Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery
Abstract Background 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. Methods We assessed 87 patients with stable coronary artery d...
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doaj-75cbf27eefe5443fb5557d7f9d312e5a2020-11-24T21:40:07ZengBMCJournal of Cardiothoracic Surgery1749-80902017-12-0112111010.1186/s13019-017-0681-6Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgeryShirjel R. Alam0Colin Stirrat1Nick Spath2Vipin Zamvar3Renzo Pessotto4Marc R. Dweck5Colin Moore6Scott Semple7Ahmed El-Medany8Divya Manoharan9Nicholas L. Mills10Anoop Shah11Saeed Mirsadraee12David E. Newby13Peter A. Henriksen14BHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghDepartment of Cardiothoracic Surgery, Edinburgh Heart CentreDepartment of Cardiothoracic Surgery, Edinburgh Heart CentreBHF Centre for Cardiovascular Science, University of EdinburghDepartment of Cardiothoracic Surgery, Edinburgh Heart CentreBHF Centre for Cardiovascular Science, University of EdinburghNHS LothianBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghClinical Research Imaging Centre, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghAbstract Background 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. Methods 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). Results 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. Conclusion 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.http://link.springer.com/article/10.1186/s13019-017-0681-6CABGTroponinInflammationType 5Myocardial infarction |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
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 |
spellingShingle |
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 Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery Journal of Cardiothoracic Surgery CABG Troponin Inflammation Type 5 Myocardial infarction |
author_facet |
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 |
author_sort |
Shirjel R. Alam |
title |
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery |
title_short |
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery |
title_full |
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery |
title_fullStr |
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery |
title_full_unstemmed |
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery |
title_sort |
myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery |
publisher |
BMC |
series |
Journal of Cardiothoracic Surgery |
issn |
1749-8090 |
publishDate |
2017-12-01 |
description |
Abstract Background 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. Methods 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). Results 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. Conclusion 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. |
topic |
CABG Troponin Inflammation Type 5 Myocardial infarction |
url |
http://link.springer.com/article/10.1186/s13019-017-0681-6 |
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