Abstract

 

Perioperative infarction is traditionally diagnosed by the electrocardiogram and elevated serum levels of creatine

kinase izoenzyme (CK-MB). Cardiac troponin I (cTnI) is a more reliable and specific marker for myocardial

damage when compared to commonly used serum enzymes. We planned this study for comparing the specifity

and the sensitivity of cardiac enzymes in detecting the myocardial injury in patients undergoing open heart

surgery.

Fifty two cases who underwent open heart surgery were included in this study. There were 39 males and 13

females with a median age of 58±2(17-75). Venous blood samples were collected to analyze CK, CK-MB and

cTnI prior to induction of anesthesia, immediately after cross-clamp and at 6 hours,12 hours and 24 hours

following surgery and daily thereafter until the fifth postoperative day. Venous blood samples were also collected

to analyze cardiac myoglobin upon the termination of the operation and at 2 hours and 9 hours following the

operation. Daily electrocardiograms were obtained for all patients.

There was no mortality during the study. Peroperative myocardial infarction was detected in two patients.

Higher cardiac marker levels were detected in patients who had valvular surgery, who had cross-clamp duration

over 60 minutes and who were given inotropic agents. Moreover; in some patients: high cardiac cTnI levels were

detected despite normal CK and CK-MB levels.

In conclusion; cTnI is a more specific marker of cardiac damage when compared to commonly used serum

enzymes. It is also more sensitive, allowing diagnosis of perioperative microinfarction and detection of acute

myocardial infarction much earlier after the onset of myocardial injury and comparing different myocardial

protection techniques.

Key words: Cardiac Troponin I, Cardiopulmonary Bypass, Myocardial Injury.