TROPONIN-T - A RELIABLE MARKER OF PERIOPERATIVE MYOCARDIAL-INFARCTION

被引：38

作者：

HAKE, U

SCHMID, FX

IVERSEN, S

DAHM, M

MAYER, E

HAFNER, G

OELERT, H

机构：

[1] Division of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University

[2] Institute of Clinical Chemistry, Johannes Gutenberg Universit

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1993年 / 7卷 / 12期

关键词：

PERIOPERATIVE MYOCARDIAL INFARCTION; TROPONIN-T; CK-MB ACTIVITY; CORONARY ARTERY SURGERY;

D O I：

10.1016/1010-7940(93)90256-B

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 mug/l (quartile 0.13-0.50 mug/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/I (quartile 12.0-21.0 U/1) to 7.0 U/l (quartile 6.0-9.0 U/1). 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 mug/l (quartile 6.34-12.50 mug/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 mug/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 mug/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 mug/l. A singular value of troponin after 6 h or 24 h may be sufficient evidence to confirm the diagnosis of a PMI.

引用

页码：628 / 633

页数：6

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