B.A. The myocardial profile of the cytosolic isozymes of cratine kinase is apparently not releated to cyanosis in congenital heart disease. Mol. Med. 1998;5:110–6. [PMC free article] [PubMed] [Google Scholar]
- 10.Siegel A. J., Sholar M.J., Dhanak E., Lewandrowski K.B. Elevated serum cardiac markers in asmptomatic marathon runners after competitions the myocardium. Cardiology. 1997;88:487–91. doi: 10.1159/000177396. [DOI] [PubMed] [Google Scholar]
- 11.Kondo K., Menohara S., Sawada Y., Irie H., Okamato K., Kinagasa S., Nakao M., Sasaki S. Indications and problems of coronary artery bypass grafting without cardiopulmonary bypass. Surrey Today. 1997;27:202–6. doi: 10.1007/BF00941645. [DOI] [PubMed] [Google Scholar]
- 12.Tietz N.W. Practice guideline for cardiac prolifing. Am. J. Clin. Pathol. 2003;108:696–9. [PubMed] [Google Scholar]
- 13.Fulda G.J., Giberson F., Hailstone D., Law A., Stillabower M. An evolution of serum troponin T and signal-averaged electrocardiography in predicting electrocardiographic abnormalities after blunt chest trauma. J. Trauma. 1997;43:304–10. doi: 10.1097/00005373-199708000-00016. [DOI] [PubMed] [Google Scholar]
- 14.Yeo T.C., Malouf J.F., Oh J.K., Seward J.B. Clinical profile and outcome in 52 patients with cardiac psuedoaneursym. Ann. Intern. Med. 1998;15:299–305. doi: 10.7326/0003-4819-128-4-199802150-00010. [DOI] [PubMed] [Google Scholar]
- 15.Garre L., Alvarez A., Rubio M., Pellegrini A., Caradi M., Berardi A., Lazarro C. Use of cardiac troponin T rapid assay in the diognosis of a myocardial injury secondary to electrical cardioversion. Clin. Cardiol. 1997;20:619–21. doi: 10.1002/clc.4960200707. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Chaturvedi R.R., Linclon C., Gothard J.W., Scallan M.H., White P.A., Redington A.N., Shor D.F. Left ventricular dysfunction after open repair of simple congenital heart defects in infants and childeren:quantitation with the use of a conductance catheter immediately after bypass. J. Thorac. Cardiovasc. Surg. 1996;115:77–83. doi: 10.1016/s0022-5223(98)70446-5. [DOI] [PubMed] [Google Scholar]
- 17.Hassan M.E., Azzazy R.H., Christenson H. Cardiac markers of acute coronary syndromes: is there a case for point-of-care testing? Clin. Biochem. 2002;35:13–27. doi: 10.1016/S0009-9120(02)00277-1. [DOI] [PubMed] [Google Scholar]
- 18.Costa A.M., Scallan M.H. Heeding the Sign of Increased CK-MB Level After Bypass Surgery. Circulation. 2001;104:2689–2693. doi: 10.1161/hc4701.099789. [DOI] [PubMed] [Google Scholar]
- 19.Newby L.K., Storrow A.B., Gilbert W.B. Bedside testing for risk stratification in chest pain units. Circulation. 2001;103:1832–7. doi: 10.1161/01.cir.103.14.1832. [DOI] [PubMed] [Google Scholar]
- 20.Strrow A.B, Gilber W.B. Chest pain centres: diagnosis of acute coronary syndromes. Ann. Emerg. Med. 2000;35:449–61. [PubMed] [Google Scholar]
- 21.Takeda S.K., Ikezaki H. Cardiac marker response t coronary artery bypass graft surgery with cardiopulmonary bypass and aortic cross-clamping. J. Cardiothorac. Vasc. Anesth. 2002;16:421–5. doi: 10.1053/jcan.2002.125150. [DOI] [PubMed] [Google Scholar]
- 22.Fransen E.J., Diris J.H., Maessen J.G., Hermens W.T., Dieijen-Visser M.P. Evaluation of “new” cardiac markers for ruling out myocardial infarction after coronary artery bypass grafting. Chest. 2002;122:1316–21. doi: 10.1378/chest.122.4.1316. [DOI] [PubMed] [Google Scholar]
- 23.Yamamoto S., Takagi Y., Gomi K., Takaba T. Clinical significance of serum Troponin T following coronary artery bypass surgery. Rinsho Byori. 1995;43:513–8. [PubMed] [Google Scholar]
- 24.Hisatomi K., Isomura T., Aoyagi S. Postoperative changes in myosin light chain and comparison with postoperative clinical variables in patients who have undergone valve surgery. Thorac. Cardiovasc. Surg. 1996;44:296–9. doi: 10.1055/s-2007-1012040. [DOI] [PubMed] [Google Scholar]
- 25.Chen T., Pan T. Variation of preoperative blood cTnT levels in patients undergoing cardiopulmonary bypass and its clinical implication. J. Tongi. Med. Univ. 2000;20:225–6. doi: 10.1007/BF02886998. [DOI] [PubMed] [Google Scholar]