title: High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery.
abstract: OBJECTIVE
  To determine whether there is a correlation between cardiac markers and peri-operative myocardial injury (PMI) and apoptosis in coronary artery bypass graft (CABG) surgery and to compare the efficacy of cardiac markers to detect PMI.
  
  
  METHODS
  The study population consisted of 37 patients (24 male, 13 female, mean age 63.4 ± 8.9 years) undergoing elective CABG. Arterial and coronary sinus blood samples were collected just before aortic cross-clamping (pre-ACC) and after aortic declamping (post-ACC). Creatine kinase-MB isoenzyme (CK-MB) activity, and high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB isoenzyme mass (CK-MB mass) and cardiac troponin I (cTnI) concentrations were measured in blood samples. Myocardial injury and apoptosis were examined in atrial biopsies.
  
  
  RESULTS
  CABG caused PMI and apoptosis in all cases. Concentrations and net releases of cardiac markers significantly increased after aortic declamping (p < 0.001 for CK-MB and CK-MB mass, p < 0.01 for cTnI, p < 0.05 for hs-cTnT). A positive correlation was found between apoptotic index (r = 0.611, p < 0.001 for cTnI; r = 0.806, p < 0.001 for hs-cTnT), myocardial injury score (r = 0.544, p < 0.001 for cTnI; r = 0.719, p < 0.001 for hs-cTnT) and cTnI and hs-cTnT values in the post-ACC period. A positive correlation was found between apoptotic index (r = 0.507, p < 0.001), myocardial injury score (r = 0.416, p = 0.010) and net release of hs-cTnT. Furthermore, a positive correlation was found between aortic cross-clamp (ACC) time (r = 0.448, p = 0.007), cardiopulmonary bypass (CPB) time (r = 0.342, p = 0.047) and net release of hs-cTnT.
  
  
  CONCLUSIONS
  Although both cTnI and hs-cTnT may be specific and efficacious markers of myocardial apoptosis and injury occurring during CABG with CPB, hs-cTnT may be a more useful marker than cTnI to detect peri-operative myocardial apoptosis and injury.
authors.affiliation: Department of Medical Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey. dremelk@hotmail.com.
authors.forename: Emel Fatma
authors.initials: EF
authors.lastname: Kocak
authors.affiliation: Department of Pathology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Kocak
authors.affiliation: Department of Cardiovascular Surgery, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aksoy
authors.affiliation: Department of Medical Biochemistry, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey.
authors.forename: Ozden Ozben
authors.initials: OO
authors.lastname: Isiklar
authors.affiliation: Department of Physiology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
authors.forename: Raziye
authors.initials: R
authors.lastname: Akcilar
authors.affiliation: Department of Cardiovascular Surgery, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey.
authors.forename: Ibrahim Fevzi
authors.initials: IF
authors.lastname: Ozdomanic
authors.affiliation: Department of Anesthesiology and Reanimation, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey.
authors.forename: Cevher
authors.initials: C
authors.lastname: Unsal
authors.affiliation: Department of Medical Biochemistry, Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey.
authors.forename: Merve
authors.initials: M
authors.lastname: Celenk
authors.affiliation: Department of Medical Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
authors.forename: Irfan
authors.initials: I
authors.lastname: Altuntas
mesh_terms: D000368:Aged; D017209:Apoptosis; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D052279:Creatine Kinase, MB Form / Q000097:blood; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology*; D059035:Perioperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C545568:TNNT2 protein, human; D019210:Troponin I; D020107:Troponin T; D052279:Creatine Kinase, MB Form