Skip to main content
PMC home page
Heart logoLink to Heart
. 1997 Apr;77(4):314–318. doi: 10.1136/hrt.77.4.314

Ischaemic preconditioning reduces troponin T release in patients undergoing coronary artery bypass surgery.

D P Jenkins 1, W B Pugsley 1, A M Alkhulaifi 1, M Kemp 1, J Hooper 1, D M Yellon 1
PMCID: PMC484723  PMID: 9155608

Abstract

OBJECTIVE: To investigate whether ischaemic preconditioning could reduce myocardial injury, as manifest by troponin T release, in patients undergoing elective coronary artery bypass surgery. DESIGN: Randomised controlled trial. SETTING: Cardiothoracic unit of a tertiary care centre. PATIENTS: Patients with three vessel coronary artery disease and stable angina admitted for first time elective coronary artery bypass surgery were invited to take part in the study; 33 patients were randomised into control or preconditioning groups. INTERVENTION: Patients in the preconditioning group were exposed to two additional three minute periods of myocardial ischaemia at the beginning of the revascularisation operation, before the ischaemic period used for the first coronary artery bypass graft distal anastomosis. MAIN OUTCOME MEASURE: Serum troponin T concentration at 72 hours after cardiopulmonary bypass. RESULTS: The troponin T assays were performed by blinded observers at a different hospital. All patients had undetectable serum troponin T (< 0.1 microgram/l) before cardiopulmonary bypass, and troponin T was raised postoperatively in all patients. At 72 hours, serum troponin T was lower (P = 0.05) in the preconditioned group (median 0.3 microgram/l) than in the control group (median 1.4 micrograms/l). CONCLUSIONS: The direct application of a preconditioning stimulus in clinical practice has been shown, for the first time, to protect patients against irreversible myocyte injury.

Full text

PDF
315

Selected References

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

  1. Anderson J. R., Hossein-Nia M., Kallis P., Pye M., Holt D. W., Murday A. J., Treasure T. Comparison of two strategies for myocardial management during coronary artery operations. Ann Thorac Surg. 1994 Sep;58(3):768–773. doi: 10.1016/0003-4975(94)90745-5. [DOI] [PubMed] [Google Scholar]
  2. Hake U., Schmid F. X., Iversen S., Dahm M., Mayer E., Hafner G., Oelert H. Troponin T--a reliable marker of perioperative myocardial infarction? Eur J Cardiothorac Surg. 1993;7(12):628–633. doi: 10.1016/1010-7940(93)90256-b. [DOI] [PubMed] [Google Scholar]
  3. Hamm C. W., Ravkilde J., Gerhardt W., Jørgensen P., Peheim E., Ljungdahl L., Goldmann B., Katus H. A. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992 Jul 16;327(3):146–150. doi: 10.1056/NEJM199207163270302. [DOI] [PubMed] [Google Scholar]
  4. Katus H. A., Schoeppenthau M., Tanzeem A., Bauer H. G., Saggau W., Diederich K. W., Hagl S., Kuebler W. Non-invasive assessment of perioperative myocardial cell damage by circulating cardiac troponin T. Br Heart J. 1991 May;65(5):259–264. doi: 10.1136/hrt.65.5.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kida M., Fujiwara H., Ishida M., Kawai C., Ohura M., Miura I., Yabuuchi Y. Ischemic preconditioning preserves creatine phosphate and intracellular pH. Circulation. 1991 Dec;84(6):2495–2503. doi: 10.1161/01.cir.84.6.2495. [DOI] [PubMed] [Google Scholar]
  6. Kloner R. A., Yellon D. Does ischemic preconditioning occur in patients? J Am Coll Cardiol. 1994 Oct;24(4):1133–1142. doi: 10.1016/0735-1097(94)90880-x. [DOI] [PubMed] [Google Scholar]
  7. Källner G., Lindblom D., Forssell G., Kallner A. Myocardial release of troponin T after coronary bypass surgery. Scand J Thorac Cardiovasc Surg. 1994;28(2):67–72. doi: 10.3109/14017439409100165. [DOI] [PubMed] [Google Scholar]
  8. Mair J., Dienstl F., Puschendorf B. Cardiac troponin T in the diagnosis of myocardial injury. Crit Rev Clin Lab Sci. 1992;29(1):31–57. doi: 10.3109/10408369209105245. [DOI] [PubMed] [Google Scholar]
  9. Mair J., Wieser C., Seibt I., Arther-Dworzak E., Furtwängler W., Waldenberger F., Balough D., Puschendorf B. Troponin T to diagnose myocardial infarction in bypass surgery. Lancet. 1991 Feb 16;337(8738):434–435. doi: 10.1016/0140-6736(91)91218-j. [DOI] [PubMed] [Google Scholar]
  10. Murry C. E., Jennings R. B., Reimer K. A. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986 Nov;74(5):1124–1136. doi: 10.1161/01.cir.74.5.1124. [DOI] [PubMed] [Google Scholar]
  11. Murry C. E., Richard V. J., Reimer K. A., Jennings R. B. Ischemic preconditioning slows energy metabolism and delays ultrastructural damage during a sustained ischemic episode. Circ Res. 1990 Apr;66(4):913–931. doi: 10.1161/01.res.66.4.913. [DOI] [PubMed] [Google Scholar]
  12. Opie L. H. Cardiac metabolism--emergence, decline, and resurgence. Part II. Cardiovasc Res. 1992 Sep;26(9):817–830. doi: 10.1093/cvr/26.9.817. [DOI] [PubMed] [Google Scholar]
  13. Reimer K. A., Murry C. E., Yamasawa I., Hill M. L., Jennings R. B. Four brief periods of myocardial ischemia cause no cumulative ATP loss or necrosis. Am J Physiol. 1986 Dec;251(6 Pt 2):H1306–H1315. doi: 10.1152/ajpheart.1986.251.6.H1306. [DOI] [PubMed] [Google Scholar]
  14. Remppis A., Scheffold T., Greten J., Haass M., Greten T., Kübler W., Katus H. A. Intracellular compartmentation of troponin T: release kinetics after global ischemia and calcium paradox in the isolated perfused rat heart. J Mol Cell Cardiol. 1995 Feb;27(2):793–803. doi: 10.1016/0022-2828(95)90086-1. [DOI] [PubMed] [Google Scholar]
  15. Riou B., Dreux S., Roche S., Arthaud M., Goarin J. P., Léger P., Saada M., Viars P. Circulating cardiac troponin T in potential heart transplant donors. Circulation. 1995 Aug 1;92(3):409–414. doi: 10.1161/01.cir.92.3.409. [DOI] [PubMed] [Google Scholar]
  16. Speechly-Dick M. E., Grover G. J., Yellon D. M. Does ischemic preconditioning in the human involve protein kinase C and the ATP-dependent K+ channel? Studies of contractile function after simulated ischemia in an atrial in vitro model. Circ Res. 1995 Nov;77(5):1030–1035. doi: 10.1161/01.res.77.5.1030. [DOI] [PubMed] [Google Scholar]
  17. Steenbergen C., Perlman M. E., London R. E., Murphy E. Mechanism of preconditioning. Ionic alterations. Circ Res. 1993 Jan;72(1):112–125. doi: 10.1161/01.res.72.1.112. [DOI] [PubMed] [Google Scholar]
  18. Taggart D. P., Bhusari S., Hopper J., Kemp M., Magee P., Wright J. E., Walesby R. Intermittent ischaemic arrest and cardioplegia in coronary artery surgery: coming full circle? Br Heart J. 1994 Aug;72(2):136–139. doi: 10.1136/hrt.72.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Uchino T., Belboul A., Roberts D., Jagenburg R. Measurement of myosin light chain I and troponin T as markers of myocardial damage after cardiac surgery. J Cardiovasc Surg (Torino) 1994 Jun;35(3):201–206. [PubMed] [Google Scholar]
  20. Walker D. M., Walker J. M., Pugsley W. B., Pattison C. W., Yellon D. M. Preconditioning in isolated superfused human muscle. J Mol Cell Cardiol. 1995 Jun;27(6):1349–1357. doi: 10.1016/s0022-2828(05)82397-1. [DOI] [PubMed] [Google Scholar]
  21. Yellon D. M., Alkhulaifi A. M., Pugsley W. B. Preconditioning the human myocardium. Lancet. 1993 Jul 31;342(8866):276–277. doi: 10.1016/0140-6736(93)91819-8. [DOI] [PubMed] [Google Scholar]
  22. de Albuquerque C. P., Gerstenblith G., Weiss R. G. Importance of metabolic inhibition and cellular pH in mediating preconditioning contractile and metabolic effects in rat hearts. Circ Res. 1994 Jan;74(1):139–150. doi: 10.1161/01.res.74.1.139. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES