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CARDIOVASCULAR ANESTHESIA

Pericardial Cardiac Troponin I Release After Coronary Artery Bypass Grafting

Jean-Luc Fellahi, MD^*, Philippe Léger, MD^*, Eddy Philippe, MD^*, Martine Arthaud, PhD, Bruno Riou, MD, PhD^*, Iradj Gandjbakhch, MD, and Pierre Coriat, MD^*

*Département d’Anesthésie-Réanimation, Laboratoire de Biologie des Urgences, and Service de Chirurgie Cardiothoracique et Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, Paris France

Address correspondence and reprint requests to Jean-Luc Fellahi, MD, Département d’Anesthésie-Réanimation, C.H.P. Saint-Martin, 18 rue des Roquemonts, F-14050 Caen, Cedex, France.

Pericardial fluid can reflect the composition of cardiac interstitium in myocardial ischemia. This study investigated the hypothesis that pericardial cardiac troponin I (CTnI) measurements could be a more accurate marker of perioperative myocardial infarction (MI) than serum CTnI after coronary artery bypass grafting (CABG). Postoperative arterial and pericardial blood samples were taken in 102 subjects undergoing elective CABG allocated to one of three groups according to the 12-lead electrocardiogram (ECG) abnormalities observed during the first postoperative 24 h: Group 1 = normal ECG; Group 2 = nonspecific ECG abnormalities; and Group 3 = perioperative Q-wave MI. Peak pericardial CTnI concentrations were much higher than peak serum concentrations in all subjects and significantly greater in Group 3 than in Groups 1 and 2 (1,318 ± 1,810 ng/mL vs 367 ± 339 ng/mL and 558 ± 608 ng/mL, respectively; P < 0.01). However, no significant difference between groups occurred at any time for pericardial/serum CTnI ratios, indicating that time courses of CTnI were not different in pericardial fluid and serum. A significant correlation was found between serum and pericardial CTnI concentrations (R = 0.70, P < 0.001). Pericardial CTnI was not more accurate than serum CTnI in predicting Q-wave MI as shown by the low value of the area under the receiver-operator characteristic curve (=0.71). Peak and early pericardial CTnI were also not accurate in predicting an increase of serum CTnI greater than a cutoff value of 19 ng/mL. Thus, pericardial CTnI measurements were less useful than serum CTnI measurements in the diagnosis of perioperative MI after CABG.

Implications: Although cardiac troponin I concentrations were much higher in pericardial fluid than in serum and significantly increased in subjects who experienced perioperative Q-wave myocardial infarction, pericardial cardiac troponin I measurements were of less value than serum cardiac troponin I measurements for the diagnosis of perioperative myocardial infarction after coronary artery bypass grafting and cannot be recommended in routine clinical practice.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999