Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

Objective This study was performed to determine the effect of dexmedetomidine (DEX) administration on myocardial damage in cardiac surgery with sevoflurane postconditioning. Methods We retrospectively examined all cardiac valve replacement surgeries from 1 April 2016 to 30 April 2017. Eligible patients were divided into two groups based on whether DEX was infused. DEX infusion was permitted only between intubation and the beginning of cardiopulmonary bypass (CPB). Sevoflurane was inhaled via the standard postconditioning procedure starting at aortic declamping. The cardiac troponin I (cTnI) level was measured at different time points. The postoperative outcomes and complications were also analyzed. Results One hundred patients were included in the study (DEX group, n = 53; non-DEX group, n = 47). Increased cTnI levels were significantly correlated with the New York Heart Association classification, CPB time, and DEX use. DEX use and the CPB time were potential independent factors contributing to changes in the cTnI level. The cTnI level at 6, 12, and 24 hours postoperatively was remarkably lower in the DEX than non-DEX group by 1.14, 7.83, and 5.86 ng/mL, respectively. Conclusions DEX decreased the cTnI level after CPB when sevoflurane postconditioning was used, especially at 6, 12, and 24 hours postoperatively.

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Propofol Is Cardioprotective in a Clinically Relevant Model of Normothermic Blood Cardioplegic Arrest and Cardiopulmonary Bypass

Experimental Biology and Medicine ◽

10.1177/15353702-0323006-09 ◽

2005 ◽

Vol 230 (6) ◽

pp. 413-420 ◽

Cited By ~ 51

Author(s):

Kelvin H. H. Lim ◽

Andrew P. Halestrap ◽

Gianni D. Angelini ◽

M.-Saadeh Suleiman

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cardiac Function ◽

Cardiac Troponin ◽

Troponin I ◽

Ischemia Reperfusion ◽

Cardiac Troponin I ◽

Cardioplegic Arrest ◽

Relevant Model ◽

Blood Cardioplegia

The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment ( n = 8) and control ( n =12) groups, were surgically prepared for cardiopulmonary bypass (CPB) and cardioplegic arrest. Doses of warm blood cardioplegia were delivered at 15-min intervals during a 60-min aortic cross-clamped period. Propofol was continuously infused for the duration of CPB and was therefore present in blood cardioplegia. Myocardial biopsies were collected before, at the end of cardioplegic arrest, and 20 mins after the release of the aortic cross-clamp. Hemodynamic parameters were monitored and blood samples collected for cardiac troponin I measurements. Propofol infusion during CPB and before ischemia did not alter cardiac function or myocardial metabolism. Propofol treatment attenuated the changes in myocardial tissue levels of adenine nucleotides, lactate, and amino acids during ischemia and reduced cardiac troponin I release on reperfusion. Propofol treatment reduced measurable hemodynamic dysfunction after cardioplegic arrest when compared to untreated controls. In conclusion, propofol protects the heart from ischemia-reperfusion injury in a clinically relevant experimental model. Propofol may therefore be a useful adjunct to cardioplegic solutions as well as being an appropriate anesthetic for cardiac surgery.

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DOES CARDIAC TROPONINÂ€“I IS RECOGNIZED AS AN EARLY POSTOPERATIVE MARKER FOR MYOCARDIAL DAMAGE IN CHILDREN?

International Journal of Advanced Research ◽

10.21474/ijar01/13011 ◽

2021 ◽

Vol 9 (06) ◽

pp. 279-286

Author(s):

Masroor H. Sharfi ◽

◽

Mohamed H. Mashali ◽

Abdelmonem Helal ◽

Abdullah A. Al-Shehri ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiac Troponin ◽

Heart Surgery ◽

Troponin I ◽

Open Heart Surgery ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Pediatric Cardiac Surgery ◽

P Value ◽

Sensitive Marker

Introduction:Cardiac troponin-I being a sensitive marker of myocardial damage needs to be analyzed in children undergoing cardiopulmonary by-pass surgery, as perioperative myocardial damage may be a significant factor of postoperative cardiac performance. The present study aims to test the prognostic value of Cardiac troponin-I concerning the early postoperative course after pediatric cardiac surgery. Methods:Cardiac troponin â€“ I levels were measured and correlated with intra and postoperative parameters of thirty-three children undergoing open-heart surgery. The cutoff point for the definition of a high and a low-risk group of Cardiac troponin-I values was set at 25 ng/ml. Results:Overall, cTnI peak value was higher than 25 ng/ml in 21 patients among these,4 died, and two of them were reported with the value of >100 ng/ml. 38.7% of the patients were complicated by different types of arrhythmias. Junctional ectopic tachycardia was the most common type of arrhythmia,while heart block complication was found only in one case, which was temporarily treated by pacing for less than 24 hours. The results showed significant correlation of troponin I values with dobutamine dose mg/kg (p-value=0.043), dobutamine duration (p-value=0.020), creatinine (p-value= 0.002), and internalcare unit stay (p-value= 0.003). Conclusion: The present study confirms that troponin I is specific and sensitive marker of myocardial injury after pediatric cardiac surgery.

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Faculty Opinions recommendation of Simultaneous measurement of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein for the prediction of long-term cardiac outcome after cardiac surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1163593.625346 ◽

2009 ◽

Author(s):

Girish Joshi ◽

Peter Hession

Keyword(s):

Cardiac Surgery ◽

Natriuretic Peptide ◽

Simultaneous Measurement ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

C Reactive Protein ◽

Reactive Protein ◽

Cardiac Outcome

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Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽

10.1177/0267659117701562 ◽

2017 ◽

Vol 32 (7) ◽

pp. 547-553 ◽

Cited By ~ 12

Author(s):

Elena Bignami ◽

Marcello Guarnieri ◽

Marina Pieri ◽

Francesco De Simone ◽

Alcira Rodriguez ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Necrosis ◽

Perioperative Period ◽

Cardiac Surgical Procedures ◽

Control Group ◽

Volatile Anaesthetics ◽

Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

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Postoperative Cardiac Troponin I (cTnI) Level and Its Prognostic Value for Patients Undergoing Mitral Valve Surgery

International Heart Journal ◽

10.1536/ihj.51.166 ◽

2010 ◽

Vol 51 (3) ◽

pp. 166-169 ◽

Cited By ~ 4

Author(s):

Kiyohiro Oshima ◽

Fumio Kunimoto ◽

Toru Takahashi ◽

Jun Mohara ◽

Izumi Takeyoshi ◽

...

Keyword(s):

Mitral Valve ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin I ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Cardiac Troponin I ◽

Ctni Level

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Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/09603271211043477 ◽

2021 ◽

pp. 096032712110434

Author(s):

Yusuf K Tekin ◽

Gülaçan Tekin ◽

Naim Nur ◽

İlhan Korkmaz ◽

Sefa Yurtbay

Keyword(s):

Carbon Monoxide ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Arterial Oxygen ◽

Co Poisoning ◽

Arterial Blood ◽

Creatine Kinase Mb

Introduction The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. Materials and methods The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. Results Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found ( p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower ( p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = −0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814–0.988, sensitivity: 87%, specificity: 84%). Conclusions The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

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Isoflurane may not influence postoperative cardiac troponin I release and clinical outcome in adult cardiac surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-200409000-00004 ◽

2004 ◽

Vol 21 (9) ◽

pp. 688-693 ◽

Cited By ~ 23

Author(s):

J.-L. Fellahi ◽

X. Gue ◽

E. Philippe ◽

B. Riou ◽

J.-L. Gerard

Keyword(s):

Cardiac Surgery ◽

Clinical Outcome ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Adult Cardiac Surgery

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Evaluation of Myocardial Damage After Electroconvulsive Therapy: Analyses of High-Sensitive Cardiac Troponin I and N-Terminal pro-B-type Natriuretic Peptide

Pharmacopsychiatry ◽

10.1055/a-0646-4278 ◽

2018 ◽

Vol 52 (02) ◽

pp. 92-93

Author(s):

Laura Kranaster ◽

Johanna Badstübner ◽

Suna Aksay ◽

Jan Bumb ◽

Rayan Suliman ◽

...

Keyword(s):

Natriuretic Peptide ◽

Electroconvulsive Therapy ◽

Cardiac Troponin ◽

Cardiovascular Events ◽

Troponin I ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Safe Procedure ◽

Increased Risk ◽

Before And After

AbstractElectroconvulsive therapy (ECT) is a remarkably safe procedure. However, there might exist a subgroup of patients with an increased risk for cardiovascular events. The cardiac-specific enzymes high-sensitive cardiac troponin I (hscTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured before and after ECT in 23 patients. No relevant increase of hscTnI after ECT was found. Mean NT-proBNP levels were higher after ECT and in three patients a new NT-proBNP elevation after ECT was identified. In conclusion, our small study did not find any evidence for myocardial damage due to ECT by measuring hsTnI, but an increase of NT-proBNP, whose clinical relevance could only be speculated, yet.

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