The value of perioperative biomarker release for the assessment of myocardial injury or infarction in cardiac surgery

Author:

Schneider Ulrich1,Mukharyamov Murat1ORCID,Beyersdorf Friedhelm23ORCID,Dewald Oliver4,Liebold Andreas5,Gaudino Mario6ORCID,Fremes Stephen7,Doenst Torsten1

Affiliation:

1. Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany

2. Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany

3. Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany

4. Department of Cardiac Surgery, University Hospital Oldenburg, Oldenburg, Germany

5. Department of Cardiothoracic and Vascular Surgery, Ulm University Hospital, Ulm, Germany

6. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA

7. Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

Abstract

Abstract OBJECTIVES Cardiac biomarkers are indicators of irreversible cell damage. Current myocardial infarction (MI) definitions require concomitant clinical characteristics. For perioperative MI, a correlation of biomarker elevations and mortality has been suggested. Definitions emerged relying on cardiac biomarker release only. This approach is questionable as several clinical and experimental scenarios exist where relevant biomarker release can occur apart from MI. METHODS We reviewed the clinical and basic science literature and revealed important aspects regarding the use and interpretation of cardiac biomarker release with special focus on their interpretation in the perioperative setting. RESULTS Ischaemic biomarkers may be released without cell death in multiple conditions, such as after endurance runs in athletes, temporary inotropic stimulation in animal models and flow variations in in vitro cell models. In addition, access through atrial tissue during cannulation or concomitant valve procedures adds sources of enzyme release that may not be related to ventricular ischaemia (i.e. MI). Such non-cell death-related mechanisms may explain the lack of poor correlations of enzyme release and long-term outcomes in recent trials. In addition, the 3 main biomarkers, troponin T, I and creatine kinase myocardial band, differ in their release kinetics, which may differentially trigger MI events in trial patients. CONCLUSIONS The identification of irreversible myocardial injury in cardiac surgery based only on biomarker release is unreliable. Cell death- and non-cell death-related mechanisms create a mix in the perioperative setting that requires additional markers for proper identification of MI. In addition, the 3 most common ischaemic biomarkers display different release kinetics adding to the confusion. We review the topic. Subj collection 120, 123

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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