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- Dahlin, Lars-Göran, 1956-, et al.
(författare)
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Early Identification of Permanent Myocardial Damage after Coronary Surgery is Aided by Repeated Measurements of CK-MB
- 2002
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 36:1, s. 35-40
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Tidskriftsartikel (refereegranskat)abstract
- Objective - ECG diagnosis of myocardial infarction after cardiac surgery is associated with major pitfalls and enzyme diagnosis is interfered by unspecific elevation unrelated to permanent myocardial injury. Sustained release of troponin-T is a marker of permanent myocardial injury if renal function is maintained. However, early identification of perioperative myocardial infarction is desirable and therefore the usefulness of creatine kinase monobasic (CK-MB) kinetics to detect myocardial injury early after coronary surgery was investigated.Design - Two hundred and eighty-six patients undergoing coronary surgery were studied with respect to release of enzymes and troponin-T preoperatively and postoperatively 3 and 8 h after unclamping the aorta, and every morning postoperative days 1-4.Results - CK-MB peak was found at 3 h ( n = 145), 8 h ( n = 103) and 16-20 h after unclamping ( n = 38). Depending on when the CK-MB peak was recorded different demographic and perioperative characteristics were found. A sustained release of troponin-T was characteristic for the group with the CK-MB peak at 16-20 h after unclamping.Conclusion - If CK-MB is measured only once it may be advisable to do it on the first postoperative morning as these measurements provided the best discrimination between patients with and without sustained elevation of troponin-T. However, repeated sampling provides additional information that aids in the early identification of permanent myocardial injury particularly in patients with borderline elevations of CK-MB.
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| 3. |
- Dahlin, Lars-Göran, 1956-, et al.
(författare)
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Perioperative myocardial infarction in cardiac surgery - risk factors and consequences : a case control study
- 2000
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 34:5, s. 522-527
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of the study was to analyze risk factors and clinical outcome in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery.Design. A retrospective, case control study was conducted, in which 42 patients fulfilling both Q-wave criteria and enzyme criteria for PMI, or autopsy diagnosis, from a cohort of 1147 operated on during the same time period were compared with matched controls. A follow-up by telephone interview was conducted, on average 24 months after the operation.Results. Unstable angina, peripheral vascular disease, short stature and low body weight were more prevalent in the PMI group. Intraoperative remarks of poor quality coronary vessels and incomplete revascularization were more frequent in the PMI group, 30-day mortality was 24% in the PMI group vs 0% in the control group (p < 0.01). The postoperative course was more complicated and protracted in the PMI group. At follow-up, the control group managed significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported an improved quality of life after surgery.Conclusions. We found that PMI was mainly associated with coronary surgery and that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infarcts and could also contribute to the impaired long-term outcome in the PMI group.
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- Dahlin, Lars-Göran, 1956-, et al.
(författare)
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Unspecific elevation of plasma troponin-T and CK-MB after coronary surgery
- 2003
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 37:5, s. 283-287
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Tidskriftsartikel (refereegranskat)abstract
- Objective - Biochemical markers of myocardial injury are frequently elevated after cardiac surgery. It is generally accepted that release unrelated to permanent myocardial damage explains a proportion of these elevations. However, little is known about the magnitude and temporal characteristics of this diagnostic noise. One way to address this issue would be to study a group without permanent myocardial injury. Design - The unique release kinetics of troponin-T (permanent myocardial injury causes a sustained release of structurally bound troponin) were used to identify patients with no or minimal permanent myocardial injury. Blood was sampled from patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) before surgery, 3 and 8 h after unclamping the aorta, and each morning until postoperative day 4, for analysis of enzymes and troponin-T. From 302 consecutive patients a subgroup was identified that fulfilled the following criteria: (a) normalized troponin-T levels =postoperative day 4, (b) no ECG changes indicating myocardial injury. Results - Seventy-seven patients fulfilled the criteria above and in this subgroup troponin-T (2.08 ▒ 1.42 ╡g/ 1, range 0.35-8.99 ╡g/l) peaked at the 3 h recording and creatine kinase monobasic (CK-MB) (28.6 ▒ 11.3 ╡g/l, range 11.9-86.0 ╡g/l) peaked at the 8 h recording after unclamping the aorta. Conclusion - Substantial early elevations of plasma CK-MB and troponin-T occurred in patients with no or minimal permanent myocardial injury after CABG. Unspecific release was most pronounced during the timeframe that is usually studied to evaluate myocardial protective strategies or to compare revascularization procedures.
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| 6. |
- Dahlin, Lars-Göran, 1956-, et al.
(författare)
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Vectorcardiography is Superior to Conventional ECG for Detection of Myocardial Injury after Coronary Surgery
- 2001
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 35:2, s. 125-128
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Tidskriftsartikel (refereegranskat)abstract
- Objective - The reliability of conventional scalar ECG for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery has been questioned. For the diagnosis of myocardial infarction in general vectorcardiography (VCG) is superior to ECG. Therefore, the usefulness of conventional VCG and computerized analysis of spatial VCG changes for diagnosis of PMI were studied.Design - VCG registrations were obtained from 218 patients undergoing coronary surgery. The spatial QRS vector loop area of each VCG registration was calculated and the loop area before surgery compared with the loop area after surgery. Conventional VCG criteria for myocardial infarction and set values for loop area reduction were related to sustained elevation of plasma troponin-T and clinical course.Results - Both conventional VCG criteria and spatial changes translated better than Q-waves on scalar ECG into elevation of biochemical markers of myocardial injury and impaired clinical course.Conclusion - VCG appears superior to conventional ECG as regards detection of myocardial injury in coronary surgery. Computerized programs have facilitated the registration and the interpretation of VCG and this methodology deserves further evaluation in cardiac surgery.
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| 8. |
- Håkansson, E, et al.
(författare)
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Management of life-threatening haemoptysis
- 2002
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 88, s. 291-295
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Tidskriftsartikel (refereegranskat)abstract
- Massive haemoptysis represents a major medical emergency that is associated with a high mortality. Here we present two cases of life-threatening haemoptysis, the first caused by rupture of an aortic aneurysm into the lung in a 37-yr-old woman with polyarteritis nodosa and the second caused by massive bleeding from an angiectatic vascular malformation in the right main bronchus in a 21-yr-old woman. Fibreoptic bronchoscopy played an essential role in the diagnostic process and management of the respiratory tract. Diagnosis in the first case was obtained by CT scan and the aneurysm was treated surgically. In the second case, bronchial arteriography contributed to both definitive diagnosis and treatment. Initial cardiorespiratory management, diagnostic procedures and definitive therapy are described and reviewed. Adequate early management of the cardiorespiratory system is essential to the outcome. Aggressive measures to elucidate the cause of haemoptysis and prompt therapy are warranted because of the high risk of recurrence.
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