Evaluation of heart fatty acid-binding protein as a rapid indicator for assessment of myocardial damage in pediatric cardiac surgery.
OBJECTIVE
Perioperative myocardial damage is a major determinant of postoperative cardiac dysfunction for congenital heart disease. Heart fatty acid-binding protein is reported to be a rapid marker of perioperative myocardial damage that peaks earlier than creatine kinase isoenzyme MB or cardiac troponin T in adults. The objective of this study was to assess the suitability of using serum concentrations of heart fatty acid-binding protein for evaluation of perioperative myocardial damage in pediatric cardiac surgery.


METHODS
After institutional review board approval and informed consent, 100 children undergoing open procedures for congenital heart disease were prospectively enrolled in the study. Mean age at operation was 4.9 +/- 0.4 years. Serum concentrations of heart fatty acid-binding protein, creatine kinase isoenzyme MB, and cardiac troponin T were measured serially before operation and at 0, 1, 2, 3, and 6 hours after aortic declamping. Relationships between serum peak level of heart fatty acid-binding protein and intraoperative and postoperative clinical variables were evaluated.


RESULTS
Serum heart fatty acid-binding protein reached its peak level at 1 hour after declamping in 95 patients (95%), which was significantly earlier (P <.01) than serum creatine kinase isoenzyme MB or cardiac troponin T. In addition, serum heart fatty acid-binding protein level immediately after declamping correlated strongly with serum peak heart fatty acid-binding protein level (r = 0.91, P <.01). The serum peak level of heart fatty acid-binding protein correlated with those of creatine kinase isoenzyme MB (r = 0.77, P <.01) and cardiac troponin T (r = 0.80, P <.01). In the forward stepwise multiple regression analysis, age (P <.0001), aortic crossclamp time (P <.0001), the presence of a ventriculotomy (P <.001), and the lowest hematocrit level during cardiopulmonary bypass (P <.05) were significant intraoperative variables that influenced the release of heart fatty acid-binding protein. There were significant relationships between serum peak heart fatty acid-binding protein level and postoperative inotropic support, duration of intubation, and intensive care unit stay (P <.01 for each).


CONCLUSIONS
Heart fatty acid-binding protein is a rapid marker for assessment of myocardial damage and clinical outcome in pediatric cardiac surgery. In particular, serum heart fatty acid-binding protein level immediately after aortic declamping may be a potentially useful prognostic indicator of myocardial damage as well as clinical outcome in pediatric cardiac surgery.
Hasegawa
Tomomi
T
Department of Cardiothoracic Surgery, Kobe Children's Hospital, Kobe, Japan.
Yoshimura
Naoki
N
Oka
Shigeteru
S
Ootaki
Yoshio
Y
Toyoda
Yoshiya
Y
Yamaguchi
Masahiro
M
D015415:Biomarkers / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002352:Carrier Proteins / Q000097:blood / Q000378:metabolism*; D002675:Child, Preschool; D003402:Creatine Kinase / Q000032:analysis / Q000378:metabolism*; D052279:Creatine Kinase, MB Form; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D050556:Fatty Acid-Binding Proteins; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007527:Isoenzymes / Q000032:analysis / Q000378:metabolism*; D008297:Male; D016343:Monitoring, Intraoperative; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; D002352:Carrier Proteins; D050556:Fatty Acid-Binding Proteins; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form