The ischemia-modified albumin in relation to pacemaker and defibrillator implantation.
BACKGROUND
Ischemia-modified albumin (IMA) is considered a marker of myocardial ischemia whereas cardiac enzymes are released when cardiac necrosis occurs. It has previously been shown that permanent pacemaker-defibrillator insertion is associated with myocardial injury expressed as cardiac enzyme rise.


OBJECTIVE
We assessed whether pacemaker-defibrillator implantation also induces changes in IMA plasma levels and whether, therefore, myocardial ischemia precedes necrosis.


METHODS
We studied 64 consecutive patients undergoing pacemaker or defibrillator implantation; 43 were men and 21 women and their age was 70 +/- 11 years (range 23-84 years). Blood samples were collected at baseline, six hours and 48 hours following the procedure. IMA measured by the albumin cobalt binding test (ACB, Integra 800 analyzer), as well as creatine kinase (CK), the MB isoenzyme of creatine kinase (CK-MB) and cardiac troponin I (Tn-I) were evaluated.


RESULTS
Data analysis showed that compared to baseline measurements, IMA increased at six hours (P = 0.015) and at 48 hours (P = 0.003)[97.6 +/- 10.2 vs 101.4 +/- 10.7 vs 102.1 +/- 9.2 U/mL at baseline, six hours and 48 hours, respectively]; similarly, CK increased at six hours (P = 0.0001) and remained high at 48 hours (P = 0.0001) [74.9 +/- 49.9 vs 136.1+/-186.7 vs 115.2 +/- 63.9 mIU/mL], while CK-MB increased at six hours (P = 0.0001), but returned to baseline values at 48 hours (P = 0.05) [0.90 +/- 0.89 vs 1.27 +/- 134 vs 0.71 +/- 0.63 ng/mL] and Tn-I increased at six hours (P = 0.0001) and returned to baseline levels at 48 hours (P = 0.32) [0.057 +/- 0.23 vs 0.16 +/- 0.36 vs 0.03 +/- 0.045 ng/mL].


CONCLUSIONS
Permanent pacemaker-defibrillator insertion is associated with myocardial ischemia and necrosis.
Sbarouni
Eftihia
E
Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece. elbee@ath.forthnet.gr
Georgiadou
Panagiota
P
Panagiotakos
Demosthenes
D
Livanis
Efthimios
E
Theodorakis
George N
GN
Kremastinos
Dimitrios Th
DT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood*; D010138:Pacemaker, Artificial; D012709:Serum Albumin / Q000032:analysis*; D018709:Statistics, Nonparametric
D015415:Biomarkers; D012709:Serum Albumin; D052279:Creatine Kinase, MB Form