Objective To investigate the perioperative change and the predictive value of myoglobin, creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) in non-coronary cardiac surgery. Methods The clinical data of 77 patients undergoing cardiac surgery for non-coronary lesions in the Shanghai Xinhua Hospital from March 2016 to November 2016 were retrospectively reviewed, including 37 males and 40 females with a median age of 2 years. There were simple congenital heart diseases in 45 patients, complicated congenital heart diseases in 10, and heart valve diseases in 22. The levels of myoglobin, CK-MB and cTnI were collected at the first postoperative day. The ventilation duration and the length of ICU stay were recorded. The recovery condition was accessed by senior surgeons. Results The myoglobin, CK-MB and cTnI concentrations increased at the first postoperative day, and cTnI increased most significantly. The multivariate linear regression analysis indicated that these changes were only related to cardiopulmonary bypass time and aortic cross-clamping time (P<0.001). The high cTnI level was associated with prolonged ventilation duration and length of ICU stay. Fourteen patients (18.2%) did not recovered well, and their cTnI level was significantly higher than that of well-recovered patients (16.8±16.7 ng/mlvs. 5.1±4.4 ng/ml,P<0.001). The cTnI cutoff value of 5.33 ng/ml could predict whether patients had good postoperative recovery (area under the receiver operating characteristic curve=0.862,P<0.001), and the predictive value of cTnI was superior to that of myoglobin and CK-MB. Conclusion The increase levels of myoglobin, CK-MB and cTnI post non-coronary cardiac surgery are associated with prolonged cardiopulmonary bypass time and aortic cross-clamping time. cTnI on postoperative 24 h may predict good recovery, and it is a useful biomarker.
ObjectiveTo investigate diagnostic and prognostic value of pulmonary embolism severity index (PESI), troponin I (cTnI) and brain natriuretic peptide (BNP) in patients with acute pulmonary embolism (APE). MethodsA total of 96 patients confirmed with APE were collected from January 2010 to January 2013, and 50 cases of non-APE controls were also selected in the same period. According to the PESI scores, patients were divided into low-risk, mid-risk, and highrisk group. According to the results of cTnI and BNP, patients were divided into positive group and negative group. Then, we evaluated the diagnostic and prognostic value of the PESI score, cTnI and BNP for patients with APE. ResultsFor the APE patients, the higher the risk was, the higher the constituent ratio of massive and sub-massive APE was (P<0.01). In the cTnI positive group, massive and sub-massive APE accounted for 82.9%, and in the cTnI negative group, non-massive APE was up to 81.9%; in the BNP positive group, massive and sub-massive APE accounted for 73.3%, and in the BNP negative group, non-massive APE was up to 86.3%. The patients with positive cTnI and BNP had a higher rate of right ventricular dysfunction, cardiogenic shock and mortality than the negative group (P<0.01). ConclusionThe combined detection of cTnI, BNP and PESI score is important in the diagnosis and risk stratification in APE patients.
Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.
目的 探讨血浆脑钠肽（BNP）及血清肌钙蛋白I（cTNI）含量改变在老年患者发生充血性心力衰竭时的临床意义。 方法 选择2010年7月－2012年8月住院的各种老年心脏病患者117例，根据纽约心功能分级分为4组（心功能Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组），分别检测血浆BNP、血清cTNI及心肌酶[肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK-MB）]进行组间比较，同时与健康老年组进行对比。 结果 ① 老年慢性充血性心力衰竭各组（心功能Ⅱ～Ⅳ级）血浆BNP水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组BNP水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，但心功能Ⅰ级组与健康对照组血浆BNP水平无明显差异。② 各组之间CK及CK-MB水平差异均无统计学意义。③ 充血性心力衰竭各组（心功能Ⅱ～Ⅳ级组血清cTNI水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组cTNI水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，而心功能Ⅰ级组及健康对照组血清cTNI水平差异无统计学意义。 结论 血浆BNP水平及血清cTNI水平在老年患者发生心力衰竭时随心力衰竭程度加重而逐渐升高，两者均对慢性充血性心力衰竭的临床诊断具有重要参考意义。
Objective To evaluate the influences of myocardial injury markers on the short-term and long-term mortality after coronary artery bypass grafting (CABG), so as to provide valuable references for clinical prognosis assessment. Methods Literature was electronically searched in CBM, PubMed, OVID, EMbase and CNKI from the date of their establishment to August 2011, meanwhile the manual searches were also performed to systemize the papers. According to the Cochrane Handbook for systematic reviews, the studies were screened by two reviewers independently, the quality of the included studies was evaluated, the data were extracted, and meta-analysis was conducted using RevMan5.0 software. Results A total of 10 observational studies including creatine kinase-myocardial band (CK-MB) and cardiac troponin I (cTnI), and the patients involved were 10 793 totally. Results of meta-analysis showed that the increasing release of CK-MB was associated with an increasing short-term mortality risk of both on-pump (RR=2.88, 95%CI 1.94 to 4.28, Plt;0.000 01) and off-pump group (RR=3.64, 95%CI 1.07 to 12.42), P=0.04). Also the increasing release of CK-MB was associated with an increasing long-term mortality risk of both on-pump (RR=2.55, 95%CI 1.91 to 3.40, Plt;0.000 01) and off-pump group (RR=3.36, 95%CI1.46 to 7.72, P=0.004). The increasing release of cTnI was also associated with an increasing risk of both short-term mortality (RR=6.45, 95%CI 2.50 to 16.66, Plt;0.1) and long-term mortality (RR=4.18, 95%CI 2.78 to 6.28, Plt;0.1). Conclusion The evidence shows that the increasing release of both CK-MB and cTnI is associated with an increasing risk of the short-term and long-term mortality.
Objective To analyze the electrocardiogram (ECG) and troponin (cTnI) in patients with acute coronary syndrome (ACS), so as to assess their value in diagnosing the extent of vascular lesions. Methods The results of ECG, cTnI and coronary angiography (CAG) were analyzed in 37 patients with ACS. Chi-square test and a logistic regression model were used for statistical analysis. Results In patients with positive ECG or cTnI, the results of Chi-square test showed that the incidences of coronary occlusion (P=0.016, 0.003, respectively) and coronary stenosis (P=0.121, 0.013, respectively) were significantly higher than for those with negative ECG or cTnI. The results of logistic regression analysis indicated that only cTnI was significantly correlated with coronary occlusion (P=0.013) and moderate to severe coronary stenosis (P=0.021). ECG has significant consistency with cTnI (Kappa=0.617, Plt;0.001). Conclusion Both ECG and the qual itative cTnI test can reflect the extent of vascular lesions in patients with ACS.
Objective To investigate whether single cycle ischemic preconditioning （IP） improves the myocardial preservation in patients undergoing cardiac valve replacement. Methods From August 2002 to April 2006, 85 patients who had chronic heart valve disease and required cardiac valve replacement were randomly divided into two groups. IP group, 47 allocated to receive IP and arrested with 4 C St. Thomas＇ Hospital cardioplegic solution during cardiopulmonary bypass（CPB）, preconditioning was accomplished by using single cycle of 2 minutes occlusion of aorta followed by 3 minutes of reperfusion before cross-clamping. Control group, 38 allocated to receive 4 C St. Thomas＇ Hospital cardioplegic solution alone. Myocardial protective effects were assessed by determinations of creatinine kinase-MB isoenzyme （CK-MB） and cardiac troponin I（cTnI）, ST-T changes, ventricular arrhythmias and other clinical data in ICU. Results Serum CK-MB and cTnI concentrations were increased postoperatively in two groups. At 24, 48 and 72h after operation, values of CK-MB in IP group was significantly lower than that in control group （P〈0.05）, cTnI at 24 and 48h after operation also less in IP group （P〈0.05）. The duration for patients needed for antiarrhythmic drugs in IP group was lower than that in control group （P〈0.05）. Compared with control group, fewer inotropic drugs were used in IP group. As a result, ICU stay time in IP group was shorter than that in control group （P〈0.05）. Conclusion IP enhances the myocardial protective effect when it was used with hypothermic hyper kalemic cardioplegic solution in patients undergoing cardiac valve replacement, IP significantly reduces the postoperative increase of CK-MB, cTnI and plessens the severity of postoperative ventricular arrhythmias.
Objective To investigate the effect of polyethylene glycolbovine hemoglobin (PEG-bHb), which was used as an oxygen carrier in cardioplegic solution, on the protection of isolated rat hearts. Methods The hearts of 32 male SD rats were harvested and transferred to Langendorff circuit. They were divided into 4 groups according to cardiocplegia: St.Thomas group (group A), 1∶2 PEG-bHb group (group B), 1∶4 PEG-bHb group (group C) and 1∶8 PEG-bHb group (group D). After 20min balance period, hearts were perfused with cold (4℃) cardioplegic solutions, and preserved at 30℃ for 60min, then reperfused. Levels of cardiac troponin I (cTn I) and adenosine triphosphate(ATP) contant in coronary effuent were detected, and ultrastructures of myocardium were observed. Results After reperfusion, cTn I contant of group A were higher (F=52.955,Plt;0.05) and ATP contant were lower (F=68.757,Plt;0.05) than those in group B, group C and group D. Myocardial water contant were lower in group B and group C(F=3.048,Plt;0.05). Conclusion PEG-bHb in cardioplegic solutions can provide better myocardial protection during ischemia.