Effects of myocardial ischemia on the release of cardiac troponin I in isolated rat hearts

Background Postpartum hemorrhage remains a major cause of global maternal morbidity and mortality, even in developed countries, despite the use of intensive care units. This study sought to (1) assess whether myocardial ischemia could be associated with and even aggravate hemorrhagic shock in young parturients admitted for postpartum hemorrhage, and (2) identify the independent risk factors for myocardial ischemia. Methods On their referral to the intensive care unit, a multidisciplinary team managed parturients with severe postpartum hemorrhage. Ventilation, transfusion, catecholamines, surgery, or angiography with uterine embolization were provided as clinically indicated. Plasma cardiac troponin I levels were used as a surrogate marker of acute myocardial injury and electrocardiograms of myocardial ischemia. Results A total of 55 parturients were referred with severe postpartum hemorrhage, all in hemorrhagic shock. Twenty-eight parturients (51%) had elevated serum levels of cardiac troponin I (9.4 microg/l [3.7-26.6 microg/l]), which were associated with electrocardiographic signs of ischemia and deteriorated myocardial contractility and correlated with the severity of hemorrhagic shock. Indeed, multivariate analysis identified low systolic and diastolic arterial blood pressure (< 88 and < 50 mmHg, respectively) and increased heart rate (> 115 beats/min) as independent predictors of myocardial injury. In addition, all patients who were given catecholamines also had elevated cardiac troponin I levels. Conclusions These results suggest that treatment of postpartum hemorrhage-induced hemorrhagic shock should be coupled with concomitant prevention of myocardial ischemia, even in young parturients.

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Cardiac troponin I—more than a biomarker for myocardial ischemia?

Annals of Translational Medicine ◽

10.21037/atm.2018.09.07 ◽

2018 ◽

Vol 6 (S1) ◽

pp. S17-S17 ◽

Cited By ~ 2

Author(s):

Li Ni ◽

Xander H. T. Wehren

Keyword(s):

Myocardial Ischemia ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I

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Direct comparison of cardiac troponin I and cardiac troponin T in the detection of exercise-induced myocardial ischemia

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2015.12.005 ◽

2016 ◽

Vol 49 (6) ◽

pp. 421-432 ◽

Cited By ~ 14

Author(s):

Seoung Mann Sou ◽

Christian Puelacher ◽

Raphael Twerenbold ◽

Max Wagener ◽

Ursina Honegger ◽

...

Keyword(s):

Myocardial Ischemia ◽

Cardiac Troponin ◽

Troponin I ◽

Troponin T ◽

Cardiac Troponin I ◽

Cardiac Troponin T ◽

Exercise Induced

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Does the Serum Cardiac Troponin I Level Increase With Stress Test-Induced Myocardial Ischemia?

Heart Disease ◽

10.1097/00132580-200207000-00004 ◽

2002 ◽

Vol 4 (4) ◽

pp. 216-219 ◽

Cited By ~ 3

Author(s):

Nagaraju L. Choragudi ◽

Wilbert S. Aronow ◽

Anita Prakash ◽

Sree K. Kurup ◽

Salvatore Chiaramida ◽

...

Keyword(s):

Myocardial Ischemia ◽

Cardiac Troponin ◽

Troponin I ◽

Stress Test ◽

Cardiac Troponin I ◽

Level Increase ◽

Serum Cardiac Troponin

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Clinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia

American Heart Journal ◽

10.1016/j.ahj.2015.11.010 ◽

2016 ◽

Vol 173 ◽

pp. 8-17 ◽

Cited By ~ 38

Author(s):

Gino Lee ◽

Raphael Twerenbold ◽

Yunus Tanglay ◽

Tobias Reichlin ◽

Ursina Honegger ◽

...

Keyword(s):

Myocardial Ischemia ◽

Clinical Benefit ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Exercise Induced

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Normal Plasma Levels of Cardiac Troponin I Measured by the High-Sensitivity Cardiac Troponin I Access Prototype Assay and the Impact on the Diagnosis of Myocardial Ischemia

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2009.05.051 ◽

2009 ◽

Vol 54 (13) ◽

pp. 1165-1172 ◽

Cited By ~ 125

Author(s):

Per Venge ◽

Nina Johnston ◽

Bertil Lindahl ◽

Stefan James

Keyword(s):

Myocardial Ischemia ◽

Plasma Levels ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Normal Plasma ◽

The Impact

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The Use of Cardiac Troponin-I (cTnI) to Determine the Incidence of Myocardial Ischemia and Injury in Patients with Aneurysmal and Presumed Aneurysmal Subarachnoid Hemorrhage

Acta Neurochirurgica ◽

10.1007/s007010050063 ◽

1998 ◽

Vol 140 (1) ◽

pp. 87-93 ◽

Cited By ~ 62

Author(s):

M.B. Horowitz ◽

D. Willet ◽

J. Keffer

Keyword(s):

Subarachnoid Hemorrhage ◽

Myocardial Ischemia ◽

Cardiac Troponin ◽

Troponin I ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cardiac Troponin I

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Brief Myocardial Ischemia Produces Cardiac Troponin I Release and Focal Myocyte Apoptosis in the Absence of Pathological Infarction in Swine

JACC Basic to Translational Science ◽

10.1016/j.jacbts.2017.01.006 ◽

2017 ◽

Vol 2 (2) ◽

pp. 105-114 ◽

Cited By ~ 29

Author(s):

Brian R. Weil ◽

Rebeccah F. Young ◽

Xiaomeng Shen ◽

Gen Suzuki ◽

Jun Qu ◽

...

Keyword(s):

Myocardial Ischemia ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Myocyte Apoptosis

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Perioperative Myocardial Ischemia and Infarction

Anesthesiology ◽

10.1097/00000542-200202000-00007 ◽

2002 ◽

Vol 96 (2) ◽

pp. 264-270 ◽

Cited By ~ 103

Author(s):

Giora Landesberg ◽

Morris Mosseri ◽

Yehuda Wolf ◽

Yellena Vesselov ◽

Charles Weissman

Keyword(s):

Myocardial Ischemia ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Electrocardiographic Monitoring ◽

St Segment ◽

On Line ◽

Cardiac Outcome ◽

Electrocardiographic Leads ◽

Ischemic Events

Background Perioperative myocardial ischemia is conventionally monitored using five electrocardiographic leads, with only one precordial lead placed at V5. This is based on studies from more than a decade ago. The authors reassessed this convention by analyzing data obtained from continuous on-line 12-lead electrocardiographic monitoring. Methods One hundred eighty-five consecutive patients undergoing vascular surgery were monitored by continuous 12-lead ST-trend analysis during and for 48-72 h after surgery. Cardiac troponin I was measured in the first 3 postoperative days, and cardiac outcome was prospectively recorded. Ischemia was defined as ST deviation, relative to the reference preanesthesia electrocardiogram, of 0.2 mV or more in one lead or 0.1 mV or more in two contiguous leads, lasting more than 10 min. Results During 11,132 patient-hours of monitoring, 38 patients (20.5%) had 66 transient ischemic events, with all but one denoted by ST-segment depression. Twelve patients (6.5%) sustained postoperative infarction (cardiac troponin I > 3.1 ng/ml). Among the 38 patients with ischemia, lead V3 most frequently (86.8%) demonstrated ischemia, followed by V4 (78.9%) and V5 (65.8%). Among the 12 patients with infarction, V4 was most sensitive to ischemia (83.3%), followed by V3 and V5 (75% each). Combining two precordial leads increased the sensitivity for detecting ischemia (97.4% for V3 + V5 and 92.1% for either V4 + V5 or V3 + V4) and infarction (100% for V4 + V5 or V3 + V5 and 83.3% for V3 + V4). On average, baseline preanesthesia ST was above isoelectric in V1 through V3 and below isoelectric in V5 through V6. Lead V4 was closest to the isoelectric level on the baseline electrocardiogram, rendering it most suitable for ischemia monitoring. Conclusions As a single lead, V4 is more sensitive and appropriate than V5 for detecting prolonged postoperative ischemia and infarction. Two precordial leads or more are necessary so as to approach a sensitivity of greater than 95% for detection of perioperative ischemia and infarction.

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