Title |
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery
|
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Published in |
Journal of Cardiothoracic Surgery, December 2017
|
DOI | 10.1186/s13019-017-0681-6 |
Pubmed ID | |
Authors |
Shirjel R. Alam, Colin Stirrat, Nick Spath, Vipin Zamvar, Renzo Pessotto, Marc R. Dweck, Colin Moore, Scott Semple, Ahmed El-Medany, Divya Manoharan, Nicholas L. Mills, Anoop Shah, Saeed Mirsadraee, David E. Newby, Peter A. Henriksen |
Abstract |
Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction. We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO). Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8] /s). Plasma hs-cTnI concentrations rose by ≥50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p < 0.01) but not systemic inflammation, myocardial inflammation or bypass time. Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations >10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 6 | 75% |
Unknown | 2 | 25% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Practitioners (doctors, other healthcare professionals) | 3 | 38% |
Science communicators (journalists, bloggers, editors) | 2 | 25% |
Members of the public | 2 | 25% |
Scientists | 1 | 13% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 72 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 9 | 13% |
Student > Bachelor | 9 | 13% |
Researcher | 7 | 10% |
Other | 4 | 6% |
Student > Doctoral Student | 3 | 4% |
Other | 6 | 8% |
Unknown | 34 | 47% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 31 | 43% |
Biochemistry, Genetics and Molecular Biology | 3 | 4% |
Nursing and Health Professions | 3 | 4% |
Economics, Econometrics and Finance | 1 | 1% |
Sports and Recreations | 1 | 1% |
Other | 1 | 1% |
Unknown | 32 | 44% |