You are here

Perioperatif Miyokardiyal Hasar Tespitinde Biyokimyasal Belirleyicilerin Rolü

The Role of Biochemical Markers in Determining Perioperative Myocardial Injury

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
Perioperative infarction is traditionally diagnosed by the electrocardiogram and elevated serum levels ofcreatine kinase izoenzyme (CK-MB). Cardiac troponin I (cTnI) is a more reliable and specific marker for myocardial damage when compared to commonly used serum enzymes. We planned this study for comparing the specifity and the sensitivity of cardiac enzymes in detecting the myocardial injury in patients undergoing open heart surgery. Fifty two cases who underwent open heart surgery were included in this study. There were 39 males and 13 females with a median age of 58+2(17-75). Venous blood samples were collected to analyze CK, CK-MB and cTnI prior to induction of anesthesia, immediately after cross-clamp and at 6 hours,12 hours and 24 hours following surgery and daily thereafter until the fifth postoperative day. Venous blood samples were also collected to analyze cardiac myoglobin upon the termination of the operation and at 2 hours and 9 hours following the operation. Daily electrocardiograms were obtained for all patients. There was no mortality during the study. Peroperative myocardial infarction was detected in two patients. Higher cardiac marker levels were detected in patients who had valvular surgery, who had cross-clamp duration over 60 minutes and who were given inotropic agents. Moreover; in some patients: high cardiac cTnI levels were detected despite normal CK and CK-MB levels. In conclusion; cTnI is a more specific marker of cardiac damage when compared to commonly used serum enzymes. It is also more sensitive, allowing diagnosis of perioperative microinfarction and detection of acute myocardial infarction much earlier after the onset of myocardial injury and comparing different myocardial protection techniques.
Abstract (Original Language): 
Perioperatif miyokard infarktüs tanısı geleneksel olarak elektrokardiogramla ve kreatin kinaz izoenziminin (CK MB) yükselmiş serum değerleriyle konur. Kardiyak troponin I (cTnI) miyokardiyal hasarlanmalarda yaygın kullanılan enzimlere göre daha güvenilir ve sipesifik bir belirleyicidır. Bu çalışma, açık kalp cerrahisi sırasında oluşan miyokardiyal hasarı değerlendirmede kardiyak enzimlerin spesifite ve sensitivitelerini karşılaştırmak amacıyla planlandı. Açık kalp cerrahisi uygulanan 52 olgu çalışmaya alınmıştır. Bu gruptaki olguların 39'u erkek, 13'ü kadın olup ortalama yaş 58±2(17-75) dir. Hastalardan; anestezi indüksiyonundan önce, kross klemp sonrası(O.saat), kross klempten 6, 12, 24, 48, 72, 96 ve 120 saat sonra venöz kanlardan CK, CK-MB ve cTnI, postoperatif 2. ve 9. saatlerde kardiyak miyoglobin calışıldı ve günlük EKG alındı. Hastalarda mortalite olmadı. İki hastada perioperatif miyokardiyal infarktüs tanısı kondu. Kapak lezyonu olan hastalarda, kross-klemp süresi 60 dakikanın üzerinde olan hastalarda ve inotrop kullanılan hastalarda kardiyak belirleyici düzeyleri daha yüksek tespit edildi. Ayrıca bazı hastalarda CK ve CK-MB değerleri normal olmasına rağmen cTnI değerleri yüksek olarak tespit edildi. Sonuç olarak; cTnI yaygın olarak kullanılan serum enzimleri ile kıyaslandığında kardiyak hasar tanısını koymada daha sipesifik bir belirleyicidir. Diğer belirleyicilere oranla daha küçük miyokardiyal hasarlar tespit edilebilir. cTnI düzeyinin tespiti çeşitli miyokard koruma tekniklerinin karşılaştırılması açısından olduğu kadar, oluşan miyokard hasarını erken dönemde göstermesi ve düzeyi hakkında bilgi vermesi açısından da faydalı bir tetkikdir.

REFERENCES

References: 

1.
Yağd
ı T, Özmen D, Atay Y, Çıkırıkçıoğlu M. Perioperatif myokardiyal hasar tespitinde biyokimyasal markırlar: Troponin'in rolü. GKDC Dergisi 1999; 7:175-182.
2. Force T, Kemper AJ, Bloomfield P, et al. Non-Q wave perioperative myocardial infarction: assesment of the incidence and severity of regional dysfunction with quantitative two-demensional echocardiography. Circulation 1985;72:781-9.
3. Bergquist BD, Leung JM, Bellows WH, et al. Transesophageal echocardiography in myocardial revascularization. 1. Accuracy of intraoperative real-time interpretation.
Anesth Analg 1996;82:1132-8.
4. Seeberger MD, Cahalan MK, Rouine—Rapp K, et al. Acute hypovolemia may cause segmental wall motion abnormalities in the absance of myocardial ischemia. Anesth
Analg 1997;85:1252-7.
5. Antman EM, Braunwald E: Acute myocardial infarction. İn: Heart Disease: ATextbook of Cardiovascular Medicine.5th ed. Braunwald, ed. Philadelphia,
W.B.Saunders Co..1997. pp.1184-1268.
6. Roberts R, Henry PD, Witteven S, et al. Quantification of serum creatine phosphokinase izoenzyme activity. Am J Cardiol 1974; 33: 350-54.
7. Adams JE, Abendschein DR. Biyochemical markers of myocardial injury: is MB creatine kinase the choice for the 1990s ? Circulation 1993; 88:750-63.
8. Puleo PR, Meyer D, Wathen C, et al. Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction. N Engl j Med 1994;
331:561-66.
9. Katus HA, Remppis A, Neuman FJ, et al. Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation 1991; 83: 902-12.
1 0. Adams JE, Bodor GS, Davila VG, et al. Cardiac troponin I: a marker with high specificity for cardiac injury. Circulation 1993; 88:101-6.
102
Perioperatif Miyokardiyal
Hasa
r Tespitinde Biyokimyasal Belirleyicilerin Rolü
11. Caputo M, Dihmis N, Birdi I, et al. Cardiac Troponin T and Troponin I release during coronary artery surgery using cold crystalloid and cold blood cardioplegia. Eur J Cardiothorac Surg 1997;12:254-260.
12. Baur HR Peterson TA, Arnar O, et al. Predictors of perioperative myocardial infarction in coronary artery operation. Ann Thorac Surg 1981:31(1):36.
13. Force T, Hibberd P, Weeks G, et al. Perioperative myocardial infarction after coronary artery bypass surgery. Clinical significance and approach to risk stratification
. Circulation 1990; 82:903.
14. Jain U. Myocardial ischemia after cardiopulmonary bypass. J Card Surg. 1995; 10:520.
15. Phillips DF, Proudfit W, Lim J, et al. Perioperative myocardial infarction: Angiographic correlation. Am J Cardiol 1977: 39:269.
16. Mangano DT. Preoperative assessment of cardiac risk. Cardiac anesthesia . 3rd edition. Edited by Kaplan J. Philadelphia, Saunders, 1993,pp 3-41.
17. Kilger E, Pichler B, Weis F, et al. Markers of myocardial ischemia after minimally invasive and conventional coronary operation. Ann Thorac Surg 2000;70:2023-8.
18. Efthimiadis A, Cheiridou M, Lefkos N, et al. The predictive value of TnT in patients who underwent an extracardiac surgery operation. Acta cardiol 1995;50:309-13.
1 9. Lofberg M, Tahtela R, Harkonen M, et al. Cardiac troponins in severe
rhabdomyolysis. Clin Chem 1996;42:1120-1.
20. Vermes E, Mesguich M, Houel R, et al. Cardiac troponin I release after open heart surgery: a marker of myocardial protection ? Ann Thorac surg 2000;70:2087-90.
21. Gensini GF, Conti AA, Calamai GC, et al. Cardiac troponin I and Q-wave perioperative myocardial infarction after coronary bypass surgery. Crit Care Med
1998;26:1986-90.
22. Etievent JP, Chocron S, Toubin G, et al. Use of cardiac Troponin I as a marker of perioperative myocardial ischemia. Ann Thorac Surg 1995;59:1192-4.
23. Alyanakian MA, Dehoux M, Chatel D, et al. Cardiac troponin I in diagnosis of perioperative myocardial infarction after cardiac surgery. J Cardiothorac Vasc
Anesthes 1998;12:288-94.
24. Jackuet L, Noirhomme P, El Koury G, et al. Cardiac troponin I as an early marker of myocardial infarction after coronary artery bypass surgery. Eur J Cardiothorac Surg
1998;13:378-84.
25. Lopez-Jimenez F, Goldman L, Sacks DB, et al. Prognostic value of cardiac troponin T after non-cardiac surgery: 6-month follow-up data. J Am Coll Cardiol
1997;29:1241-45.

Thank you for copying data from http://www.arastirmax.com