title: Release of creatine kinase, troponin-T, and tissue plasminogen activator in arterial and coronary venous blood during coronary artery bypass surgery.
abstract: Tissue plasminogen activator (t-PA) as a possible marker of endothelial injury during elective coronary artery bypass surgery was studied. T-PA antigen and activity were measured in arterial and coronary venous plasma in 14 patients, and compared to the markers of myocyte injury creatine kinase (CK-MB) and troponin-T (TnT). Cardiopulmonary bypass (CPB) lasted 86 (55-107) min, and aortic cross-clamping (cold, crystalloid cardioplegia) lasted 41 (25-62) min (median (central 90% percentile)). Blood flow in the great cardiac vein was measured by retrograde thermodilution, and increased from 49 (27-90) ml/min before CPB to a maximum of 92 (55-125) ml/min 40 min after declamping (not significant). CK-MB, TnT, and t-PA antigen and activity all increased during CPB, and were significantly higher in coronary sinus than arterial plasma after declamping the aorta. Net cardiac release ([coronary sinus-arterial concentration] x coronary flow) of TnT increased after the aorta was declamped, and was higher in the seven patients with the longest cross-clamping time than in the seven with the shortest time (p < 0.01). Cardiac release of CK-MB and t-PA antigen also increased after declamping, but with no significant difference between long and short cross-clamp times. t-PA activity, however, increased more in the patients with the longest cross-clamp times (p < 0.008). In conclusion, CK-MB, TnT and t-PA were released from the postcardioplegic heart. Release of t-PA indicates that postcardioplegic coronary endothelial activation or injury occurred t-PA activity as well as TnT increased more in patients with long times of cross-clamping, indicating that t-PA activity may be a possible marker of postcardioplegic endothelial injury or activation.
authors.affiliation: Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Valen
authors.forename: A
authors.initials: A
authors.lastname: Owall
authors.forename: E
authors.initials: E
authors.lastname: Eriksson
authors.forename: A
authors.initials: A
authors.lastname: Kallner
authors.forename: B
authors.initials: B
authors.lastname: Risberg
authors.forename: J
authors.initials: J
authors.lastname: Vaage
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003331:Coronary Vessels / Q000201:enzymology* / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood*; D004730:Endothelium, Vascular / Q000201:enzymology / Q000293:injuries / Q000378:metabolism; D004789:Enzyme Activation; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000201:enzymology / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000097:blood* / Q000276:immunology; D014336:Troponin / Q000097:blood*; D020107:Troponin T
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase; D010959:Tissue Plasminogen Activator