Evaluation of cardiac involvement following major orthopedic surgery
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Martina Montagnana
Abstract
Background: Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery.
Methods: A total of 37 patients undergoing major orthopedic surgery were longitudinally evaluated for NT-proBNP, IMA, cardiac troponin T (cTnT), creatine kinase isoenzyme MB and myoglobin 3h before surgery and 4 and 72h thereafter.
Results: NT-proBNP values were significantly increased at 72h postoperative compared to both 3h preoperative and 4h postoperative (NT-proBNP: 20 vs. 4.5pmol/L, p<0.001 and 20 vs. 5.9pmol/L, p<0.001). IMA levels were significantly increased at 4 and 72h postoperative vs. 3h preoperative (132 vs. 113kU/L, p=0.02 and 151 vs. 113kU/L, p<0.001). In a stepwise regression model, the perioperative liquid amount and degree of modification in postoperative creatinine levels (delta-creatinine) were independently related to the NT-proBNP increase.
Conclusions: The significant increase observed in NT-proBNP suggests that patients undergoing major uncomplicated orthopedic surgery may develop subclinical cardiac stress, presumably attributable to the considerable infusion of liquids. The clinical significance of this finding deserves further investigation, especially in patients at higher risk of heart failure.
Clin Chem Med Lab 2006;44:1340–6.
References
1. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg 2002; 94:1052–64.10.1097/00000539-200205000-00002Search in Google Scholar PubMed
2. Ouchterlony J, Arvidsson S, Sjostedt L, Svardsudd K. Perioperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery. Acta Anaesthesiol Scand 1995; 39:643–52.10.1111/j.1399-6576.1995.tb04142.xSearch in Google Scholar PubMed
3. Schwilk B, Muche R, Treiber H, Brinkmann A, Georgieff M, Bothner U. A cross-validated multifactorial index of perioperative risks in adults undergoing anaesthesia for non-cardiac surgery. J Clin Monit 1998; 14:283–94.10.1023/A:1009916822005Search in Google Scholar
4. Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 1995; 338:1750–6.Search in Google Scholar
5. Panteghini M. Role and importance of biochemical markers in clinical cardiology. Eur Heart J 2004; 25:1187–96.10.1016/j.ehj.2004.04.026Search in Google Scholar PubMed
6. Christenson RH, Duh SH, Sanhai WR, Wu AH, Holtman V, Painter P, et al. Characteristics of an albumin cobalt binding test for assessment of acute coronary syndrome patients: a multicenter study. Clin Chem 2001; 47:464–70.10.1093/clinchem/47.3.464Search in Google Scholar
7. Roy D, Quiles J, Aldama G, Sinha M, Avanzas P, Arroyo-Espliguero R, et al. Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. Int J Cardiol 2004; 97:297–301.10.1016/j.ijcard.2004.05.042Search in Google Scholar PubMed
8. Roy D, Quiles J, Sharma R, Sinha M, Avanzas P, Gaze D, et al. Ischemia-modified albumin concentrations in patients with peripheral vascular disease and exercise induced skeletal muscle ischemia. Clin Chem 2004; 50:1656–60.10.1373/clinchem.2004.031690Search in Google Scholar PubMed
9. Wu AH. The ischemia-modified albumin biomarker for myocardial ischemia. MLO Med Lab Obs 2003; 35:36–8.Search in Google Scholar
10. Anwaruddin S, Januzzi JL Jr, Baggish AL, Lewandrowski EL, Lewandrowski KB. Ischemia-modified albumin improves the usefulness of standard cardiac biomarkers for the diagnosis of myocardial ischemia in the emergency department setting. Am J Clin Pathol 2005; 123:140–5.10.1309/4BCTG5UCYMQFWBLRSearch in Google Scholar
11. Montagnana M, Lippi G, Fava C, Minuz P, Lechi Santonastaso C, Arosio E, et al. Ischemia-modified albumin and NT-prohormone-brain natriuretic peptide in peripheral arterial disease. Clin Chem Lab Med 2006; 44:207–12.10.1515/CCLM.2006.038Search in Google Scholar PubMed
12. Ng LL, Loke IW, Davies JE, Geeranavar S, Khunti K, Stone MA, et al. Community screening for left ventricular systolic dysfunction using plasma and urinary natriuretic peptides. J Am Coll Cardiol 2005; 45:1043–50.10.1016/j.jacc.2004.12.058Search in Google Scholar PubMed
13. Vanderheyden M, Bartunek J, Goethals M. Brain and other natriuretic peptides: molecular aspects. Eur J Heart Fail 2004; 6:261–8.10.1016/j.ejheart.2004.01.004Search in Google Scholar
14. Collinson PO, Barnes SC, Gaze DC, Galasko G, Lahiri A, Senior R. Analytical performance of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) assay on the Elecsys 1010 and 2010 analysers. Eur J Heart Fail 2004; 6:365–8.10.1016/j.ejheart.2004.01.011Search in Google Scholar
15. Jarai R, Wojta J, Huber K. Circulating B-type natriuretic peptides in patients with acute coronary syndromes. Pathophysiological, prognostical and therapeutical considerations. Thromb Haemost 2005; 94:926–32.10.1160/TH05-06-0395Search in Google Scholar
16. Reichek N, Devereux RB. Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings. Circulation 1981; 63:1391–8.10.1161/01.CIR.63.6.1391Search in Google Scholar
17. Gidenne S, Ceppa F, Fontan E, Perrier F, Burnat P. Analytical performance of the Albumin Cobalt Binding (ACB) test on the Cobas MIRA Plus analyzer. Clin Chem Lab Med 2004; 42:455–61.10.1515/CCLM.2004.079Search in Google Scholar
18. Eagle KA, Brundage BH, Chaitman BR, Ewy GA, Fleisher LA, Hertzer NR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 1996; 27:910–48.Search in Google Scholar
19. Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med 1990; 323:1781–8.10.1056/NEJM199012273232601Search in Google Scholar
20. Raby KE, Goldman L, Creager MA, Cook EF, Weisberg MC, Whittemore AD, et al. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 1989; 321:1296–300.10.1056/NEJM198911093211904Search in Google Scholar
21. Raby KE, Barry J, Creager MA, Cook EF, Weisberg MC, Goldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. J Am Med Assoc 1992; 268:222–7.10.1001/jama.1992.03490020070033Search in Google Scholar
22. Hobisch-Hagen P, Schobersberger W, Falkensammer J, Luz G, Innerhofer P, Frischhut B, et al. No release of cTnI during major orthopedic surgery after acute normovolemic hemodilution. Acta Anaesthesiol Scand 1998; 42:799–804.10.1111/j.1399-6576.1998.tb05325.xSearch in Google Scholar
23. Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. American College of Physicians. Ann Intern Med 1997;127:309–12.Search in Google Scholar
24. Vuolteenaho O, Ala-Kopsala M, Ruskoaho H. BNP as a biomarker in heart disease. Adv Clin Chem 2005; 40:1–36.10.1016/S0065-2423(05)40001-3Search in Google Scholar
25. Kikuta K, Yasue H, Yoshimura M, Morita E, Sumida H, Kato H, et al. Increased plasma levels of B-type natriuretic peptide in patients with unstable angina. Am Heart J 1996; 132:101–7.10.1016/S0002-8703(96)90396-8Search in Google Scholar
26. Jernberg T, Stridsberg M, Venge P, Lindahl B. N-Terminal pro-brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST segment elevation. J Am Coll Cardiol 2002; 40:437–45.10.1016/S0735-1097(02)01986-1Search in Google Scholar
27. Campbell DJ, Munir V, Hennessy OF, Dent AW. Plasma aminoterminal pro-brain natriuretic peptide levels in subjects presenting to the emergency department with suspected acute coronary syndrome: possible role in selecting patients for follow up? Intern Med J 2001; 31:211–9.10.1046/j.1445-5994.2001.00042.xSearch in Google Scholar PubMed
28. Omland T, Persson A, Ng L, O'Brien R, Karlsson T, Herlitz J, et al. N-Terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 2002; 106:2913–8.10.1161/01.CIR.0000041661.63285.AESearch in Google Scholar PubMed
29. Hong SN, Yoon NS, Ahn Y, Lim SY, Kim YS, Yun KH, et al. N-terminal pro-B-type natriuretic peptide predicts significant coronary artery lesion in the unstable angina patients with normal electrocardiogram, echocardiogram, and cardiac enzymes. Circ J 2005; 69:1472–6.10.1253/circj.69.1472Search in Google Scholar PubMed
30. Clerico A, Emdin M. Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides: a review. Clin Chem 2004; 50:33–50.10.1373/clinchem.2003.024760Search in Google Scholar PubMed
31. Hamm CW, Ravkilde J, Gerhardt W, Jorgensen P, Peheim E, Ljungdahl L, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med 1992; 327:146–50.10.1056/NEJM199207163270302Search in Google Scholar PubMed
32. Stubbs P, Collinson P, Moseley D, Greenwood T, Noble M. Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. Circulation 1996; 94:1291–7.10.1161/01.CIR.94.6.1291Search in Google Scholar
33. Stubbs P, Collinson P, Moseley D, Greenwood T, Noble M. Prospective study of the role of cardiac troponin T in patients admitted with unstable angina. Br Med J 1996; 313:262–4.10.1136/bmj.313.7052.262Search in Google Scholar PubMed PubMed Central
34. Provenchere S, Berroeta C, Reynaud C, Baron G, Poirier I, Desmonts JM, et al. Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortality. Crit Care Med 2006; 34:995–1000.10.1097/01.CCM.0000206110.94385.C4Search in Google Scholar PubMed
35. Adams JE, Sicard GA, Allen BT, Bridwell KH, Lenke LG, Davila-Roman VG, et al. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I. N Engl J Med 1994; 330:670–4.10.1056/NEJM199403103301003Search in Google Scholar
36. Lee TH, Thomas EJ, Ludwig LE, Sacks DB, Johnson PA, Donaldson MC, et al. Troponin T as a marker for myocardial ischemia in patients undergoing major noncardiac surgery. Am J Cardiol 1996; 77:1031–6.10.1016/S0002-9149(96)00126-9Search in Google Scholar
37. Metzler H, Gries M, Rehak P, Lang T, Fruhwald S, Toller W. Perioperative myocardial cell damage: the role of troponins. Br J Anaesth 1997; 78:386–90.10.1093/bja/78.4.386Search in Google Scholar
38. Mahla E, Tiesenhausen K, Rehak P, Fruhwald S, Purstner P, Metzler H. Perioperative myocardial cell injury: the relationship between troponin T and cortisol. J Clin Anesth 2000; 12:208–12.10.1016/S0952-8180(00)00150-1Search in Google Scholar
39. Jules-Elysee K, Urban MK, Urquhart B, Milman S. Troponin I as a diagnostic marker of a perioperative myocardial infarction in the orthopedic population. J Clin Anesth 2001; 13:556–60.10.1016/S0952-8180(01)00337-3Search in Google Scholar
40. Neill F, Sear JW, French G, Lam H, Kemp M, Hooper RJ, et al. Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients. Anaesthesia 2000; 55:641–7.10.1046/j.1365-2044.2000.01420.xSearch in Google Scholar
41. Storrow AB, Gibler WB. Chest pain centers: diagnosis of acute coronary syndromes. Ann Emerg Med 2000; 35:449–61.10.1016/S0196-0644(00)70006-0Search in Google Scholar
42. Lippi G, Brocco G, Salvagno GL, Montagnana M, Dima F, Guidi GC. High-workload endurance training may increase serum ischemia-modified albumin concentrations. Clin Chem Lab Med 2005; 43:741–4.10.1515/CCLM.2005.126Search in Google Scholar PubMed
43. Wang YF, Gwathmey JK, Zhang G, Soriano SG, He S, Wang Y. Cerebrospinal fluid may mediate CNS ischemic injury. Cerebrospinal Fluid Res 2005; 2:7.10.1186/1743-8454-2-7Search in Google Scholar PubMed PubMed Central
44. Collinson PO. Biomarkers in angina. Scand J Clin Lab Invest 2005; 240:86–92.10.1080/00365510500236002Search in Google Scholar PubMed
45. Milionis HJ, Liberopoulos E, Goudevenos J, Bairaktari ET, Seferiadis K, Elisaf MS. Risk factors for first-ever acute ischemic non-embolic stroke in elderly individuals. Int J Cardiol 2005; 99:269–75.10.1016/j.ijcard.2004.01.013Search in Google Scholar PubMed
46. Dziedzic T, Slowik A, Szczudlik A. Serum albumin level as a predictor of ischemic stroke outcome. Stroke 2004; 35:156–8.10.1161/01.STR.0000126609.18735.beSearch in Google Scholar PubMed
47. Roy D, Quiles J, Sinha M, Aldama G, Gaze D, Kaski JC. Effect of direct-current cardioversion on ischemia-modified albumin levels in patients with atrial fibrillation. Am J Cardiol 2004; 93:366–8.10.1016/j.amjcard.2003.10.023Search in Google Scholar PubMed
48. McCord J. Oxygen-derived free radicals in post ischemic tissue injury. N Engl J Med 1985; 312:159–63.10.1056/NEJM198501173120305Search in Google Scholar PubMed
49. Cobbe SM, Poole-Wilson PA. The time of onset and severity of acidosis in the myocardial ischemia. J Mol Cell Biol 1980; 12:745–60.Search in Google Scholar
50. Borderie D, Allanore Y, Meune C, Devaux JY, Ekindjian OG, Kahan A. High ischemia-modified albumin concentration reflects oxidative stress but not myocardial involvement in systemic sclerosis. Clin Chem 2004; 50:2190–3.10.1373/clinchem.2004.034371Search in Google Scholar PubMed
51. Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of “ischemia modified albumin”, a new biochemical marker of myocardial ischemia, in the early diagnosis of acute coronary syndromes. Emerg Med J 2004; 21:29–34.10.1136/emj.2003.006007Search in Google Scholar PubMed PubMed Central
52. Bhagavan NV, Lai EM, Rios PA, Yang J, Ortega-Lopez AM, Shinoda H, et al. Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction. Clin Chem 2003; 49:581–5.10.1373/49.4.581Search in Google Scholar PubMed
53. van der Zee PM, Verberne HJ, van Straalen JP, Sanders GT, Van Eck-Smit BL, de Winter RJ, et al. Ischemia-modified albumin measurements in symptom-limited exercise myocardial perfusion scintigraphy reflect serum albumin concentrations but not myocardial ischemia. Clin Chem 2005; 51:1744–6.10.1373/clinchem.2005.054635Search in Google Scholar PubMed
54. Lippi G, Montagnana M, Guidi GC. Predicting cardiac outcomes. Can Med Assoc J 2005; 173:1206–7.10.1503/cmaj.1050168Search in Google Scholar PubMed PubMed Central
©2006 by Walter de Gruyter Berlin New York
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Articles in the same Issue
- Renal function – estimation of glomerular filtration rate
- Research translation: a new frontier for clinical laboratories
- Association of APOA5 c.553G>T polymorphism with type 2 diabetes mellitus in a Chinese population
- MTRR 66A>G polymorphism in relation to congenital heart defects
- Increased homocysteine in heart failure: a result of renal impairment?
- Urine flow cytometry and detection of glomerular hematuria
- Chymotrypsin effects on the determination of sperm parameters and seminal biochemistry markers
- Evaluation of cardiac involvement following major orthopedic surgery
- Increased sensitivity in detecting renal impairments by quantitative measurement of marker protein excretion compared to detection of pathological particles in urine sediment analysis
- Clinical chemistry reference values for 75-year-old apparently healthy persons
- Serum pro-hepcidin concentrations and their responses to oral iron supplementation in healthy subjects manifest considerable inter-individual variation
- Comparability of five analytical systems for the determination of triiodothyronine, thyroxine and thyroid-stimulating hormone
- Automated analysis of pleural fluid total and differential leukocyte counts with the Sysmex XE-2100
- Automation and validation of a fast method for the assessment of in vivo oxidative stress levels
- Analytical validation of the new plasma calibrated Accu-Chek® Test Strips (Roche Diagnostics)
- Use of insulin immunoassays in clinical studies involving rapid-acting insulin analogues: Bi-insulin IRMA preliminary assessment
- Analytical and clinical evaluation of a new heart-type fatty acid-binding protein automated assay
- A caveat for OV-Monitor (CA 125 antigen) measurement: something is improving, something is not
- Reply to the letter written by Dorizzi et al.