Recognition and quantification of myocardial injury by means of plasma enzyme and isoenzyme activities after cardiac surgery.

Serial plasma enzyme determinations were carried out in 32 patients who underwent cardiac surgery with the aid of extracorporeal circulation. Plasma creatine kinase (CK), the cardiospecific isoenzyme of CK (CKMB), and alpha-hydroxybutyrate dehydrogenase (HBDH) were determined from the onset of surgery up to 100 to 120 hours after operation. From the plasma enzyme activities, the total amount of enzyme released by the injured heart into the circulation could be calculated using mathematical equations solved numerically by means of a computer. The calculated amount of CK, CKMB, and HBDH released by the heart correlated well with (1) postoperative mortality, and (2) peak activities of the respective enzymes. The calculated amount of any of the 3 enzymes released showed poor or no correlation with (1) electrocardiographic criteria of myocardial infarction, (2) duration of cardiopulmonary bypass, and (3) duration of total aortic cross-clamping. This study shows that the extent of myocardial injury after surgery can be assessed quantitatively using the calculated amounts of enzyme released, as well as using peak plasma activities of CKMB and HBDH.     

Recognition of myocardial infarction after cardiac surgery and its relation to cardiopulmonary bypass

The incidence of operatively related acute myocardial infarction in patients undergoing coronary artery bypass surgery and open-heart surgery was determined and compared. Elevation of at least two enzymes, SGOT > 200, LDH > 400, and CPK > 800, was noted in patients with myocardial infarction (P < 0.05). The overall incidence of infarction was 17 per cent, and there was no significant difference in frequency of infarction in the two groups. Inferior myocardial infarction was the most common locus of damage. All patients developing myocardial infarction in the coronary bypass surgery group had evidence of generalized coronary artery disease. Infarction most frequently developed in patients requiring multiple vessel bypasses. Lesions of the left main coronary artery seem to be critical. The cardiopulmonary bypass pump time was 33 per cent longer in patients sustaining myocardial infarction, a statistically significant difference (P < 0.02). Age, sex, arrhythmias, congestive heart failure, serum cholesterol, or uric acid levels appeared not to be related to the development of postsurgical myocardial infarction in these cases. These data indicate that myocardial infarction is common both after coronary bypass surgery and open-heart surgery, and that the incidence rises with the more difficult and longer operations.     

急性心肌梗死患者非手术相关性急性肾损伤

目的:探讨急性心肌梗死(AMI)非手术相关性急性肾损伤(AKI)的危险因素。方法:回顾性分析2008-12-01~2012-12-31在苏州大学附属第三医院诊断AMI后未行手术治疗发生AKI的患者及对照组人群资料共计656例,根据KDIGO指南推荐的标准定义AKI。结果:AMI后非手术(包括冠脉造影术、冠脉搭桥术)治疗后发生的AKI共计228例(34.8%),其病死率显著高于对照组(P0.001)。多因素Logistic回归分析结果 :基线e GFR下降(OR=2.049,95%CI 1.246~3.370)、空腹血糖(FBG)升高(OR=1.070,95%CI 1.018~1.124)、利尿剂(OR=1.867,95%CI 1.220~2.856)和心肌梗死KillipⅣ级(OR=1.362,95%CI 1.059~3.170)是AKI患病的独立危险因素(P0.05),入院时舒张压(DBP)增高(OR=0.986,95%CI 0.974~0.998)是AKI患病的保护性因素(P0.05)。结论:住院AMI非手术治疗患者发生AKI的患病率、病死率较高。基础肾功能减退、空腹血糖增加、心功能下降及利尿剂为该人群患病的独立危险因素,基础舒张压水平升高为保护性因素。     

Plasma troponin levels after cardiac surgery vs after myocardial infarction

Raised plasma troponin, a diagnostic marker for myocardial infarction, usually occurs after cardiac surgery, leading to difficulties in diagnosing postoperative myocardial infarction. To ascertain whether the same processes influence troponin elevation in both conditions, a literature search was performed for plasma troponin elimination curves after myocardial infarction, myocardial infarction with reperfusion, and cardiac surgery. From 70 studies, 11 curves using the Stratus immunoassay kit were analyzed: 5 post-cardiac surgery (412 patients), 2 after myocardial infarction with reperfusion (169 patients), and 4 after myocardial infarction (640 patients). For each group, a new plot was formulated from the mean troponin level at each time interval. While the up-slope of the cardiac surgery curve was much steeper than that of myocardial infarction, resembling that of myocardial infarction with reperfusion, its down-slope was significantly more gentle than that of both other groups (-0.91 vs -5.31, t = 3.47, df = 8, p < 0.01). This suggests that postoperative troponin elevation involves enhanced cell permeability as seen after ischemia reperfusion rather than permanent cellular damage. The gentler down-slope may point to surgery-induced impaired troponin removal from the circulation. Due to the different mechanisms proposed, implications from post-myocardial infarction troponin levels may not be conferred on post-cardiac surgery patients.     

Iatrogenic cardiac herniation and torsion after surgery for a penetrating cardiac injury

Cardiac herniation and torsion is a rare condition associated with a high mortality rate. We present an unusual case of sudden cardiogenic shock that was caused by torsion and herniation of the heart after an operation for a penetrating cardiac injury. The patient was successfully treated by urgent surgical intervention.     

党参对心肌缺血/再灌注损伤家兔血流动力学和心肌酶的影响

目的探讨党参对家兔心肌缺血/再灌注(I/R)损伤的保护作用及其机制。方法家兔30只,随机分为3组(n=10):对照组、缺血再灌注损伤(MIRI)组、党参组,统一标准喂养,行药物预处理10 min,手术结扎家兔冠状动脉左心室支,建立急性心肌缺血再灌注模型,观察急性心肌缺血和再灌注状态下血流动力学及心肌组织中酶的变化。结果与对照组比较:MIRI组心脏舒缩功能减退,丙二醛(MDA)含量增高,超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)和细胞能源Na+,K+-ATP及Ca2+-ATP酶活性降低,乳酸脱氢酶(LDH)、肌酸激酶(CK)大量释放。而与MIRI组比较:党参组能不同程度的恢复左心室收缩压(LVSP)、心室内压最大变化速率(±dp/dtmax)(Р<0.01),降低左室舒张末期压(LVEDP)(Р<0.01),抑制MDA、LDH、CK升高,增强SOD、GSH-Px、Na+,K+-ATP及Ca2+-ATP活力。结论党参对心肌MIRI具有明显的保护作用。     

Quantitation of infarct size in man by means of plasma enzyme levels.

A method is described in which the extent of myocardial infarction in man is assessed by mathematical analysis of the rise in plasma enzyme levels after infarction. Five enzymes are used in this study: lactate dehydrogenase (LDH); alpha-hydroxybutyrate dehydrogenase (alpha-HBDH); aspartate aminotransferase (GOT); creatine phosphokinase (CPK); and phosphohexoseisomerase (PHI). It is shown that a reasonable assessment of the total enzyme release, reflecting the extent of the infarcted area, can be made when a sufficient number of blood samples are taken after infarction. This could provide a method by which to judge therapeutic effects of intervention in the course of a myocardial infarction, as demonstrated in this study by the assessment of the effect of urokinase on the enzyme release after an infarct.     

Quantitation of infarct size in man by means of plasma enzyme levels.

A method is described in which the extent of myocardial infarction in man is assessed by mathematical analysis of the rise in plasma enzyme levels after infarction. Five enzymes are used in this study: lactate dehydrogenase (LDH); alpha-hydroxybutyrate dehydrogenase (alpha-HBDH); aspartate aminotransferase (GOT); creatine phosphokinase (CPK); and phosphohexoseisomerase (PHI). It is shown that a reasonable assessment of the total enzyme release, reflecting the extent of the infarcted area, can be made when a sufficient number of blood samples are taken after infarction. This could provide a method by which to judge therapeutic effects of intervention in the course of a myocardial infarction, as demonstrated in this study by the assessment of the effect of urokinase on the enzyme release after an infarct.     

Changes of myocardial enzyme activities in atrial fibrillation.

Cholinesterase and succinyldehydrogenase activity of surgically removed left atrial auricles from patients in atrial fibrillation and in sinus rhythm have been compared, using histochemical methods. Higher cholinesterase and lower succinyldehydrogenase activity has been found in atrial fibrillation than in sinus rhythm. The pulmonary capillary mean pressure of patients with atrial fibrillation and sinus rhythm have been also compared. There was no significant difference between the two groups. On the basis of the reported examinations, it is not possible to decide whether the changes in enzyme activities are the cause or the result of atrial fibrillation.     

Myocardial enzyme activities in plasma after whole-heart irradiation in rats

Plasma levels of myocardial enzymes present after local heart irradiation were studied in a rat model. The purpose was to investigate whether, within days after irradiation, these enzyme levels change to such an extent that they may be helpful in assessing the severity of cardiac damage after radiotherapy. Therefore, activities of creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and α-hydroxybutyrate dehydrogenase (α-HBDH) were determined in the plasma and left ventricular myocardium of rats following local heart irradiation with a single dose of 20 Gy. A dose of 20 Gy is known to cause irreversible cardiac damage and to reduce survival times of the animals. Cardiac enzyme assays were performed directly after and twice daily for up to 2 weeks after radiation. Plasma CK, LDH, AST and α-HBDH levels were increased between 2 h and 24 h after irradiation. Plasma ALT levels remained unchanged. Myocardial enzyme levels, measured between 24 h and 16 days after radiation, did not differ between irradiated and control animals, although acute (first 12 h) reductions were observed in the irradiated group. The elevated enzyme levels in plasma appeared to correlate with the acutely reduced myocardial enzyme levels. Although irradiation with a dose of 20 Gy induced acute rises of cardiac enzyme levels in plasma, it is doubtful that fractionated radiation, as applied clinically for treatment of solid tumors, will induce plasma enzyme elevations that are large enough to indicate the extent of cardiac damage occurring acutely or chronically. Received: 15 March 1999 / Accepted: 12 July 1999     

心肌肌钙蛋白T和心肌酶谱变化与心肌损伤的关系及临床意义

目的 :探讨血清心肌肌钙蛋白 T（c Tn T）和心肌酶谱在心肌损伤前后含量的变化与其临床意义。方法 :动态观察 2 0例二尖瓣瓣膜置换术 （MVR）患者手术前、手术后 2 h及 2 4h血清 c Tn T和心肌酶谱变化。另制备家兔心肌损伤模型 ,检测动物模型伤前和伤后 4,8,2 4h血清 c Tn T的变化特点。结果 :二尖瓣瓣膜置换术患者血清 c Tn T含量、心肌酶谱活性在术后 2 ,2 4h较术前显著升高 （P<0 .0 1） ,其中血清 c Tn T含量术后 2 h增加倍数高于其他指标。家兔心肌损伤模型伤后 4,8,2 4h血清 c Tn T含量较伤前升高非常显著 （P<0 .0 1）。结果 ;血清 c Tn T含量及心肌酶谱活性均对心肌损伤的诊断有意义 ,c Tn T的心肌特异性及早期灵敏度更高     

Intra-aortic balloon assistance in cardiogenic shock after myocardial infarction or cardiac surgery.

Sixty-eight patients were referred for consideration of intra-aortic balloon assistance, 55 of whom were accepted. Thirty-one patients were in cardiogenic shock after myocardial infarction and the remaining 24 were cardiac surgical patients. Twenty-three of the myocardial infarct group were established on IABA and all 24 of the cardiac surgical patients. Of the 23 patients with cardiogenic shock after myocardial infarction, 19 showed initial haemodynamic improvement on intra-aortic balloon assistance and 5 (22%) survived to leave hospital. Of the 24 cardiac surgical patients, 15 could not be withdrawn from total cardiopulmonary bypass. With intra-aortic balloon assistance, 11 (73%) could be withdrawn from cardiopulmonary bypass and 5 (33%) were hospital and long-term survivors. The remaining 9 surgical patients were in cardiogenic shock in the early postoperative phase, though 5 showed initial haemodynamic improvement there was only one hospital survivor in this group. Intra-aortic balloon assistance was, therefore, of most value in patients dependent on cardiopulmonary bypass. The survival in patients with cardiogenic shock after myocardial infarction was marginally improved.     

心脏及大血管外科术后并发急性肺损伤的多因素分析

目的 探讨心脏及大血管手术后急性肺损伤(ALI)的发生及其相关危险因素.方法 回顾性分析2017年1月至2020年12月我院心胸外科行心脏或大血管手术的患者,整理其临床资料,统计ALI的发病及其相关高危因素.结果 1440例心脏及大血管手术患者,心脏外科手术1239例,大血管手术201例,并发ALI175例(12.15...     

Altered therapeutic range for quinidine after myocardial infarction and cardiac surgery

Although most assays for measuring drug levels in serum determine the total concentration, effects from a drug are determined better by measuring the concentration of unbound (free) drug in serum. When the free fraction of a drug is constant, the total drug concentration may act as a good guide in predicting drug activity. However, if the free fraction is altered from normal, the serum concentration of the total drug may be misinterpreted. Quinidine has a high binding affinity for alpha-1-acid glycoprotein. We present the case of a woman who had a myocardial infarction; after cardiac surgery, she was found to have high concentrations of alpha-1-acid glycoprotein (228 mg/dL) and a low free fraction of quinidine (0.032). At that time the patient had a total concentration of quinidine of 33.9 mumol/L (11 micrograms/mL) but showed no signs or symptoms of toxicity because the concentration of free quinidine was not high. Physicians should be aware of the limitations of assays in determining the unbound concentration of drugs in serum. This awareness is particularly crucial with drugs that bind well to serum proteins, especially when pathologic conditions change the extent of binding.