MB Levels Research Articles

Soluble interleukin-2 receptor and interleukin-8 plasma levels during and after cardiopulmonary bypass: correlations with creatine kinase and creatine kinase MB.

In this study, soluble receptor of interleukin-2, interleukin-8, creatine kinase, and creatine kinase MB isoenzyme levels were determined serially before, during, and after cardiopulmonary bypass in blood samples of 24 patients. Interleukin-2 receptor levels were 683+/-80 U/ml in the preoperative period and 640+/-60 U/ml during hypothermia. Subsequently, these levels increased significantly at the end of the procedure (791+/-70 U/ml, P<0.01), remaining elevated 1 h after (882+/-92 U/ml, P<0.001) and reaching peak values 24 h postoperatively (1,752+/-200 U/ml, P<0.001). Preoperative plasma values of interleukin-8 were 230+/-43 pg/ml. Interleukin-8 concentrations were 185+/-25 pg/ml during hypothermia. The peak interleukin-8 levels were observed at the end of cardiopulmonary bypass (754+/-94 pg/ml, P<0.001) and tended to decrease 1 h after the procedure (643+/-76 pg/ml, P<0.001), declining to preoperative values, 24 h postoperatively (273+/-41 pg/ml). Interleukin-2 receptor levels correlated well with creatine kinase levels during the procedure. Furthermore, creatine kinase MB levels were correlated with interleukin-2 receptor values only at the end and 1 h after completion of cardiopulmonary bypass. We concluded that interleukin-8 and Interleukin-2 receptor levels are elevated after cardiopulmonary bypass and may contribute to myocardial injury as reflected by increased levels of creatine kinase and creatine kinase MB and correlations between interleukin-2 receptor and both creatine kinase and creatine kinase MB levels.

Cardiac biochemical markers after cardioversion of atrial fibrillation or atrial flutter

Background Cardioversion or defibrillation of cardiac arrhythmias is often necessary in acutely ill cardiac patients. The electrical current may cause elevation of biochemical markers used to diagnose acute myocardial infarction. Therefore it is important to find cardiac markers with high specificity for myocardial necrosis. The purpose of this study was to assess the effects of elective cardioversion of atrial fibrillation or flutter on troponin T and I among conventional markers in patients with no evidence of acute ischemia. Methods and Results Fifty-seven consecutive patients underwent 1 to 4 direct current shocks (mean cumulative energy 407 J, range 100 to 920 J) under general anesthesia. At baseline, all had normal troponin levels; 50 patients (mean age 68 years, range 33 to 84 years) had normal cardiac enzymes and were included in the final analysis. Blood samples were drawn at baseline, and 1 to 2, 6 to 8, and 20 to 24 hours after cardioversion. The troponin levels were unaffected by cardioversion in all patients, whereas creatine kinase and myoglobin increased more than 10-fold. Creatine kinase MB mass and aspartate aminotransferase were above reference limits in 18% and 24% of patients, respectively, 20 to 24 hours after cardioversion. There was a significant association between elevated creatine kinase, myoglobin, and creatine kinase MB levels with cumulated energy delivered as well as when possible confounders such as age and sex were adjusted for. High international normalized ratio with warfarin use was associated with increased levels of creatine kinase, aspartate aminotransferase, lactate dehydrogenase, and myoglobin. Conclusions The increase of conventional biochemical markers after direct current cardioversion is positively associated with cumulative energy delivered and international normalized ratio (INR) values; neither influences levels of the cardiac troponins. (Am Heart J 2000;140:690-6.)

Prodromal unstable angina in acute myocardial infarction: Prognostic value of short- and long-term outcome and predictor of infarct size

Background An estimated 50% of patients with myocardial infarction have prodromal unstable angina. There is controversy over whether prodromal unstable angina identifies a group of patients at lower risk of short- and long-term death and the clinical importance of recording this event. Methods Of 207 patients enrolled at a single Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) site, 196 survived the 24 hours after presentation, achieved peak creatine kinase MB concentrations, and were classified as having either abrupt symptom onset or prodromal unstable angina in the 2 weeks before myocardial infarction. Creatine kinase MB peak was used to categorize infarct size as aborted myocardial infarction, minor myocardial damage, or extensive myocardial injury. Follow-up was performed at 24 hours, 30 days, 1 year, and 5 years. Multiple variables, including prodromal unstable angina, time to treatment, age, sex, previous infarction and infarct location, were analyzed for predicting infarct size. Also, these variables plus peak creatine kinase MB level and a combined variable of prodromal unstable angina and peak creatine kinase MB level were examined for predicting survival. Results Mortality rate was 2.5% within 24 hours, 9.0% at 30 days, 13.5% at 1 year, and 27.1% at 5 years. Patients categorized as either aborted infarction or minor myocardial damage were significantly more likely to have prodromal unstable symptoms (81.3% vs 51.2%, P <.001) and better survival at each follow-up period. Prodromal presentation was the most significant predictor of infarct size category (P =.001). Five-year survival was predicted by age (P <.0001), peak creatine kinase MB level (P =.007), infarct location (P =.009), the combined variables (P =.029), and prodromal unstable angina (P =.017). Prodromal unstable angina had the highest odds ratio for 5-year survival at 3.83 (95% confidence interval 1.27-11.47). Conclusions Prodromal unstable angina is a strong predictor of infarct size and survival. Recognizing prodromal unstable angina is important for clinically assessing prognosis. (Am Heart J 2000;140:126-33.)

Effects of Density on Mixed Mating Systems and Reproduction in Natural Populations ofImpatiens capensis

Understanding the role of plant density in natural populations necessitates evaluation of density effects on both mating system and reproduction. I estimated parameters of the mixed mating system of Impatiens capensis, including plant outcrossing rate (t) and level of biparental inbreeding (mb), along with reproductive components at three densities typically found within three natural populations. As a result of coexisting cleistogamous (CL) and chasmogamous (CH) flowers on individual I. capensis, an estimate of t at each density was obtained by multiplying the percentage of CH seeds and the multilocus estimate of outcrossing rate among CH seeds (tCH). Estimation of mb was based on the relationships between fixation indices of selfed and outcrossed progeny. These estimates led to evaluation of average inbreeding coefficients in seeds (f) and at equilibrium (fe). When plant density decreased from high (>100 plants/m2) to low (ca. 20–30 plants/m2), the estimated tCH increased significantly from 0.44 to 0.62. The estimated mb and tCH were not correlated, but lower mb and higher tCH were significantly associated with higher fruit set and more seeds per CH fruit. I extended Ritland's estimation of inbreeding depression to the case of biparental inbreeding and found that mb affects inbreeding depression positively; the effect of t on inbreeding depression can be negative or positive, depending on the level of mb; magnitudes of both effects rely on the level of f. Plant mixed mating system not only responds to densities but also assists in maintaining population density through its association with reproduction and inbreeding depression.

Beware of bosses bearing beverages

To the Editor We investigated a presumptive food-borne outbreak in Los Angeles County with a surprise ending. On August 27, 1997, an emergency department reported an outbreak of acute illness to the Communicable Disease Control unit in Los Angeles County. The acute illness affected 13 of 16 workers from a night-time construction site. During the night, all 13 workers who had a drink provided by their employer became ill with symptoms that included dizziness, nausea, vomiting, rapid breathing, nervousness, and numbness of the upper body. One worker had fainted; two workers said they had experienced increased strength. Symptoms began 15 minutes to 3 hours after consumption of the drink. No illness occurred in at least two of the three workers who did not consume the drink (risk ratio for drink consumption = indefinite; P < 0.01). Laboratory tests of specimens taken at the emergency department showed that the ill workers had rhabdomyolysis, as verified by a raised creatine kinase concentration with normal MB level, and a urinary screening test result was positive for amphetamines. All the workers recovered without being admitted to the hospital. Immediately before the crew's departure to the construction site, the employer had provided them with thermoses of a drink containing “herbal ingredients” and had advised them “not to drink too much.” A sample of the drink tested negative for amphetamine, but it could not be guaranteed that the sample had not been replaced or tampered with. The symptoms and laboratory test results were consistent with taking amphetamines; the beverage was epidemiologically linked to the illnesses. This is the first reported outbreak of amphetamine poisoning associated with consumption of a contaminated drink. Similar cases may arise, however. Since first quantified in 1995, the number of clandestine methamphetamine laboratories destroyed in California has risen steadily (K Yamada, California Environmental Protection Agency, written communication, April 1999) indicating an increasing use of this drug. Physicians might see other patients presenting with amphetamine overdose, even in unusual settings, and should consider this and other toxic causes in disease outbreaks suspected to be of food-borne or waterborne origin.

Troponin T as a Marker of Infarction during Coronary Bypass Surgery

To evaluate serum troponin T as a marker of perioperative myocardial infarction, 50 patients undergoing coronary artery bypass grafting were divided into 2 groups. Group A (14 patients) had serum creatine kinase MB-isoenzyme levels above 100 U·L−1 and electrocardiographic changes indicative of infarction. Group B (36 patients) had creatine kinase MB levels below 100 U·L−1 and no electrocardiographic changes. Blood samples were obtained preoperatively, 6 hours after aortic declamping, and on postoperative day 1, 2, and 3. Following surgery, all patients had increased levels of troponin T and creatine kinase MB. Troponin T was significantly higher in group A compared to group B at 6 hours, day 1, and day 2 postoperatively. Creatine kinase MB levels were significantly higher in group A compared to group B at 6 hours and day 1 postoperatively. The increased levels of troponin T in patients without myocardial infarction suggest that some operative myocardial damage occurred. Patients with perioperative myocardial infarction had significantly higher levels of troponin T up to postoperative day 2, whereas creatine kinase MB levels were almost normal by day 2. This suggests that troponin T may be used up to 2 days postoperatively for detection of myocardial infarction.

Plasma Levels of Brain Natriuretic Peptides Reflect Left Ventricular Function in Patients under Percutaneus Cardiopulmonary Support

Brain natriuretic peptide (BNP) is a novel cardiac hormone secreted predominantly from the ventricle. The previous studies have shown the effectiveness of plasma BNP levels for the detection of left-ventricular (LV) systolic dysfunction. However, the dynamics of BNP has not been clarified in severe heart failure patients under mechanical circulatory support. The aim of this study was to investigate the usefulness of plasma BNP levels for the evaluation of LV function in patients with cardiogenic shock under percutaneus cardiopulmonary support (PCPS). Six patients underwent PCPS at Osaka Police Hospital in 1999 were included in this study. The diagnosis were AMI (LMT) in 3, unstable angina, LV rupture and DCM in each one. An additional CABG or PTCA was performed under PCPS in 5, a LVAS was subsequently implanted in one. Plasma BNP and creatine kinase (CK)-MB levels were serially measured after the initiation of PCPS and early mortality were evaluated. Three patients were weaned from PCPS (group S) and the others died (group D). There was no significant difference in max BNP and CK-MB levels between the two groups. The BNP level showed a significant positive correlation with CK-MB level in group S. The BNP levels decreased in group S after the initiation of PCPS although didn't decrease in group D. These results thus demonstrated plasma BNP levels might reflect myocardial damage in patients under PCPS, and be a reliable marker for the timing of weaning from mechanical support.

Cigarette smoking status and outcome among patients with acute coronary syndromes without persistent ST-segment elevation: Effect of inhibition of platelet glycoprotein IIb/IIIa with eptifibatide

Background Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypothesis that selective inhibition of the platelet glycoprotein IIb/IIIa receptor with eptifibatide would improve outcomes among cigarette smokers. Methods The study of population included patients enrolled in the PURSUIT trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) with known smoking status presenting with ischemic chest pain ≤24 hours and having either ischemic electrocardiographic changes without persistent ST-segment elevation or elevated creatine kinase MB levels. Patients were randomly assigned to receive a bolus and infusion of either eptifibatide or placebo in addition to standard therapy. The primary end point was a composite of death or nonfatal myocardial infarction within 30 days. Results of the 9406 patients with known smoking status, 2677 were current smokers, 3086 were former smokers, and 3643 were nonsmokers. Cigarette smokers had better 30-day outcomes (12.3%, 16.8%, and 15.4% for smokers, former smokers, and nonsmokers, respectively; P = .001). However, after adjusting for differences in baseline clinical variables, smoking status was not a predictor of 30-day outcome ( P = .45). There was a reduction in the composite end point overall with eptifibatide compared with placebo (14.3% vs 15.7%, P = .054) but no interaction between smoking status and treatment strategy ( P = .68). Conclusions Among patients with ACS without persistent ST-segment elevation, cigarette smokers had better short-term outcomes because of their more favorable clinical profile. Although prior studies have suggested that smokers more commonly have platelet-rich thrombi than nonsmokers, eptifibatide did not result in more improvement in their outcome compared with former smokers or nonsmokers.

Cigarette smoking status and outcome among patients with acute coronary syndromes without persistent ST-segment elevation: Effect of inhibition of platelet glycoprotein IIb/IIIa with eptifibatide

Background Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypothesis that selective inhibition of the platelet glycoprotein IIb/IIIa receptor with eptifibatide would improve outcomes among cigarette smokers. Methods The study of population included patients enrolled in the PURSUIT trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) with known smoking status presenting with ischemic chest pain ≤24 hours and having either ischemic electrocardiographic changes without persistent ST-segment elevation or elevated creatine kinase MB levels. Patients were randomly assigned to receive a bolus and infusion of either eptifibatide or placebo in addition to standard therapy. The primary end point was a composite of death or nonfatal myocardial infarction within 30 days. Results of the 9406 patients with known smoking status, 2677 were current smokers, 3086 were former smokers, and 3643 were nonsmokers. Cigarette smokers had better 30-day outcomes (12.3%, 16.8%, and 15.4% for smokers, former smokers, and nonsmokers, respectively; P = .001). However, after adjusting for differences in baseline clinical variables, smoking status was not a predictor of 30-day outcome ( P = .45). There was a reduction in the composite end point overall with eptifibatide compared with placebo (14.3% vs 15.7%, P = .054) but no interaction between smoking status and treatment strategy ( P = .68). Conclusions Among patients with ACS without persistent ST-segment elevation, cigarette smokers had better short-term outcomes because of their more favorable clinical profile. Although prior studies have suggested that smokers more commonly have platelet-rich thrombi than nonsmokers, eptifibatide did not result in more improvement in their outcome compared with former smokers or nonsmokers.

Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-segment elevation. PURSUIT Steering Committee. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy.

Controversy surrounds the diagnostic and prognostic importance of slightly elevated cardiac markers in patients with acute coronary syndromes without ST-segment elevation. To investigate the relationship between peak creatine kinase (CK)-MB level and outcome and to determine whether a threshold CK-MB level exists below which risk is not increased. Retrospective observational analysis of data from the international Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, conducted from November 1995 to January 1997. A total of 8250 patients with acute coronary syndromes without ST-segment elevation who had at least 1 CK-MB sample collected during their index hospitalization. Mortality at 30 days and 6 months, was assessed by category of index-hospitalization peak CK-MB level (0-1, >1-2, >2-3, >3-5, >5-10, or >10 times the upper limit of normal). Multivariable logistic regression was used to determine the independent prognostic significance of peak CK-MB level after adjustment for baseline predictors of 30-day and 6-month mortality. Mortality at 30 days and 6 months increased from 1.8% and 4.0%, respectively, in patients with normal peak CK-MB levels, to 3.3% and 6.2 % at peak CK-MB levels 1 to 2 times normal, to 5.1% and 7.5% at peak CK-MB levels 3 to 5 times normal, and to 8.3% and 11.0% at peak CK-MB levels greater than 10 times normal. Log-transformed peak CK-MB levels were predictive of adjusted 30-day and 6-month mortality (P<.001 for both). Our data show that elevation of CK-MB level is strongly related to mortality in patients with acute coronary syndromes without ST-segment elevation, and that the increased risk begins with CK-MB levels just above normal. In the appropriate clinical context, even minor CK-MB elevations should be considered indicative of myocardial infarction.

Blood versus crystalloid cardioplegia for myocardial protection of donor hearts during transplantation: A prospective, randomized clinical trial

Objective: To assess the safety and efficacy of myocardial protection of the donor heart during transplantation with the use of blood cardioplegia, a prospective randomized clinical trial was undertaken between January 1997 and March 1998. Methods: Forty-seven consecutive patients were assigned either to crystalloid (27 patients; group 1) or blood cardioplegia (20 patients; group 2). Comparison of recipient age (54 ± 11 years vs 55 ± 7 years; P = .9), sex (89% vs 90% male patients; P = .9), diagnosis (63% vs 65% dilated cardiomyopathy; P = .8), elevated pulmonary vascular resistance (30% vs 30%; P = .9), prior cardiac operations (22% vs 30%; P = .5), need for urgent heart transplantation (7% vs 20%; P = .2), donor age (32 ± 11 years vs 31 ± 13 years; P = .7), cause of death (33% vs 40% vascular; P = .5), and global myocardial ischemia (176 ± 51 minutes vs 180 ± 58 minutes; P = .5) showed no difference. Hemodynamically unstable donors (15% vs 45%; P = .02) were more prevalent in group 2. Results: Operative mortality rates (4% vs 5%; P = .8), high-dose inotropic support (41% vs 30%; P = 0.6), and postoperative mechanical assistance (11% vs 10%; P = 0.9) were comparable in the 2 groups. Prevalence of acute right heart failure (27% vs 0; P = .02) and of temporary complete atrioventricular block (52% vs 20%; P = .02) were greater in group 1. Spontaneous sinus rhythm recovery was more prevalent in group 2 (11% vs 40%; P = .02). Higher peak creatine kinase (1429 ± 725 u/L vs 868 ± 466 u/L; P = .01) and creatine kinase MB (144 ± 90 u/L vs 102 ± 59 u/L; P = .06) levels suggested more severe ischemic injury in group I. Conclusion: Use of blood cardioplegia was associated with a lower prevalence of right heart failure, cardiac rhythm dysfunction, and laboratory evidence of ischemia. (J Thorac Cardiovasc Surg 1999;118:787-95)

Maternal cardiac troponin I levels during normal labor and delivery

Objective: Diagnosis of myocardial infarction in pregnant women on the basis of changes in biochemical markers is complicated by the release of some of these markers from noncardiac tissue sources. We compared troponin I levels with those of other markers in normal pregnant women. Study Design: In 51 healthy women at term in labor, cardiac troponin I, myoglobin, creatine kinase, and creatine kinase MB levels were determined at admission, during the second stage of labor, and within 30 minutes, 12 hours, and 24 hours after delivery. Results: Mean admission levels for all markers were below the upper limit of normal. Mean concentrations of myoglobin, creatine kinase, and creatine kinase MB mass were increased nearly twofold within 30 minutes after delivery. The highest level of troponin I (0.134 ng/mL) at all time points was below the cutoff value (0.15 ng/mL) for discriminating myocardial infarction. Conclusions: Because only troponin I levels remained undetectable during and after delivery, it is potentially the most useful biochemical marker for monitoring pregnant women for myocardial injury. (Am J Obstet Gynecol 1999;180:122-7.)

QT dispersion may be a useful adjunct for detection of myocardial infarction in the chest pain center

Background QT dispersion has been proposed as a noninvasive measurement of the degree of inhomogeneity in myocardial repolarization. Increased QT dispersion has been reported after myocardial infarction. We hypothesized that increased QT dispersion may be a useful adjunct for risk stratification in patients being evaluated in a chest pain center. Methods and Results Patients were admitted to the chest pain center for evaluation of chest pain. Exclusion criteria included (1) systolic blood pressure <90 mm Hg, (2) ischemia or infarction on the initial electrocardiograph (ECG), (3) elevated creatine kinase or MB fraction, and (4) chest pain associated with cocaine use. Serial creatine kinase and MB levels and ECGs were obtained at 0, 6, and 9 hours. Patients were monitored for (1) creatine kinase and MB rise, (2) ECG changes for infarction, (3) ST-segment changes, and (4) rest angina. A negative evaluation at the chest pain center led to an exercise stress test. Patients with a positive exercise stress test were admitted for further evaluation and patients with a negative exercise stress test result were discharged home. Patients were divided into 3 groups. Group 1 consisted of patients who were found to have an acute myocardial infarction (AMI), group 2 consisted of patients with prior history of coronary artery disease but no evidence of AMI, and group 3 consisted of patients without prior coronary artery disease or AMI. QT dispersion was measured on the initial ECG in all patients. A total of 586 patients were evaluated. Group 1 consisted of 13 patients with mean QT dispersion of 44.6 ± 18.5 ms, group 2 consisted of 267 patients with a mean QT dispersion of 10.0 ± 13.8 ms, and group 3 consisted of 303 patients with a mean QT dispersion of 10.5 ± 10.0 ms. Analysis of variance showed a significantly higher QT dispersion in patients who had AMI compared with other patients with chest pain ( P < .001). Conclusions QT dispersion can be a useful diagnostic adjunct for detection of AMI in patients with chest pain with a normal ECG and normal cardiac enzymes. (Am Heart J 1998;136:496-8)

Prognostic significance of hypertension and albuminuria for early mortality after acute myocardial infarction.

To assess the risk of mortality associated with hypertension and microalbuminuria in patients with acute myocardial infarction. A prospective study. Intensive care units in three Italian general hospitals. In total 309 consecutive patients (including 97 women) aged 66.6 +/- 12.5 years, admitted to hospital for acute myocardial infarction. Albumin excretion rate measured by radioimmunoassay of 24 h urine samples, on the first and third days after admission to hospital. In-hospital mortality rate among the patients stratified according to their history of hypertension and albumin excretion rate. Of the patients, 147 had histories of hypertension. Forty-four per cent of the normotensive and 43% of the hypertensive subjects had microalbuminuria on the first day. On the third day the percentages were 25 and 29%, respectively. Twenty-two patients died before discharge from hospital. Patients were divided into four groups according to whether they had microalbuminuria or not and likewise for hypertension. Mortality rate among the subjects with hypertension and microalbuminuria combined was greater than those among the other three groups (P < 0.0001 on the first and third days). The relative hazard ratio was 11.7 on the first day, and 15.6 on the third day. In a multivariate Cox's model hypertension and microalbuminuria combined had a greater predictive power for mortality than either variable alone. Killip class, age, and creatinine kinases MB level were other significant predictors of death. These results show that the combination of hypertension and microalbuminuria is associated with a greater risk of in-hospital mortality among subjects with acute myocardial infarction, independently of degree of heart failure and other possible confounders.

Assessment of left ventricular function using serum cardiac troponin I measurements following myocardial infarction

The prognosis and extent of injury to the myocardium have previously been assessed by increased serum creatine kinase (CK) MB levels. We report findings from 39 consecutive, acute myocardial infarction (AMI) patients presenting 4.5 h (range, 0.7–12.1 h) after the onset of chest pain. We compared CK MB mass (upper reference limit, 5.0 ng/ml) and cardiac troponin I (cTnI; upper reference limit, 0.8 ng/ml) (Stratus II, Dade International) in serial serum specimens obtained over 36 h after chest pain from AMI patients; within 6 h after onset of chest pain. While the appearance of the kinetics of CK MB and cTnI were similar during the initial 24 h following the onset of chest pain, cTnI was increased significantly ( p<0.05) over CK MB after 9 to 12 h. Half-life determinations (mean±S.D.) in 22 of the 39 AMI patients demonstrated a significantly ( p<0.01) shorter half-life in non-Q-wave infarcts [ t 1/2 6.8 h (±5.6)] vs. Q-wave infarcts [ t 1/2 20.4 h (±10.7)]. Further serial time versus marker (mean±S.D.) results were significantly correlated ( p<0.001, r=0.66). Sixteen of twenty patients assessed by echocardiography had an abnormal left ventricular ejection fraction (LVEF); mean 37.6 (S.D. 15.2)%, ranging from 15.4 to 67.6%. LVEF was significantly and inversely correlated to peak CK MB ( r=.50, p=0.03), as well as to peak cTnI ( r=0.46, p=0.04). Based on these findings, cTnI shows excellent promise as a useful marker of infarct size, for the assessment of left ventricular function, and may potentially replace CK MB as the cardiac-specific marker for AMI detection.

Myocardial injury in a 100-km ultramarathon

Impaired cardiac function after strenuous exercise, such as an ultramarathon or triathlon, has been ascribed to “cardiac fatigue.” However, a reduction of cardiac function in strenuous sports in the absence of coronary artery disease might also be based on myocardial injury because of excess catecholamines. We studied the cardiac injury in runners of a 100-km ultramarathon by determination of levels of serum troponin T, which is highly specific for myocardial injury. Blood was collected from 13 healthy adult men before, immediately after, and the next morning after participation in a 100-km ultramarathon. Creatine kinase (CK), isozyme of CK with muscle and brain subunits (MB), and cardiac troponin T levels were determined. Creatine kinase levels were 207 ± 108 IU/L before the marathon, 10,313 ± 10,273 IU/L immediately after, and 10,799 ± 6593 IU/L on the next day. Creatine kinase MB levels at the same time points were 12 ± 14 IU/L, 197 ± 170 IU/L, and 166 ± 108 IU/L, respectively. Cardiac troponin T level was ⩽0.1 ng/mL in all subjects before the marathon and increased significantly to a mean of 0.68 ± 0.73 ng/mL immediately after, exceeding the normal limit in seven subjects. It then returned to normal (0.15 ± 0.07 ng/mL) on the next day, while CK, which referred to skeletal muscle damage, was still elevated at a high level. Because cardiac troponin T levels increased after the ultramarathon, myocardial injury was considered to have occurred.

479 - The relations of radiation induced ultrastructural cardiac damage with serum troponin T and creatin kinase MB levels

479 - The relations of radiation induced ultrastructural cardiac damage with serum troponin T and creatin kinase MB levels

Increased Serum Total Creatine Kinase and Creatine Kinase Isoenzyme MB After Cryosurgical Ablation of the Prostate

Purpose Several reports have documented that the MB isoenzyme of creatine kinase is present in prostatic tissue. However, since it has been shown that lower urinary tract manipulations, including transurethral prostatectomy, do not significantly increase serum creatine kinase isoenzyme MB levels, such elevations, which are found in patients after prostatic surgery, are believed to be specific for myocardial infarction. We examined whether cryosurgical ablation of the prostate altered serum creatine kinase or isoenzyme MB levels. Materials and Methods In 81 consecutive patients undergoing routine cryosurgical ablation of the prostate serum levels of creatine kinase and creatine kinase isoenzyme MB were measured from peripheral blood specimens drawn preoperatively, in the recovery room and at 8 and 24 hours postoperatively. Postoperative electrocardiograms were compared to the preoperative study. Results In 72 of 81 patients (89%) significant elevations in creatine kinase and creatine kinase isoenzyme MB levels were noted at all time points after cryosurgical ablation of the prostate and appeared to reach a peak at 16 hours postoperatively. The mean increases within the first 8 hours after cryosurgical ablation of the prostate were 1,355 units per 1. for creatine kinase and 46.6 ng./ml. for creatine kinase isoenzyme MB. No patient had any significant changes on the postoperative electrocardiogram. All 9 patients (11%) who did not have significant creatine kinase or creatine kinase isoenzyme MB levels after cryosurgery had undergone prior cryosurgery or combined radiation and hormonal therapy. Conclusions Cryosurgical ablation of the prostate appears to produce elevations in serum creatine kinase and creatine kinase isoenzyme MB, which are specific to the procedure. Assays for creatine kinase isoenzyme MB are unreliable to render a diagnosis of myocardial infarction after cryosurgical ablation of the prostate.

Body mass index as a correlate of postoperative complications and resource utilization

To describe the relationship of body mass index (BMI) with postoperative complications and resource utilization. Two thousand nine hundred and sixty-four patients 50 years or older undergoing elective noncardiac surgery with an expected length of stay > or = 2 days were enrolled in a prospective cohort study to measure major cardiac complications, noncardiac complications, length of stay, and costs. The setting was an urban teaching hospital. A preoperative history, physical, electrocardiogram (ECG), and chart review were performed by study personnel. Postoperative complications were detected by ECGs, creatine kinase and creatine kinase MB levels, and daily chart review. Total costs were obtained from the hospital's computerized database. Complication rates were not different among BMI groups (underweight < 20, normal 20 to 29, overweight 30 to 34, most overweight > 34), but patients with BMI 30 to 34 and > 34 who underwent abdominal or gynecologic procedures had significantly higher wound infection rates (11% each) than normal weight patients (4.7%) or the underweight (0%). After adjusting for age, race, gender, smoking history, comorbid diseases, procedure type, and insurance status, there were nonsignificant trends toward increased resource utilization by the most overweight patients (BMI > 34). These patients stayed 0.8 days longer (P = 0.13) and had total costs that were $843 higher (P = 0.17) than patients of normal weight (BMI 20 to 29). The underweight patients stayed 0.9 days longer (P = 0.23) and had total costs that were $3,150 higher (P = 0.04) than patients of normal weight. Quadratic models to test for a U-shaped relationship found no correlation between BMI and length of stay, but did find that BMI was significantly correlated with total costs (P = 0.04). This relationship persisted when patients who had complications were excluded from the analysis. Overall, BMI was not significantly correlated with postoperative complications or length of stay. However, overweight patients who underwent abdominal or gynecologic procedures had higher wound infection rates, and patients with the highest and lowest BMIs had significantly higher adjusted total costs.

What is the best perfusion temperature for coronary revascularization?

Background: A National Institutes of Health–funded clinical trial of patients undergoing coronary artery bypass randomized perfusate and myocardial preservation to cold, tepid, or warm temperatures. The goal of the trial was to evaluate neurologic function before and after operation (4 days and 1 month after operation) and to measure hematologic data for fibrinolytic potential. Methods: The three groups comprised 116 patients who completed neurologic evaluation by means of the Mathew scale out of 130 entered into the trial (37 cold group, 50 tepid, and 43 warm). Twenty-five patients had complete hematologic studies done. All three groups were comparable before operation. The myocardial preservation protocol used blood cardioplegic solution at cold (8º to 10º C), tepid (32º C), or warm (37º C) temperature and the systemic perfusate temperature during cardiopulmonary bypass was 20º (cold), 32º C (tepid), or 37º C (warm). Results: Patients in the cold group had a longer duration of intubation and postoperative hospitalization and a slightly but significantly higher peak postoperative creatine kinase MB level than patients in the warm group. There were no deaths. There was deterioration in Mathew scale findings in all three groups, and no distinction could be made between groups. However, a significantly higher number in the cold group had an abnormal postoperative neurologic examination result that prompted computed tomographic scanning (18.9% cold, 2% tepid, 9.3% warm). A cerebrovascular accident was documented by computed tomographic scanning in 8.1%, 0%, and 4.7% of patients in the cold, tepid, and warm groups, respectively (not significant). Hematologic data documented significantly increased fibrinolytic potential in the warm group. Conclusions: Perfusion temperature is a factor in recovery from cardiopulmonary bypass. Cold has more adverse neurologic sequelae that prompt computed tomographic scanning whereas warm has more activation of fibrinolytic potential. Tepid is the best temperature for optimizing recovery from cardiopulmonary bypass. (J T horac C ardiovasc S urg 1996;112:1622-33)