Abstract
SummaryAimTo 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.MethodsThe 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.ResultsCABG 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.ConclusionAlthough 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.
Highlights
Aim: 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
Creatine kinase-MB isoenzyme (CK-MB) activity, and high-sensitivity cardiac troponin T, creatine kinase-MB isoenzyme mass (CK-MB mass) and cardiac troponin I concentrations were measured in blood samples
Our results showed that CABG surgery with cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) caused slightto-moderate myocardial injury and moderate-to-severe apoptosis in all cases (Table 1)
Summary
This prospective study was carried out in Dumlupinar University Evliya Celebi Research and Education Hospital, Turkey, between April and September 2014. BMI: body mass index; NYHA: New York Heart Association; LVEF: left ventricular ejection fraction; MI: myocardial infarction; ACE: angiotensin converting enzyme; ACC: aortic cross-clamping; CPB: cardiopulmonary bypass; TUNEL: terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling; SD: standard deviation. Blood samples were drawn after atrial cannulation, just before aortic cross-clamping (pre-ischaemic sample), and within 15 minutes of aortic declamping (reperfusion sample). Myocardial biopsy samples from the same site of the right atrial appendage were taken from each patient within 15 minutes of aortic declamping. The comparison of cardiac marker values between pre-ACC (just before aortic cross-clamping) and post-ACC (within 15 minutes of aortic declamping) periods was analysed using the Mann–Whitney U-test. The correlation between apoptotic index (TUNEL), histopathological myocardial injury score, intra-operative data and cardiac marker values in the post-ACC period was analysed using Spearman’s correlation analysis. A p-value < 0.05 was considered statistically significant
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