Abstract:
BACKGROUND:Troponin I (TnI) is increasingly employed as a highly specific marker of acute myocardial ischemia. The value of this marker after cardiac surgery is unclear. HYPOTHESIS:The purpose of this study was to measure serum TnI levels prospectively at 1, 6, and 72 h after elective cardiac operations. In addition, TnI levels were measured from the shed mediastinal blood at 1 and 6 h postoperatively. Serum values were correlated with cross clamp time, type of operation, incidence of perioperative myocardial infarction, as assessed by postoperative electrocardiograms (ECG) and regional wall motion, as documented by intraoperative transesophageal echocardiography (TEE). METHODS:Sixty patients underwent the following types of surgery: coronary artery bypass graft (CABG) (n = 45), valve repair/replacement (n = 10), and combination valve and coronary surgery (n = 5). Myocardial protection consisted of moderate systemic hypothermia (30-32 degrees C), cold blood cardioplegia, and topical cooling for all patients. RESULTS:Of 60 patients, 57 (95%) had elevated TnI levels, consistent with myocardial injury, 1 h postoperatively. This incidence increased to 98% (59/60) at 6 h postoperatively. There was a positive correlation between the length of cross clamp time and initial postoperative serum TnI (r = 0.70). There was no difference in the serum TnI values whether or not surgery was for ischemic heart disease (CABG or CABG + valve versus valve). There were no postoperative myocardial infarctions as assessed by serial ECGs. There was no evidence of diminished regional wall motion by TEE. Levels of TnI in the mediastinal shed blood were greater than assay in 58% (35/60) of the patients at 1 h and in 88% (53/60) at 6 h postoperatively. Patients who received an autotransfusion of mediastinal shed blood (n = 22) had on average a 10-fold postoperative increase in serum TnI levels between 1 and 6 h. Patients who did not receive autotransfusion average less than doubled their TnI levels over the same interval. At 72 h, TnI levels were below the initial postoperative levels but still indicative of myocardial injury. CONCLUSION:Postoperative TnI levels are elevated after all types of cardiac surgery. There is a strong correlation between intraoperative ischemic time and postoperative TnI level. Further elevation of TnI is significantly enhanced by reinfusion of mediastinal shed blood. Despite these postoperative increases in TnI, there was no evidence of myocardial infarction by ECG or TEE. The postoperative TnI value is even less meaningful after autotransfusion of shed mediastinal blood.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Horvath KA,Parker MA,Frederiksen JW,Palmer AS,Fullerton DAdoi
10.1002/clc.4960231009subject
Has Abstractpub_date
2000-10-01 00:00:00pages
731-3issue
10eissn
0160-9289issn
1932-8737journal_volume
23pub_type
杂志文章abstract::More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with C...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.21965
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Apixaban is a non-vitamin K oral anticoagulant approved for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). Current labeling recommends dose reduction based on patient age, weight, and renal function. HYPOTHESIS:The aim of this study was to analyze adherence...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22949
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Although women typically develop coronary artery disease several years after men, once they have symptomatic disease their thromboembolic complications are worse than in men. The mechanism mediating this gender difference in outcome after thromboembolic events is unknown. We previously studied platelet funct...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1002/clc.4960191106
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:The real-world impact of remote pulmonary artery pressure (PAP) monitoring on New York Heart Association (NYHA) class improvement and heart failure (HF) hospitalization rate is presented here from a single center. HYPOTHESIS:METHODS: Seventy-seven previously hospitalized outpatients with NYHA class III HF w...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22643
更新日期:2017-03-01 00:00:00
abstract::Fourteen morbidly obese patients scheduled for gastric bypass surgery were diagnosed preoperatively as suffering from sleep apnea syndrome. There were 13 males and 1 female aged 24 to 59 years. Mean preoperative excessive body weight was 222 +/- 38%; mean apnea index prior to surgery was 84 +/- 44. A whole night lead ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960081005
更新日期:1985-10-01 00:00:00
abstract::Although certain classes of drugs appear to possess benefits apart from their blood-pressure lowering capability, reduction of blood pressure remains the single most important action of antihypertensive therapy. Calcium-channel blockers (CCBs) have long been recognized as potent agents for hypertension therapy. This i...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960261404
更新日期:2003-02-01 00:00:00
abstract::To analyze the paradox of acute myocardial infarction (AMI) with an initially normal electrocardiogram (ECG), we reviewed the records of 732 patients discharged with a final diagnosis of AMI over a 2-year period. Twenty-one patient were identified whose initial ECG was normal and who underwent coronary arteriography d...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960181006
更新日期:1995-10-01 00:00:00
abstract::A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age ...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960110705
更新日期:1988-07-01 00:00:00
abstract:BACKGROUND:It is known that exercise-induced ST-segment elevation in lead V1 (V1-E) detects left anterior descending (LAD) stenosis. It was also postulated that ST elevation in aVR and simultaneous ST depression in V5 (aVR-E + V5-D) is a marker of ischemia due to significant stenosis of the LAD in patients with single-...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960260506
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:We previously reported that an index of afterload-related left ventricular diastolic function, operant diastolic elastance (Ed)/effective arterial elastance (Ea) = E/e'/(0.9 × systolic blood pressure), was significantly higher in elderly hypertensive women. We aimed to determine sex-related differences in th...
journal_title:Clinical cardiology
pub_type: 杂志文章,多中心研究
doi:10.1002/clc.23073
更新日期:2018-12-01 00:00:00
abstract::The purpose of this study was to examine signal-averaged electrocardiographic (SA-ECG) late potentials to predict ventricular arrhythmias during intrinsic cardiac rhythm and during ventricular pacing in children with complete heart block (CHB). Recordings of SA-ECG were obtained from eight patients (aged 3-18 years) w...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960170610
更新日期:1994-06-01 00:00:00
abstract::Atrial fibrillation (AF) is the most common form of tachyarrhythmia and carries a significant risk of serious thromboembolic complications. Anticoagulation is used for long-term thromboprophylaxis and for short-term management in a number of clinical situations, among which is the medical or electrical cardioversion o...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960241306
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:The implantable cardioverter defibrillator (ICD) is the most effective treatment available for terminating potentially life-threatening ventricular tachycardia and ventricular fibrillation and reducing the risk of mortality. Despite its established health benefits, ICD therapy is accompanied by a unique arra...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.20035
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND AND HYPOTHESIS:Noninvasive evaluation of left ventricular (LV) diastolic function was performed on 12 patients with atrial fibrillation (AF) using posterior aortic wall echocardiogram and a parameter for determining the optimal heart rate in patients with chronic atrial fibrillation was considered. METHODS:...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960190316
更新日期:1996-03-01 00:00:00
abstract::Signal-averaged electrocardiograms were obtained in 53 consecutive patients with a first acute myocardial infarction (AMI) who survived the first 10 days of hospitalization. The recording was performed twice, at Day 1 and at Day 10 of hospitalization, in patients without bundle-branch block and who did not receive ant...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960131005
更新日期:1990-10-01 00:00:00
abstract::Until recently, instrumenting the pericardium was possible only when a pericardial effusion is present or by surgical exposure of the pericardium. Techniques are now being developed to instrument the normal pericardium. This development will allow clinicians and investigators to study pericardial fluid in health and i...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960221304
更新日期:1999-01-01 00:00:00
abstract::A community-wide study of patients hospitalized with acute myocardial infarction in metropolitan Baltimore was conducted to examine socio-demographic and clinical characteristics in association with ventricular fibrillation and cardiac arrest (VF/CA). Multivariate analyses revealed that variables significantly associa...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960040404
更新日期:1981-07-01 00:00:00
abstract::The realization that cardiovascular morbidity and mortality increases in patients with mild elevation of either systolic or diastolic blood pressure has led to a consideration to treat millions of patients with mild diastolic or isolated systolic hypertension. The cost of administering a successful antihypertensive tr...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章
doi:10.1002/clc.4960060101
更新日期:1983-01-01 00:00:00
abstract::On the basis of our reported experience with colchicine for recurrent pericarditis, we administered colchicine to two patients with large pericardial effusions complicating idiopathic pericarditis. The first was a 26-year-old male who showed clinical deterioration following emergency pericardiocentesis and aspirin (3 ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960210220
更新日期:1998-02-01 00:00:00
abstract:BACKGROUND:To evaluate the prognostic value of early and intensive lipid-lowering treatment on ventricular premature beat or nonsustained ventricular tachycardia (NSVT) after acute coronary syndrome (ACS) (ST-elevation myocardial infarction [STEMI], non-STEMI, and unstable angina pectoris). HYPOTHESIS:Provided that ea...
journal_title:Clinical cardiology
pub_type: 杂志文章,随机对照试验,收录出版
doi:10.1002/clc.20818
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Acute aortic dissection (AAD) is a life-threatening medical emergency that requires immediate diagnosis and rapid treatment. There is a paucity of data on the role of biomarkers in risk stratification of patients with AAD. HYPOTHESIS:N-terminal pro-brain natriuretic peptide (NT-proBNP) is associated with sh...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.23436
更新日期:2020-11-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960190711
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:QT dispersion (QTd = QTmax-QTmin) measured as interlead variability of QT interval reflects the spatial inhomogeneity of ventricular repolarization times, and increased QTd may provide a substrate for malignant ventricular arrhythmias. Ischemia is associated with regional abnormalities of conduction and repo...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960220109
更新日期:1999-01-01 00:00:00
abstract::According to the Rosenblueth-Simeone model, the heart rate (HR) is proportional to the sympathovagal balance. The individual proportionality constant is the intrinsic HR, which can be determined only invasively. The percentage low-frequency spectral HR variability power, relative to the low- plus high-frequency spectr...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960190112
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:Early reperfusion improves left ventricular (LV) function and survival after acute myocardial infarction (MI). Thrombolytic therapy achieves early patency of the infarct artery in about two-thirds of patients. In nearly half of the remaining patients, in whom early reperfusion was not achieved with thromboly...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960221206
更新日期:1999-12-01 00:00:00
abstract::During the last several years dilating balloons have been applied in the treatment of stenotic cardiac valves. This interest has been extended to stenotic porcine bioprosthetic valves. Part I of this review discusses the pathologic changes producing stenotic porcine prosthetic valves. Part II of this review describes ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960140912
更新日期:1991-09-01 00:00:00
abstract::Coronary artery disease (CAD) is still the number-one killer in the world, and clinical trials indicate that it is preventable. Mortality and morbidity can be reduced by at least 30% to 40% by treating known risk factors. Genetic susceptibility is claimed to account for 50% of predisposition. The challenge of preventi...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.22002
更新日期:2012-09-01 00:00:00
abstract::Diabetes mellitus is a significant condition, affecting major segments of all population groups studied. With the introduction of insulin and oral hypoglycemic therapy, together with better understanding of diet and weight control gained over the past half century, the primary causes of diabetic morbidity and mortalit...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960121110
更新日期:1989-11-01 00:00:00
abstract:BACKGROUND:Syndrome X is defined as typical angina pectoris, positive treadmill exercise test, negative intravenous ergonovine test, and angiographically normal coronary arteries. HYPOTHESIS:In the present study, we investigated the anti-ischemic and antianginal effects of nisoldipine and ramipril in patients with syn...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章
doi:10.1002/clc.4960220513
更新日期:1999-05-01 00:00:00
abstract::Therapy with an angiotensin-converting enzyme (ACE) inhibitor is established for reducing excessive blood pressure, reducing mortality in patients with congestive heart failure (CHF), preventing the development of CHF in patients with asymptomatic left ventricular (LV) dysfunction, and preventing death and CHF when in...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960230704
更新日期:2000-07-01 00:00:00