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

@article{citeulike:577747, abstract = {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.}, address = {Division of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany.}, author = {Hake, U. and Schmid, F. X. and Iversen, S. and Dahm, M. and Mayer, E. and Hafner, G. and Oelert, H.}, citeulike-article-id = {577747}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/8129955}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=8129955}, issn = {1010-7940}, journal = {Eur J Cardiothorac Surg}, keywords = {cardiacsurgery, perioperativeinfarction, troponin}, number = {12}, pages = {628--633}, posted-at = {2006-04-06 03:16:38}, priority = {3}, title = {Troponin T--a reliable marker of perioperative myocardial infarction?}, url = {http://view.ncbi.nlm.nih.gov/pubmed/8129955}, volume = {7}, year = {1993} }

TY - JOUR ID - citeulike:577747 L3 - citeulike-article-id:577747 N2 - 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. IS - 12 JF - Eur J Cardiothorac Surg SN - 1010-7940 AD - Division of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany. EP - 633 TI - Troponin T--a reliable marker of perioperative myocardial infarction? VL - 7 SP - 628 KW - cardiacsurgery KW - perioperativeinfarction KW - troponin AU - Hake, U AU - Schmid, FX AU - Iversen, S AU - Dahm, M AU - Mayer, E AU - Hafner, G AU - Oelert, H PY - 1993/// UR - http://view.ncbi.nlm.nih.gov/pubmed/8129955 ER -