HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hake, U. Articles by Oelert, H. Search for Related Content PubMed PubMed Citation Articles by Hake, U. Articles by Oelert, H.

European Journal of Cardio-Thoracic Surgery, Vol 7, 628-633, Copyright © 1993 by European Association for Cardio-thoracic Surgery

ARTICLES

Troponin T--a reliable marker of perioperative myocardial infarction?

U Hake, FX Schmid, S Iversen, M Dahm, E Mayer, G Hafner and H Oelert
Division of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany.

Following cardiac surgery, electrocardiography and creatine kinase isoenzyme MB (CK-MB) activities are of limited value in diagnosing a non-transmural infarction. With the recent availability of an assay to detect serial levels of the specific cardiocyte contractile protein troponin T the possibility has been increased of closing a diagnostic gap among cardiosurgical patients. Ninety patients with severe diffuse three-vessel disease undergoing myocardial revascularization were grouped by their postoperative electrocardiographic (ECG) findings (group I--unchanged ECG; group II--new Q-waves representing perioperative myocardial infarction (PMI)). Serial levels of troponin T and the activity of CK-MB were measured 6, 12, 24 and 48 h after aortic unclamping. The course of CK-MB activity was compared to a profile and values derived from patients with unchanged (n = 1312) or new Q-wave ECGS (n = 89). In 72 patients (80.0%) with unchanged postoperative ECG (group I) serial troponin T levels remained constantly low and reached a median peak value of 0.37 microgram/l (quartile 0.13-0.50 microgram/l) after 24 h. Serial CK-MB activities demonstrated the typical non-ischemic course with a monoexponential decline from an initial median peak value of 15.5 U/l (quartile 12.0-21.0 U/l) to 7.0 U/l (quartile 6.0-9.0 U/l). In seven patients (7.8%) with new Q-waves and a pathologic CK-MB profile (group II) troponin T reached median levels of 10.47 micrograms/l (quartile 6.34-12.50 micrograms/l) (P < 0.001 I vs II). Four of five patients with a new right bundle branch block demonstrated low troponin T levels below 1 microgram/l and a normal CK-MB profile. Among six patients with unchanged QRS- configuration and elevated troponin T levels between 0.84 and 4.99 micrograms/l CK-MB activity showed a characteristic PMI pattern in two patients. Troponin T is characterized by a very narrow margin of normal values represented by a maximum third quartile of 0.50 microgram/l. A singular value of troponin after 6 h or 24 h may be sufficient evidence to confirm the diagnosis of a PMI.

This article has been cited by other articles:

				P. Botha, D. V. Nagarajan, P. S. Lewis, and J. Dunning Can cardiac troponins be used to diagnose a perioperative myocardial infarction post cardiac surgery? Interactive CardioVascular and Thoracic Surgery, September 1, 2004; 3(3): 442 - 449. [Abstract] [Full Text] [PDF]

				V. Vijay and J. P. Gold Late Complications of Cardiac Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 521 - 537. [Full Text]

				J. L. Januzzi Jr, K. Lewandrowski, T. E. MacGillivray, J. B. Newell, S. Kathiresan, S. J. Servoss, and E. Lee-Lewandrowski A comparison of cardiac troponin T and creatine kinase-MB for patient evaluation after cardiac surgery J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1518 - 1523. [Abstract] [Full Text] [PDF]

				V. Gulielmos, M. Menschikowski, H.-M. Dill, M. Eller, S. Thiele, S. M. Tugtekin, W. Jaross, and S. Schueler Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting - a prospective randomized comparison of the conventional and three minimally invasive surgical techniques Eur. J. Cardiothorac. Surg., November 1, 2000; 18(5): 594 - 601. [Abstract] [Full Text] [PDF]

				D. M. Yellon and A. Dana The Preconditioning Phenomenon : A Tool for the Scientist or a Clinical Reality? Circ. Res., September 29, 2000; 87(7): 543 - 550. [Abstract] [Full Text] [PDF]

				R. Svedjeholm, L. G. Dahlin, C. Lundberg, Z. Szabo, B. Kagedal, E. Nylander, C. Olin, and H. Rutberg Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery? Eur. J. Cardiothorac. Surg., June 1, 1999; 13(6): 655 - 661. [Abstract] [Full Text] [PDF]

				L. Coudrey The Troponins Arch Intern Med, June 8, 1998; 158(11): 1173 - 1180. [Full Text] [PDF]

				V. Sadony, M. Korber, G. Albes, V. Podtschaske, T. Etgen, T. Trosken, U. Ravens, and M. E. Scheulen Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery Eur. J. Cardiothorac. Surg., January 1, 1998; 13(1): 57 - 65. [Abstract] [Full Text] [PDF]

				D. M Yellon, G. F Baxter, D. Garcia-Dorado, G. Heusch, and M. S Sumeray Ischaemic preconditioning: present position and future directions Cardiovasc Res, January 1, 1998; 37(1): 21 - 33. [Abstract] [Full Text] [PDF]

				D. M. Nguyen, B. M. Gilfix, F. Dennis, D. Blank, D. A. Latter, P. L. Ergina, J. E. Morin, and B. de Varennes Impact of Transfusion of Mediastinal Shed Blood on Serum Levels of Cardiac Enzymes Ann. Thorac. Surg., July 1, 1996; 62(1): 109 - 114. [Abstract] [Full Text]