Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery

Shirjel R. Alam; Colin Stirrat; Nick Spath; Vipin Zamvar; Renzo Pessotto; Marc R. Dweck; Colin Moore; Scott Semple; Ahmed El-Medany; Divya Manoharan; Nicholas L. Mills; Anoop Shah; Saeed Mirsadraee; David E. Newby; Peter A. Henriksen

doi:10.1186/s13019-017-0681-6

Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery

Shirjel R. Alam^*, Colin Stirrat, Nick Spath, Vipin Zamvar, Renzo Pessotto, Marc R. Dweck, Colin Moore, Scott Semple, Ahmed El-Medany, Divya Manoharan, Nicholas L. Mills, Anoop Shah, Saeed Mirsadraee, David E. Newby, Peter A. Henriksen

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction.

Methods: We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO).

Results: Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8]/s). Plasma hs-cTnI concentrations rose by >= 50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p <0.01) but not systemic inflammation, myocardial inflammation or bypass time.

Conclusion: Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations > 10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations.

Original language	English
Article number	115
Number of pages	10
Journal	Journal of cardiothoracic surgery
Volume	12
DOIs	https://doi.org/10.1186/s13019-017-0681-6
Publication status	Published - 16 Dec 2017

Keywords / Materials (for Non-textual outputs)

CABG
Troponin
Inflammation
Type 5
Myocardial infarction
CARDIAC TROPONIN-I
CARDIOPULMONARY BYPASS
IRON-OXIDE
REPERFUSION
TRIAL

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10.1186/s13019-017-0681-6

s13019-017-0681-6
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Alam, S. R., Stirrat, C., Spath, N., Zamvar, V., Pessotto, R., Dweck, M. R., Moore, C., Semple, S., El-Medany, A., Manoharan, D., Mills, N. L., Shah, A., Mirsadraee, S., Newby, D. E., & Henriksen, P. A. (2017). Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. Journal of cardiothoracic surgery, 12, Article 115. https://doi.org/10.1186/s13019-017-0681-6

@article{feac77857fb1413e820e984cdbf539f1,

title = "Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery",

abstract = "Background: Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction.Methods: We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO).Results: Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8]/s). Plasma hs-cTnI concentrations rose by >= 50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20\% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9\% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p <0.01) but not systemic inflammation, myocardial inflammation or bypass time.Conclusion: Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations > 10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations.",

keywords = "CABG, Troponin, Inflammation, Type 5, Myocardial infarction, CARDIAC TROPONIN-I, CARDIOPULMONARY BYPASS, IRON-OXIDE, REPERFUSION, TRIAL",

author = "Alam, \{Shirjel R.\} and Colin Stirrat and Nick Spath and Vipin Zamvar and Renzo Pessotto and Dweck, \{Marc R.\} and Colin Moore and Scott Semple and Ahmed El-Medany and Divya Manoharan and Mills, \{Nicholas L.\} and Anoop Shah and Saeed Mirsadraee and Newby, \{David E.\} and Henriksen, \{Peter A.\}",

year = "2017",

month = dec,

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doi = "10.1186/s13019-017-0681-6",

language = "English",

volume = "12",

journal = "Journal of cardiothoracic surgery",

issn = "1749-8090",

publisher = "BioMed Central",

}

Alam, SR, Stirrat, C, Spath, N, Zamvar, V, Pessotto, R, Dweck, MR, Moore, C, Semple, S, El-Medany, A, Manoharan, D, Mills, NL, Shah, A, Mirsadraee, S, Newby, DE & Henriksen, PA 2017, 'Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery', Journal of cardiothoracic surgery, vol. 12, 115. https://doi.org/10.1186/s13019-017-0681-6

TY - JOUR

T1 - Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery

AU - Alam, Shirjel R.

AU - Stirrat, Colin

AU - Spath, Nick

AU - Zamvar, Vipin

AU - Pessotto, Renzo

AU - Dweck, Marc R.

AU - Moore, Colin

AU - Semple, Scott

AU - El-Medany, Ahmed

AU - Manoharan, Divya

AU - Mills, Nicholas L.

AU - Shah, Anoop

AU - Mirsadraee, Saeed

AU - Newby, David E.

AU - Henriksen, Peter A.

PY - 2017/12/16

Y1 - 2017/12/16

N2 - Background: Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction.Methods: We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO).Results: Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8]/s). Plasma hs-cTnI concentrations rose by >= 50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p <0.01) but not systemic inflammation, myocardial inflammation or bypass time.Conclusion: Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations > 10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations.

AB - Background: Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction.Methods: We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO).Results: Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8]/s). Plasma hs-cTnI concentrations rose by >= 50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p <0.01) but not systemic inflammation, myocardial inflammation or bypass time.Conclusion: Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations > 10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations.

KW - CABG

KW - Troponin

KW - Inflammation

KW - Type 5

KW - Myocardial infarction

KW - CARDIAC TROPONIN-I

KW - CARDIOPULMONARY BYPASS

KW - IRON-OXIDE

KW - REPERFUSION

KW - TRIAL

UR - https://www.scopus.com/pages/publications/85038084875

U2 - 10.1186/s13019-017-0681-6

DO - 10.1186/s13019-017-0681-6

M3 - Article

SN - 1749-8090

VL - 12

JO - Journal of cardiothoracic surgery

JF - Journal of cardiothoracic surgery

M1 - 115

ER -

Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery

Abstract

Keywords / Materials (for Non-textual outputs)

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CH/09/002/26360 BHF Scholarship Scheme - Salary costs

High-Sensitivity Cardiac Troponin and Coronary Heart Disease

An Intermediate Clinical Research Fellowship in Cardiovascular Non- Invasive Molecular Imaging

Cite this

Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery

Abstract

Keywords / Materials (for Non-textual outputs)

Access to Document

Other files and links

Fingerprint

Projects

CH/09/002/26360 BHF Scholarship Scheme - Salary costs

High-Sensitivity Cardiac Troponin and Coronary Heart Disease

An Intermediate Clinical Research Fellowship in Cardiovascular Non- Invasive Molecular Imaging

Cite this