Creatinine kinase-MB Levels Research Articles

Myocardial Injury After Transcatheter Mitral Valve Replacement Versus Surgical Reoperation

This study aimed to evaluate the incidence and clinical implications of myocardial injury, as determined by cardiac biomarker increase, in patients who underwent mitral bioprosthesis dysfunction treatment with transcatheter mitral valve replacement (TMVR) versus surgical mitral valve replacement reoperation (SMVR-REDO). Between 2014 and 2023, 310 patients with mitral bioprosthesis failure were included (90 and 220 patients for TMVR and SMVR-REDO, respectively). Multivariable analysis and propensity score matching were performed to adjust for the intergroup differences in baseline characteristics. Creatinine kinase-MB (CK-MB) and cardiac troponin I (cTn) were collected at baseline and 6 to 12, 24, 48, and 72 hours after intervention. The cardiac biomarkers values were evaluated in relation to their reference values. The outcomes were determined according to the Mitral Valve Academic Research Consortium criteria. CK-MB and cTn increased above the reference level in almost all patients after SMVR-REDO and TMVR (100% vs 94%, respectively), with the peak occurring within 6 to 12 hours. SMVR-REDO was associated with a two- to threefold higher increase in cardiac biomarkers. After 30 days, the mortality rates were 13.3% in the TMVR and 16.8% in the SMVR-REDO groups. At a median follow-up of 19 months, the mortality rates were 21.1% in the TMVR and 17.7% in the SMVR-REDO groups. Left ventricular ejection fraction, estimated glomerular filtration rate, CK-MB, and cTn were predictors of mortality. In conclusion, some degree of myocardial injury occurred systematically after the treatment of mitral bioprosthetic degeneration, especially after SMVR, and higher CK-MB and cTn levels were associated with increased cumulative late mortality, regardless of the approach.

Perioperative selenium administration in cardiac surgery patients, a way out to reduce post surgical adversities? A meta analysis.

The oxidative damage suffered in cardiac surgery is associated with declining trace elements which lead to the development of multi organ dysfunction (MOD), acute kidney injury (AKI), or increased length of hospital stay (LOS). Recent evidence shows the cardioprotective role of the trace element selenium as it mitigates worsening outcomes post cardiac surgery. Hence, this meta analysis aims to investigate the role of selenium in lowering cardiac surgery related adverse outcomes. Literature search of five electronic databases was performed from the inception of the paper till 29th July, 2023. Eligibility criteria included; (a) randomized clinical trials with Adult patients (≥18 years) undergoing cardiac surgery (b) intervention with selenium pre or/and postoperatively; (c) a control group of a placebo, normal saline, or no selenium. Outcomes of interest include postoperative mortality, LOS in the hospital and Intensive Care Unit (ICU), AKI, troponin I, and Creatinine Kinase-MB (CK-MB). The Cochrane bias assessment tool was used to evaluate the risk of bias. Outcomes were pooled with the Mantel-Haenszel Random-effects model using Review Manager. Seven RCTs with 2,521 patients and 65% of males were included in this paper. No noticable differences were observed between selenium and control groups in terms of postoperative AKI, mortality, LOS in hospital and ICU, troponin I, and CK-MB levels. All studies had a low risk of bias on quality assessment. Our meta analysis demonstrated no discernible effects of selenium infusion on post operative complications among patients undergoing cardiac surgery. Further large scale multi centered studies comparing the protective role of selenium with combined therapy of other bioactive agents are needed to provide convincing explanations. PROSPERO Identifier: 424920.

Anti-inflammatory effect of omega-7 against doxorubicin-induced cardiotoxicity in male rats: An observational study

Background: Doxorubicin is a crucial anticancer medication, however, cardiotoxicity is a severe adverse effect of doxorubicin therapy. Various mechanisms, including inflammation, have been postulated to account for this negative effect. The omega-7 fatty acid is a polyunsaturated fatty acid with anti-inflammatory and antioxidant properties. Therefore, the study's objective was to see whether omega-7 had any possible protective benefits against doxorubicin-induced cardiotoxicity in male rats. Methods: 28 male Wister rats were split into four groups (seven per group). Group 1 (negative control): healthy animals received normal saline orally as the vehicle for eight successive days and were sacrificed on day nine. Group 2 (positive control): animals that received a single dose of doxorubicin hydrochloride (IP 15mg/kg) were sacrificed the next day. Group 3: the animals were administered omega-7 orally at a 100 mg/kg/day dose for eight days. A single injection of doxorubicin IP (15 mg/kg) was given on day nine. The animals were sacrificed on day 10. Group 4: the animal was administered omega-7 orally at a 300 mg/kg/day dose for eight days. A single injection of doxorubicin IP (15 mg/kg) was given on day nine. The animals were sacrificed on day 10. Serum was collected and used to measure lactate dehydrogenase, creatinine kinase-MB, tumor necrosis factor-alpha, interleukin-6, and interleukin-1beta. Results: Lactate dehydrogenase and creatinine kinase-MB levels in group 3 (100mg/kg) were significantly lower than in group 2 (p>0.05) and significantly lower in group 4 (300mg/kg) than in group 2. Tumor necrosis factor-alpha, interleukin-6, and interleukin-1beta levels were considerably lower in the omega-7-treated groups (100 and 300mg/kg) than in the positive control group (p<0.05). Conclusion: Through a mechanism involving the reduction of inflammation, omega-7 may preserve the cardiac tissue against doxorubicin-induced damage.

Analysis of changes in the rat cardiovascular system under the action of lead intoxication and muscular exercise

Introduction. One of the risk factors for cardiovascular diseases is the toxic metal pollution of the industrial area and the environment. Lead is the most critical of toxic metals. In industrial conditions, the body’s exposure to harmful substances is often combined with muscular work of varying severity. It has not been studied enough how these combinations influence the development of pathological processes associated with harmful exposure. Materials and methods. The subchronic experiment was carried out on white outbred male rats for six weeks. Intoxication was simulated by repeated intraperitoneal injections of lead acetate three times a week. Running was chosen to model the muscle exercise at a 25 m/min speed for 10 minutes 5 days a week. We performed biochemical and electrocardiographic studies. Blood pressure parameters were recorded. Muscle contractility was studied on isolated multicellular preparations of the right ventricular myocardium in isometric and physiological contraction modes. The ratio of myosin heavy chains was determined by the polyacrylamide gel electrophoresis. The sliding velocity of reconstituted thin filaments on myosin using an in vitro motility assay. Results. Physical exercise under lead intoxication normalized the level of calcium and the angiotensin-converting enzyme activity in the blood serum, the voltage of the isoelectric line and the amplitude of the T wave on the electrocardiogram. The combined action of lead and physical exercise showed an increase in the creatinine kinase-MB level. We found that the effect of exercise under lead intoxication on myocardial contractility was ambiguous. The maximum isotonic shortening velocity in trabeculae was normalized, but the maximum rate of strength development in the isometric mode in the papillary muscles decreased to a greater extent than under lead intoxication. The maximum sliding velocity of reconstituted thin filaments and myosin and the heavy chain ratio was partly normalized. Conclusion. In general, muscle exercise attenuated the lead cardiotoxic effects.

Valproate attenuates hypertonic glycerol-induced rhabdomyolysis and acute kidney injury

Background and aimThe current study investigated the effects of treatment with 300 mg/kg valproic acid on rhabdomyolysis and acute kidney injury induced by intramuscular injection of hypertonic glycerol in rats. MethodsFour groups of male wistar rats: control and hypertonic glycerol, valproic acid and valproic acid + hypertonic glycerol treated groups were used. Blood urea nitrogen, serum creatinine, creatinine kinase (CK) and CK MB, myoglobin and renal reduced glutathione (GSH) levels were measured. Histopathological examination of the kidneys was carried out to evaluate the degree of renal injury in each group. The expression of interleukin-1 beta “IL-1β” in renal tissue was detected using immunohistochemistry. ResultsHypertonic glycerol administration led to severe renal tubular damage with a significant elevation of blood urea nitrogen, serum creatinine, creatinine kinase, CK MB and myoglobin levels and overexpression of IL-1β compared to control group. Valproic acid administration attenuated both the muscle injury and the acute kidney injury induced by hypertonic glycerol, estimated through a significant reduction of creatinine kinase, myoglobin, and serum creatinine. Valproic acid administration caused a significant increase in GSH in the hypertonic glycerol + valproic acid group compared to the hypertonic glycerol group. A significant decrease in tubular necrosis grade, and expression of IL-1β in hypertonic glycerol + valproic acid group compared to the hypertonic glycerol group was observed. ConclusionThis study demonstrates, for the first time to the best of our knowledge, that valproic acid could ameliorate the rhabdomyolysis and the related acute kidney injury in rats.

Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction

Introduction: Right Ventricular Myocardial Infarction (RVMI) along with inferior wall left ventricular (LV) dysfunction or Inferior Wall Myocardial Infarction (IWMI) is found in 30-50% of the cases. Isolated Right Ventricular (RV) dysfunction or infarction is rare except in iatrogenic (interventional) procedures. RVMI is being more commonly diagnosed retrospectively in the era of primary angioplasty, when these patients post-procedure fail to improve satisfactorily as compared to isolated IWMI patients. Clues to identify early RV involvement in acute IWMI patients will help in better management and less morbidity in this group of patients. Aim: The study was undertaken to search for any correlation between cardiac biomarkers {Troponin I (Trop I), Creatinine Kinase-MB (CK-MB), Brain Natriuretic Peptide (BNP)} and RV involvement using echocardiographic parameters in inferior Acute Myocardial Infarction (AMI), with and without associated RVMI, in patients who underwent primary Percutaneous Coronary Intervention (PCI). Materials and Methods: This was a cross-sectional study, conducted from September, 2018 to August, 2019, in the Cardiology Department of ABVIMS and Dr. Ram Manohar Hospital. A total of 294 patients, presenting with acute IWMI, were included in the study. Samples for Trop-I, CK-MB and BNP were taken immediately after admission. One hundred and thirty two patients had an associated RVMI. Two-dimensional Echocardiography was done within the first 12 hours of admission. Electrocardiography (ECG) and Echocardiography (EEG) assessments were used to determine RV involvement. Comparison was done first between patients with and without RV involvement, followed by comparison among groups for quantitative parameters, especially biomarkers, for finding correlation between biomarker levels and echocardiographic parameters (both RV and LV functions). Results: Patients presenting with IWMI with an associated RVMI had increased LV E/E’ ratio. Also, as predicted, they had a low Tricuspid Annulus Plane Systolic Excursion (TAPSE) and a low RV fractional area change, as well, due to stunning of right ventricle in the acute phase. In the group with higher BNP levels (≥400 pg/mL), the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/E’) was increased; on the other hand LV ejection fraction and TAPSE were decreased. There was negative correlation between RSm (RV systolic wave), TAPSE and BNP levels. BNP, Trop I and CK-MB levels showed a positive correlation with E/E’ at higher levels. Hypotension was more in patients presenting with RVMI, but it did not reach statistical significance. The mortality was 4.5% in the inferior Myocardial Infarction (MI) with RV involvement group versus 1.8% in isolated inferior MI group (during hospital stay). Conclusion: In acute Inferior wall MI, higher levels of BNP, CK-MB, Trop I, alone or in combination, might be used for prediction of RV involvement. BNP levels ≥400 pg/mL, Trop I levels ≥1.1 ng/mL, and CK-MB levels ≥4.5 ng/mL, along with hypotension and higher E/E’ ratio were observed in such cases and were associated with RV dysfunction and increased mortality.

Arrhythmias in patients with acute ST elevation myocardial infarction

Purpose: Arrhythmias and conduction disturbances are common during acute myocardial infarction (AMI) and a major cause of death in the pre-hospital phase. The aim of this study was to investigate common predictors for all arrhythmias in patients with ST elevation AMI (STEMI) during in-hospital phase. Materials and Methods: Ninety patients (74 male, 55 ±11 years) with acute STEMI were included. Clinical charesteristics were recorded and laboratory parameters including serum C- reactive protein (CRP), creatinine kinase MB (CKMB) and potassium levels were measured. The patients were divided into two groups according to development of arrhythmias.Results: Group 1 (n=42) patients had new onset arrhythmias and Group 2 (n=48) patients had without arrhythmias. Median baseline CRP levels were significantly higher in group 1 (36.6 (21.8-77) mg/dl vs. 21.8 (24.2-30.7) mg/dl), especially in patients with atrial fibrillation and ventricular arrhythmias. Logistic regression analysis showed that baseline higher CRP level, peak CKMB level and inferior localization of AMI were significantly associated with the development of arrhythmia following AMI. Conclusion: Levels of CRP and CKMB and inferior infarct localization have predictive values for all the arrhythmic events during AMI. CRP levels were found to be associated with both atrial and ventricular arrhythmias. The assessment of CRP levels can be used to detect patients at high risk for arrhythmic events after STEMI.

A prospective study on cardiac changes (electrocardiographic, enzymatic and echocardiographic) in birth asphyxiated neonates admitted in tertiary care centre

Background: Reduced myocardial performance and cardiac output following perinatal asphyxia may significantly complicate perinatal management and may contribute to increased end-organ damage and mortality. Hence the present study was done with the aim to assess the usefulness of echocardiography, electrocardiography (ECG), and cardiac enzymes in evaluating myocardial damage in perinatal asphyxia neonates and to assess their correlation with different stages of hypoxic-ischemic encephalopathy (HIE) and outcome.Methods: The study was conducted in the NICU, Department of Pediatrics, Government Chengalpattu Medical college hospital between August 2017 and August 2018 using 70 birth asphyxiated term babies. The asphyxiated babies were resuscitated as per NRP guidelines and were stratified into HIE stages as per Levene system of classification and were managed as per clinical condition. ECG grading, echo changes were noted. Creatinine kinase-MB (CKMB) levels were measured and documented after 12 hours of life among these babies and were analysed.Results: Of 70 cases, 36 (51.4%) had mild, 26 (37.1%) moderate and 8 (11.4%) severe HIE. Abnormal ECG was observed in 63 cases. Raised CKMB levels were found in 67 (95.7%) and abnormal echo findings were noted in 46 (65.7%) babies. ECG, echo changes and CKMB levels showed increasing abnormalities with increasing severity of HIE (p=0.000, 0.030 and 0.001 respectively). 8 babies in present study expired.Conclusions: Cardiac abnormalities among asphyxiated neonates requires high index of suspicion. ECG abnormalities, echo changes, elevated CK-MB levels in babies with HIE can help us identify neonates at risk of complications and guide in timely intervention that can prevent mortality of these babies and help us achieve better neurological outcome in these babies.

Diazoxide Attenuates Ischemic Myocardial Injury in a Porcine Model.

We hypothesized that diazoxide, a mitochondrial ATP-sensitive potassium channel opener, has cardioprotective effects during acute myocardial ischemia. Diazoxide is suggested to act through protein kinase Cε (PKCε) activation. Twelve piglets were randomly assigned to receive intravenous infusion of diazoxide (3.5 mg/kg) with solvent or only solvent (6 animals per group) before cardiac ischemia. Myocardial ischemia was induced by occluding the left circumflex artery (LCX) for 40 minutes. The reperfusion and follow-up period lasted for three hours. Throughout the experiment hemodynamic measurements and blood samples were collected, and after the follow-up period the hearts were harvested for transmission electron microscopy (TEM) as well as histopathological and immunohistochemical analyses. TEM showed less ischemic damage on a cellular level in the diazoxide group (P = .004) than in the control group. Creatinine kinase MB levels (Pt*g = .030) were lower, and oxygen consumption (Pt*g = .037) and delivery (Pg = .038) were higher in the diazoxide group compared to the controls. Diazoxide preserves myocardial cellular structure and cellular function, and thus it may have benefits in treating ischemic myocardial injury.

Effects of Acute Carbon Monoxide Poisoning on ECG and Echocardiographic Parameters in Children.

The aim of the current study is to investigate the effects of CO (carbon monoxide) on the cardiovascular system via electrocardiographic, echocardiographic and biochemical findings in children. This prospective study included 22 children with CO poisoning and 24 healthy children as a control group. The CO-intoxicated children were evaluated via electrocardiography and echocardiography 1h after admission to the emergency department and daily until their discharge from the hospital. Blood gasses, complete blood account, troponin I and creatinine kinase-MB(CK-MB) were assessed daily. Tpeak-end (p:0.001), QTc durations (p:0.02), Tpeak-end dispersion (p:0.001) and Tpeak-end/QT ratio (p:0.001) of CO-intoxicated patients were significantly higher than those in the control group. Mitral E duration (p:0.001), mitral E/A ratio (p:0.001) and left ventricle contractile fraction (p:0.023) at admission were significantly lower, and left ventricle myocardial performance index was higher (p:0.001) in the CO poisoning group. Troponin I and CK-MB levels were higher at admission in 6 (27%) and 4 (18%) patients, respectively. The heart is the most critical organ in pediatric CO poisoning. These children present subclinical systolic and diastolic left ventricle dysfunction even in mild cases. Although, in children with acute CO-intoxication ventricular repolarization is impaired, it seems to be reversible like other findings.

Effect of Enalapril on Preventing Anthracycline-Induced Cardiomyopathy

Anthracycline (ANT) is a topoisomerase-interacting agent that is used in most malignancy treatments. We investigated the efficacy of enalapril (angiotensin-converting enzyme inhibitor) in the prevention of ANT-induced cardiomyopathy. In this randomized, single-blind, and placebo-controlled study, 69 patients with a newly diagnosed malignancy for which ANT therapy was planned were randomly assigned to either a group receiving enalapril (n=34) or placebo (n=35). Echocardiography studies were performed before chemotherapy and at 6months after randomization. Additionally, troponin I and creatinine kinase-MB (CK-MB) were measured 1month after the initiation of chemotherapy. In the enalapril group, the mean left ventricular ejection fraction (LVEF) (p=0.58) was the same at baseline and 6months after randomization. Conversely, LVEF significantly decreased in the control group (p<0.001). Additionally, LV end systolic volume and left atrial diameter were significantly increased compared with the baseline measures in the control group. According to the tissue Doppler study, the mitral annuli early diastolic (e') and peak systolic (s') velocities were significantly reduced, and the E (the peak early diastolic velocity)/e' ratio was significantly increased in the control group. Furthermore, the TnI and CK-MB levels were significantly higher in the control group than in the enalapril group. Enalapril appears efficacious in preserving systolic and diastolic function in cancer patients treated with ANTs.

Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation

Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies. One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 ± 3 h and 43 ± 3 h after ablation. At the first postprocedural sample, cTnI and CK-MB levels were found elevated in all 110 patients with a median value of 2.11 ng/mL and 8.95 ng/mL, respectively. Group B showed cTnI levels increased (median 5.96 ng/mL) compared to other groups (median Group A: 1.72 ng/mL, Group C: 1.54 ng/mL, Group D: 2.0 ng/mL; p < 0.001). Also CK-MB levels resulted higher in cryoablation (median 26.4 ng/mL) compared to other groups (median Group A: 6.40 ng/mL, Group C: 7.15 ng/mL, Group D: 6.50 ng/mL; p < 0.001). No significant association was observed between biomarker levels and recurrences of atrial fibrillation after a mean follow-up of 369 ± 196 days. Highest markers for myocardial injury were observed in the cryoballoon group. It is possible that a longer delivery energy duration and other factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown.

The diagnostic role of signal peptide–C1r/C1s, Uegf, and Bmp1–epidermal growth factor domain-containing protein 1 in non–ST-elevation acute coronary syndrome

ObjectiveChest pain and/or electrocardiogram changes in non–ST elevation or suspicious chest pain and cardiac marker elevations are defined as non–ST-elevation acute coronary syndrome (NSTE-ACS). Serial electrocardiogram and marker follow-up are needed to make a diagnosis of NSTE-ACS and to eliminate noncoronary chest pain (NCCP). Signal peptide–C1r/C1s, Uegf, and Bmp1–epidermal growth factor domain-containing protein 1 (SCUBE1) is stored within the α granules of inactive platelets and secreted at a high rate during thrombosis. We believe that SCUBE1 may be a sensitive early diagnostic indicator in distinguishing coronary-induced chest pain from noncoronary-induced chest pain. Materials and methodsThe study included 190 patients with an initial diagnosis of acute coronary syndrome in the emergency department. Based on a definitive diagnosis, these patients were classified into 3 groups: ST-elevation myocardial infarction (STEMI), NSTE-ACS, and NCCP. ResultsPlasma SCUBE1 levels were significantly higher in the STEMI group when compared with those of the other groups (P < .05). They were also significantly higher in the NSTE-ACS group when compared with those of the NCCP group (P < .01). Troponin I, creatinine kinase, and creatinine kinase MB levels were significantly different in the NSTE-ACS group when compared with those of the NCCP group (P < .05). ConclusionHigh rates of SCUBE1 were found both in the STEMI and NSTE-ACS patients. Furthermore, in the study group, SCUBE1 was an adequate marker for distinguishing NSTE-ACS from NCCP.

Minimally Invasive Mitral Valve Surgery: Influence of Aortic Clamping Technique on Early Outcomes

Several methods of aortic clamping have been described for minimally invasive mitral valve surgery (MIMVS). The aim of this study was to compare the endoaortic balloon occlusion technique with the transthoracic clamp approach in terms of perioperative outcomes. Between May 2006 and October 2011, a total of 259 patients underwent MIMVS through a 4 to 5 cm right anterolateral minithoracotomy. In 243 (93.8%) of these, the aorta was clamped using either the endoaortic balloon occlusion technique (endoballoon, n= 140) or the transthoracic clamp technique (transthoracic, n= 103). Patients in the endoballoon group had significantly longer operating time (4.3 ± 1.0 hours vs 3.2± 0.8 hours, p < 0.001), cardiopulmonary bypass time (143± 44 minutes vs 111 ± 29 minutes , p < 0.001), and cross-clamp time (114 ± 38 minutes vs 86 ± 23 minutes , p < 0.001). Perioperative blood loss was higher in the endoballoon group (287 ± 239 mL vs 213 ± 189 mL, p= 0.008) as was the mean postoperative creatinine kinase-MB level (36 ± 44 μg/L vs 26 ± 12 μg/L, p= 0.011). The repair rate was 99% or greater in both groups (p= 0.99). All patients left the operating room with no or trivial residual mitral regurgitation on transesophageal echocardiographic evaluation. In the endoballoon group there was 1 stroke (1%) and 5 myocardial infarctions (4%), compared with 2 strokes (2%) in the transthoracic group (p= not significant). There were 4 cases of postoperative cardiogenic shock, all of which occurred in the endoballoon group (p= 0.14). In-hospital mortality occurred in 2 patients from each group (p=0.99). Minimally invasive mitral valve surgery can be performed successfully using either the endoaortic balloon technique or the transthoracic clamp approach. However, the transthoracic technique results in shorter operation time, less perioperative bleeding and better myocardial protection.

PP-212 ANTERIOR ACUTE MYOCARDIAL INFARCTION DUE TO CORONARY EMBOLISM IN A PATIENT WITH MECHANICAL AORTIC VALVE PROSTHESIS

Introduction: Myocardial infarction secondary to coronary artery embolism in the presence of mechanical aortic valve prosthesis is a rare condition. In this report we aimed to present a case of anterior acute myocardial infarction due to coronary embolism in a 46 year-old-man with mechanical aortic valve prosthesis. Case: A 46-year-old man presented with chest pain for 5 hours. He had undergone aortic valve replacement with St Jude mechanical valve 2 years before. The patient had been using warfarin since the operation. However, it was learnt that he suspended the use of warfarin for 15 days due to emotional stress. Systolic ejection murmur grade 3/6 on the second right parasternal space and a mechanical valve click were the cardiac auscultation findings of the patient. Electrocardiogram showed sinus rhythm and ST elevation in leads DI, aVL, V2-V5 and ST depression in DII, DIII and aVF. Transthorasic echocardiography showed akinesia of anterior and apical segments and ejection fraction was 35%. Maximum 80mmHg, mean 42mmHg gradient was measured on mechanical aortic bileaflet prosthesis. Moderate degree of aortic regurgitation was detected. Dysfunction due to trombus load was considered in aortic valve. The cardiac enzyme levels revealed troponin T level of 2.1 ng/ml and creatinine kinase-MB level of 138U/L. The patient’s INR level was 1.1 and reflecting prothrombotic state. Emergent coronary angiography showed a total occlusion of mid left anterior descending artery. After advancing a 0.014 inch floppy guidewire and passing through the lesion, we tried to aspirate the thrombus by using a thrombus aspiration catheter (Export Medtronic, Minneapolis, Minnesota). After aspiration, thrombus causing partial obstruction in distal was observed. The procedure was ceased. The patient was started intravenous tirofiban. Tirofiban was administered for 30 minutes 0.4m/kg/min intravenous and 0.10mg/kg/min 48 hours infusion. In transesofageal echocardiography in the follow-up valve maximum 30mmHg, mean 14mmHg gradient was taken on the valve. Aortic regurgitation was minimal and no thrombus was found on the valve. The patient was discarded from the hospital with optimal INR value (INR: 3.2). Conclusion: In conclusion, inpatients with prosthesis coronary valve, it should be considered that myocardial infraction due to coronary embolism can develop. The use of glycoprotein IIb/IIIa inhibitors together with catheter aspiration embolectomy to treat these patients can improve results in patients with suspected accompanying prosthetic valve thrombosis.

AS-057 The Assessment of Shin's Method for The Prediction of Creatinine Kinase-MB Elevation after Percutaneous Coronary Intervention: An Intravascular Ultrasound Study

Cardiac enzyme release is common after percutaneous coronary intervention (PCI). At present there is no established relationship between the quantity of necrotic core and dense calcium, as assessed by Shin’s method using intravascular ultrasound virtual histology (VH-IVUS), and post-PCI creatinine kinase-MB (CK-MB) elevation. A total of 112 consecutive patients with unstable angina and a normal pre-PCI CK-MB level were imaged using VH-IVUS. Patients were divided into 2 groups according to the presence (CK-MB group, n = 22) or absence (non CK-MB group, n = 90) of a post-PCI CK-MB elevation >1.0 the upper limit of normal (3.6 ng/ml). Using Shin’s method contours were drawn around the IVUS catheter (instead of the lumen), and the vessel. Mean area and volume of necrotic core and dense calcium were significantly greater in CK-MB group than in non CK-MB group (1.7 ± 0.9 mm2 vs. 0.9 ± 0.6 mm2, P < 0.001; 17.2 ± 8.8 mm3 vs. 8.8 ± 5.8 mm3, P < 0.001, and 0.9 ± 0.6 mm2 vs. 0.4 ± 0.4 mm2, P = 0.001; 9.1 ± 5.8 mm3 vs. 3.9 ± 3.7 mm3, P < 0.001, respectively). Percent necrotic core and dense calcium areas calculated by external elastic membrane (EEM) area were significantly greater in CK-MB group than in non CK-MB group (11.9 ± 5.1 vs. 6.6 ± 4.0%, P < 0.001 and 6.5 ± 4.0 vs. 3.0 ± 2.9%, P < 0.001, respectively). In the multivariate analysis, dense calcium volume and percent necrotic core to EEM at the most diseased segment were the only independent predictors of post-PCI CK-MB elevation (odds ratio: 1.22; 95% confidence interval: 1.09–1.37, P < 0.001 and odds ratio: 1.26; 95% confidence interval: 1.12–1.43, P < 0.001). Lesions with a greater amount of dense calcium volume and percent necrotic core to EEM, which can be easily identified and quantified on VH-IVUS analyzed using Shin’s method, are responsible for post-PCI CK-MB elevation. With a rapid analyzing time, Shin’s method may increase the identification of high risk lesions likely to induce a post-procedural myocardial injury in the catheterization laboratory facilitating on-line clinical decision making.

Effects of delayed recanalization on left ventricular function in diabetic and non-diabetic patients with acute anterior wall myocardial infarction

To investigate the effects of delayed recanalization through percutaneous coronary intervention (PCI) on the left ventricular function after acute anterior wall myocardial infarction in diabetes (DM) and non-DM patients, a total of 125 consecutive subjects with acute anterior wall myocardial infarction were recruited and divided into DM group (n=43) and non-DM group (n=82) based on the presence of DM. All patients received successful PCI at about 2 weeks after symptom onset. Ischemic viable myocardium was detected with low-dose dobutamine stress echocardiogram test, and left ventricular function and wall motion were also assessed before PCI. Clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB (CK-MB) and troponin T (TnT) before PCI, 6 and 24 h after PCI were determined. All patients received clinical and echocardiographic follow-up 6 months after PCI. Higher rate of TIMI flow grade 2 and lower rate of TIMI flow grade 3 were observed immediately after PCI, and the elevation of serum CK-MB and/or TnT levels were higher in DM group when compared with non-DM group (P 0.05). There were no significant differences in the LVEF, LVEDVI, LVESVI or wall motion score (WMS) between two groups before PCI (P>0.05). But, 6 months after PCI, WMS and LVEF were decreased and increased, respectively, in non-DM group, and the WMS and LVEF in DM group were not changed and the LVEDVI increased, when compared with before PCI. The LVEDVI, LVESVI, LVEF, and WMS differed significantly between two groups 6 months after PCI. Compared with non-diabetics, delayed revascularization with PCI in diabetics with acute myocardial infarction has less benefit on the improvement of left ventricular function, and it may be the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contribute to the poor result. Key words: Diabetes, myocardial infarction, left ventricular function, percutaneous coronary intervention, delayed recanalization.

The assessment of Shin’s method for the prediction of creatinine kinase-MB elevation after percutaneous coronary intervention: an intravascular ultrasound study

Cardiac enzyme release is common after percutaneous coronary intervention (PCI). At present there is no established relationship between the quantity of necrotic core and dense calcium, as assessed by Shin's method using intravascular ultrasound virtual histology (VH-IVUS), and post-PCI creatinine kinase-MB (CK-MB) elevation. A total of 112 consecutive patients with unstable angina and a normal pre-PCI CK-MB level were imaged using VH-IVUS. Patients were divided into 2 groups according to the presence (CK-MB group, n=22) or absence (non CK-MB group, n=90) of a post-PCI CK-MB elevation>1.0 the upper limit of normal (3.6ng/ml). Using Shin's method contours were drawn around the IVUS catheter (instead of the lumen), and the vessel. Mean area and volume of necrotic core and dense calcium were significantly greater in CK-MB group than in non CK-MB group (1.7±0.9mm(2) vs. 0.9±0.6mm(2), P<0.001; 17.2±8.8mm(3) vs. 8.8±5.8mm(3), P<0.001, and 0.9±0.6mm(2) vs. 0.4±0.4mm(2), P=0.001; 9.1±5.8mm(3) vs. 3.9±3.7mm(3), P<0.001, respectively). Percent necrotic core and dense calcium areas calculated by external elastic membrane (EEM) area were significantly greater in CK-MB group than in non CK-MB group (11.9±5.1 vs. 6.6±4.0%, P<0.001 and 6.5±4.0 vs. 3.0±2.9%, P<0.001, respectively). In the multivariate analysis, dense calcium volume and percent necrotic core to EEM at the most diseased segment were the only independent predictors of post-PCI CK-MB elevation (odds ratio: 1.22; 95% confidence interval: 1.09-1.37, P<0.001 and odds ratio: 1.26; 95% confidence interval: 1.12-1.43, P<0.001). Lesions with a greater amount of dense calcium volume and percent necrotic core to EEM, which can be easily identified and quantified on VH-IVUS analyzed using Shin's method, are responsible for post-PCI CK-MB elevation. With a rapid analyzing time, Shin's method may increase the identification of high risk lesions likely to induce a post-procedural myocardial injury in the catheterization laboratory facilitating on-line clinical decision making.

Intraoperative detection of left atrial clot using transoesophageal echocardiography in a patient undergoing off-pump coronary artery bypass grafting

Intraoperative detection of left atrial clot using transoesophageal echocardiography in a patient undergoing off-pump coronary artery bypass grafting

Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function

We examined intraoperative microembolic signals (GME), inflammatory response, hemolysis, perioperative regional cerebral oxygen saturation (rSO(2)), myocardial protection and desorbed protein amount on oxygenator fibers in high-risk patients undergoing coronary revascularization (CABG) with minimized and conventional cardiopulmonary bypass (CPB). Over a ten-month period, 40 Euroscore 6+ patients undergoing CABG were prospectively randomized to one of the two perfusion protocols (N=20): Group 1: minimized extracorporeal circuits (Mini-CPB) (ROCsafe MPC, Terumo, Ann Arbor, MI, USA) and Group 2: conventional extracorporeal circuits (CECC) (Capiox SX18, Terumo, USA). Serum creatinine kinase-MB (CKMB), free hemoglobin, interleukin-6 (IL-6) and C3a levels were measured. Blood samples were collected at T1: following induction of anesthesia; T2: thromboelastography control; T3:15 min after commencement of CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal and T6: ICU. Serum IL-6 levels were significantly lower in the Mini-CPB group at T4 and T5 and C3a levels were significantly less in the Mini-CPB group at T3, T4 and T5 vs. CECC (p<0.01). CKMB levels in coronary sinus blood demonstrated well preserved myocardium in the Mini-CPB group. Percentage expression of neutrophil CD11b/CD18 levels were significantly lower in the Mini-CPB group at T4 and T5 (p<0.05). There were no significant differences in air handling characteristics or free plasma hemoglobin levels in either circuit. rSO(2) measurements were significantly better at T3 and T4 in the Mini-CPB vs. CECC (p<0.05) and always higher in the Mini-CPB during follow-up. Blood protein adsorption analysis of oxygenator membranes demonstrated a significantly increased amount of microalbumin on CECC fibers (p<0.05). Mini-CPB provided a comfort and safety level similar to conventional control via satisfactory air handling, attenuated inflammatory response and hemodilution, with a better clinical outcome in patients undergoing high-risk CABG.