title: Short-term prognostic value of perioperative coronary sinus-derived-serum cardiac troponin-I, creatine kinase-MB, lactate, pyruvate, and lactate-pyruvate ratio in adult patients undergoing open heart surgery.
abstract: OBJECTIVE
  To investigate the release pattern of different cardiac metabolites and biomarkers directly from the coronary sinus (CS) and to establish the diagnostic discrimination limits of each marker protein and metabolites to evaluate perioperative myocardial injury in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).
  
  
  METHODS
  Sixty-eight patients undergoing first mitral and/or aortic valve replacements with/without coronary artery bypass grafting and Bentall procedure under CPB and blood cardioplegic arrest were studied. All cardiac metabolites and biomarkers were measured in serial CS-derived blood samples at pre-CPB, immediate post aortic declamping, 10 minutes post-CPB and 12 hrs post-CPB.
  
  
  RESULTS
  Receiver operating characteristic curve analysis of cardiac biomarkers indicated lactate-pyruvate ratio as the superior diagnostic discriminator of myocardial injury with an optimal "cut-off" value >10.8 immediately after aortic declamping (AUC, 0.92; 95% CI: 0.85-0.98). Lactate was the second best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2mmol/l at immediately after aortic declamping (AUC, 0.89; 95% CI: 0.80-0.96). Cardiac troponin-I was the third best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2.1ng/ml at immediately after aortic declamping (AUC, 0.88; 95% CI: 0.80-0.95). Creatine kinase-MB was the fourth best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >58 log units/ml prior to decanulation (AUC, 0.85; 95% CI: 0.78-0.94).
  
  
  CONCLUSIONS
  Measurable cardiac damage exists in all patients undergoing cardiac surgery under cardioplegic arrest. The degree of myocardial injury is more in patients with poor ventricular function and those requiring longer aortic clamp time. CS-derived lactate-pyruvate ratio, lactate, cTn-I served as superior diagnostic discriminators of peri-operative myocardial damage.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ujjwal Kumar
authors.initials: UK
authors.lastname: Chowdhury
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
authors.forename: Avneesh
authors.initials: A
authors.lastname: Sheil
authors.affiliation: Department of Cardiovascular Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.affiliation: Department of Cardiology, CNC, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Narang
authors.affiliation: Department of Cardiovascular Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Gharde
authors.affiliation: Department of Cardiovascular Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vishwas
authors.initials: V
authors.lastname: Malik
authors.affiliation: Department of Baiostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.affiliation: Department of Cardiovascular Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arindam
authors.initials: A
authors.lastname: Chaudhury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D054326:Coronary Sinus / Q000378:metabolism; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011379:Prognosis; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000097:blood*; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I; D019344:Lactic Acid; D019289:Pyruvic Acid; D052279:Creatine Kinase, MB Form