Dosage des isoformes cardiaques des troponines T ou I : intérêt en cardiologie et en anesthésie–réanimation

[Cardiac biomarkers in perioperative risk stratification]

OBJECTIVES

The field of new cardiac biomarkers has triggered physicians' enthusiasm because of their potential diagnostic and prognostic values for routine clinical practice in the surgical setting. The objective of the present article is to review the role of new cardiac biomarkers and their potential additive clinical value in predicting short- and long-term risk following cardiac and non-cardiac surgery.

DATA SOURCES

A PubMed(®) database research in English and French languages published until June 2010. Keywords were cardiac biomarkers, troponins, cardiac troponin I (cTnI), natriuretic peptides, B-type natriuretic peptide (BNP), C-reactive protein (CRP), multiple markers approach, risk stratification, clinical risk scores.

DATA SYNTHESIS

Numerous publications deal with the diagnostic and prognostic values of new cardiac biomarkers in cardiac and non-cardiac surgical settings and provide an increasing evidence of their interest, validating different hierarchical steps which are mandatory before recommending a wide use of biomarkers for routine practice. Even if the first studies demonstrating an additional prognostic value of serum postoperative cTnI and/or preoperative BNP when compared with clinical predictive models are now available, we still lack data concerning an actual positive impact of new biomarkers measurements on clinical decision making or practice, as well as patient care and outcome.

CONCLUSIONS

While use of new cardiac biomarkers in the perioperative period appears to be a simple and objective tool for risk stratification at the bedside, we still need to remain cautious concerning their additional clinical value on existing predictive models for routine practice.

Assessment of serum enzymatic markers of cardiomyocytes injury in female dogs submitted to ketamine S(+), atropin and xylazine association

PURPOSE

To assessment of the aspartate aminotransferase (AST), creatine kinase (CK) and creatine kinase isoenzyme fraction MB (CK-MB) serum activity in female dogs anesthetized with ketamine S (+), atropine and xylazine in several associations.

METHODS

Twenty three healthy female dogs randomly distributed in four groups named as GI (n=6), GII (n=6), GIII (n=6) and GIV (n=5) were treated respectively with atropine and ketamine S(+) (0.04 mg/kg; 10 mg/kg); ketamine S(+) (10 mg/kg); atropine, xylazine and ketamine S(+) (0.04 mg/kg; 1.1 mg/kg; 10 mg/kg) and xylazine and ketamine S(+) (1.1 mg/kg; 10 mg/kg). AST, CK and CK-MB serum activity measurement before pre-medication (M0) and one, two, three, six, 12, 24, 36 hours after.

RESULTS

There was no significant change in AST, CK e CK-MB serum activity among groups. However, CK serum activity in relation to moments within the groups was increased in all groups over the time in spite of treatment, except GI. In relation to CK-MB activity, in the moments within the group, it was observed an increase compared to baseline in all groups.

CONCLUSION

Creatine kinase and creatine kinase fraction MB isoenzyme showed changes in their mean values remained higher than baseline for a longer time in GIII and GIV.

[Cardiac biomarkers for diagnosis of myocardial infarction]

Diagnosis of postoperative myocardial infarction is often difficult, based on tools with a low sensitivity (clinical symptoms, EKG), or with a low specifity (old biomarkers, echocardiographic abnormalities) or inadequate for clinical practice (scintigraphy). Since 1995, clinicians may use more cardiospecific markers (troponin) allowing to modify strategy for postoperative myocardial infarction diagnosis. The aim of this review is to resume such an attitude.