Biochemical markers of myocardial injury in the pericardial fluid of patients undergoing heart surgery.
The purpose of this study was to compare cardiac markers in the pericardial fluid and serum in order to evaluate preoperative myocardial injury. Thirty patients were divided into three groups. The first group (AVR; n=10) received an aortic valve replacement. The second group (SA; n=10) included patients with stable angina who underwent elective coronary artery bypass grafting (CABG). The third group (ACS; n=10) included patients with acute coronary syndrome who underwent urgent CABG. Pericardial fluid and venous samples were taken after opening the pericardium and 24 h postoperatively. Serum and pericardial concentration of troponin I (cTnI), creatine kinase (CK), its MB isoenzyme (CK-MB) and myoglobin were determined. Preoperative pericardial cTnI was significantly (P<0.01) higher than in serum in all groups. Preoperative pericardial CK, CK-MB and myoglobin were significantly (P<0.01) lower than in serum in groups AVR and SA. Preoperative pericardial and serum cTnI were significantly higher in the ACS than in AVR and SA groups (P<0.01). Postoperative pericardial concentration of all markers was significantly higher (P<0.01) than in serum in all groups. We conclude that preoperative pericardial accumulation of cTnI may reflect subclinical injury which may not be demonstrated by the usual laboratory tests.
Fernández
Angel L
AL
Department of Cardiac Surgery, University Hospital of Santiago, 15706 Santiago de Compostela, Spain. alfg@secardiologia.es
García-Bengochea
José B
JB
Alvarez
Julián
J
González Juanatey
José R
JR
D054058:Acute Coronary Syndrome / Q000209:etiology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D015415:Biomarkers / Q000097:blood / Q000378:metabolism*; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000378:metabolism; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D045604:Extracellular Fluid / Q000201:enzymology / Q000378:metabolism*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D009206:Myocardium / Q000201:enzymology / Q000378:metabolism* / Q000473:pathology; D009211:Myoglobin / Q000378:metabolism; D010496:Pericardium / Q000201:enzymology / Q000378:metabolism*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000378:metabolism
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form