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Perioperative troponin

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https://www.readbyqxmd.com/read/27882105/a-pilot-study-of-perioperative-esmolol-for-myocardial-protection-during-on-pump-cardiac-surgery
#1
Xue Liu, Fengxia Shao, Liu Yang, Youhai Jia
The protective effects of preprocedural esmolol on myocardial injury and hemodynamics have not, to date, been investigated in patients who were scheduled for cardiac surgeries under a cardiopulmonary bypass (CPB). A pilot randomized controlled trial was performed at The First Affiliated Hospital of Dalian Medical University (Dalian, China). Patients scheduled for elective open-heart surgeries under CBP were included, and were randomized to esmolol and control groups. For patients in the esmolol groups, intravenous esmolol (70 µg/kg/min) was administered at the time of incision until CPB was performed...
November 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27870734/incremental-value-of-preoperative-copeptin-for-predicting-myocardial-injury
#2
Eckhard Mauermann, Daniel Bolliger, Esther Seeberger, Christian Puelacher, Sydney Corbiere, Miodrag Filipovic, Manfred Seeberger, Christian Mueller, Giovanna Lurati Buse
BACKGROUND: Copeptin, a novel marker of endogenous stress, has shown diagnostic and prognostic value in nonsurgical patients with a suspected coronary event. We aimed to assess the incremental value of copeptin in addition to established preoperative risk indices to predict the occurrence of postoperative myocardial injury. METHODS: This secondary analysis of prospectively collected data included adults undergoing noncardiac surgery with risk factors for adverse perioperative cardiac events based on preoperative risk stratification...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#3
Emmanuelle Duceppe, Joel Parlow, Paul MacDonald, Kristin Lyons, Michael McMullen, Sadeesh Srinathan, Michelle Graham, Vikas Tandon, Kim Styles, Amal Bessissow, Daniel I Sessler, Gregory Bryson, P J Devereaux
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery...
October 4, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27833481/cardiac-and-renal-protective-effects-of-dexmedetomidine-in-cardiac-surgeries-a-randomized-controlled-trial
#4
A S Ammar, K M Mahmoud, Z A Kasemy, M A Helwa
BACKGROUND: Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries. MATERIALS AND METHODS: Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27775784/serum-troponin-i-concentrations-assessed-18-24-hours-after-coronary-artery-bypass-grafting-are-significant-predictors-of-early-patient-prognosis
#5
Q-L Ma, H-J Wang, M-N Shi, J-H An, J Ma, D Yu, M Tang, F-W Shi
OBJECTIVE: Coronary heart disease (CHD) is a frequent medical condition in developed countries and is one of the most serious diseases threatening patients' lives. Perioperative myocardial infarction is the major cause of perioperative cardiac death and cardiac arrest, but is difficult to be precisely identified by observing clinical symptoms or assessing cardiac enzyme levels or by ECG examination. Therefore, assessment of patient prognosis requires reliable predictors. In this regard, we tested the prognostic value of serum troponin I (TnI) concentrations...
October 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27738245/perioperative-myocardial-infarction-in-non-cardiac-surgery-patients-a-prospective-observational-study
#6
A Ollila, L Vikatmaa, J Virolainen, P Vikatmaa, A Leppäniemi, A Albäck, M Salmenperä, V Pettilä
BACKGROUND AND AIMS: Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials. MATERIAL AND METHODS: We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older...
October 13, 2016: Scandinavian Journal of Surgery: SJS
https://www.readbyqxmd.com/read/27726853/frequency-of-increase-in-cardiac-troponin-levels-after-peripheral-arterial-operations-carotid-endarterectomy-abdominal-aorta-procedure-distal-bypass-and-their-effect-on-medical-management
#7
Yader Sandoval, Marina Zakharova, Thomas S Rector, Emmanouil S Brilakis, Todd Drexel, Edward O McFalls, Santiago Garcia
The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant...
September 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27688236/cardiac-remote-ischemic-preconditioning-prior-to-elective-vascular-surgery-cripes-a-prospective-randomized-sham-controlled-phase%C3%A2-ii-clinical-trial
#8
Santiago Garcia, Thomas S Rector, Marina Zakharova, Rebekah R Herrmann, Selcuk Adabag, Stefan Bertog, Yader Sandoval, Steve Santilli, Emmanouil S Brilakis, Edward O McFalls
BACKGROUND: Remote ischemic preconditioning (RIPC) has been shown to reduce infarct size in animal models. We hypothesized that RIPC before an elective vascular operation would reduce the incidence and amount of a postoperative rise of the cardiac troponin level. METHODS AND RESULTS: Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES) was a prospective, randomized, sham-controlled phase 2 trial using RIPC before elective vascular procedures...
September 29, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27687420/surgical-apgar-score-is-associated-with-myocardial-injury-after-noncardiac-surgery
#9
L McLean House, Khensani N Marolen, Paul J St Jacques, Matthew D McEvoy, Jesse M Ehrenfeld
STUDY OBJECTIVE: To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. DESIGN: Single-center retrospective cohort study of surgical patients from 2007 to 2012. SETTING: Postanesthesia care unit, intensive care unit, and medical-surgical ward at an academic tertiary medical center. PATIENTS: A total of 46,799 adult noncardiac, nonthoracic surgery patients, for which 2290 peak cardiac troponin (cTn) levels were available...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27631445/-the-perioperative-myocardial-infarction-an-interdisciplinary-task
#10
Konstantinos Karatolios, Caroline Rolfes, Hinnerk Wulf, Bernhard Schieffer
Cardiovascular complications, particularly perioperative myocardial infarction (PMI), are major contributors to mortaliyt after noncardiac surgery. PMI often occurs unnoticed without symptoms or ECG changes. Despite ist silent presentation, PMI is associated with increased mortality. The combination of high associated mortality and diagnostic challenges mandates increased awareness of PMI. Perioperative myocardial infarction may result from plaque rupture (PMI type I) or be caused by a myocardial supply-demand imbalance of oxygen without plaque rupture (PMI type II)...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27595528/efficacy-of-different-perioperative-statin-regimens-on-protection-against-post-coronary-artery-bypass-grafting-major-adverse-cardiac-and-cerebral-events
#11
Aya G Elmarsafawi, Maggie M Abbassi, Sameh Elkaffas, Hassan M Elsawy, Nirmeen A Sabry
OBJECTIVES: Comparing different perioperative statin regimens for the prevention of post-coronary artery bypass grafting adverse events. DESIGN: A randomized, prospective study. SETTING: Cardiothoracic surgical units in a government hospital. PARTICIPANTS: The study comprised 94 patients scheduled for elective, isolated on- or off- pump coronary artery bypass grafting. INTERVENTIONS: Patients were assigned randomly to 1 of the following 3 treatment groups: group I (80 mg of atorvastatin/day for 2 days preoperatively), group II (40 mg of atorvastatin/day for 5-9 days preoperatively), or group III (80 mg of atorvastatin/day for 5-9 days preoperatively)...
December 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27443427/percutaneous-intervention-for-myocardial-infarction-after-noncardiac-surgery-patient-characteristics-and-outcomes
#12
Akhil Parashar, Shikhar Agarwal, Amar Krishnaswamy, Karan Sud, Kanhaiya L Poddar, Mehak Bassi, Stephen Ellis, E Murat Tuzcu, Venu Menon, Samir R Kapadia
BACKGROUND: Few studies have explored percutaneous coronary intervention (PCI) in perioperative myocardial infarction (PMI), even though PMI is a major cause of mortality in patients undergoing urgent/emergent noncardiac surgery. OBJECTIVES: This study sought to describe the angiographic characteristics and outcomes in patients presenting to the cardiac catheterization laboratory for myocardial infarction sustained after undergoing noncardiac surgery, with a detailed analysis of those undergoing PCI...
July 26, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27403189/acute-fulminant-myocarditis-successfully-bridged-to-recovery-with-left-ventricular-assist-device-and-complicated-by-flail-mitral-valve
#13
Pınar Türker Duyuler, Serkan Duyuler, Ekrem Şahan, Şeref Alp Küçüker
Acute fulminant myocarditis is a life-threatening inflammatory disease of the myocardium characterized by the rapid deterioration of the hemodynamic status of the affected individual. With prompt recognition and appropriate management, complete recovery of ventricular function is likely within a few weeks. We introduce a 28-year-old man with acute fulminant myocarditis, who experienced circulatory collapse following acute angina and dyspnea. The patient had high troponin levels with low ejection fraction and normal coronary arteries...
January 13, 2016: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/27397448/short-term-prognostic-value-of-perioperative-coronary-sinus-derived-serum-cardiac-troponin-i-creatine-kinase-mb-lactate-pyruvate-and-lactate-pyruvate-ratio-in-adult-patients-undergoing-open-heart-surgery
#14
Ujjwal Kumar Chowdhury, Avneesh Sheil, Poonam Malhotra Kapoor, Rajiv Narang, Parag Gharde, Vishwas Malik, Mani Kalaivani, Arindam Chaudhury
OBJECTIVES: To investigate the release pattern of different cardiac metabolites and biomarkers directly from the coronary sinus (CS) and to establish the diagnostic discrimination limits of each marker protein and metabolites to evaluate perioperative myocardial injury in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). PATIENTS AND METHODS: Sixty-eight patients undergoing first mitral and/or aortic valve replacements with/without coronary artery bypass grafting and Bentall procedure under CPB and blood cardioplegic arrest were studied...
July 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27382817/peri-anesthesia-anaphylaxis-paa-we-still-have-not-started-post-paa-testing-for-inciting-anesthesia-related-allergens
#15
Taghreed Alshaeri, Deepak Gupta, Ananthamurthy Nagabhushana
Anaphylaxis during anesthesia is uncommon. Diagnosis of peri-anesthesia anaphylaxis (PAA) requires anesthesia providers' vigilance for prompt diagnosis and treatment. In this case report, we present a challenging case with suspected PAA including its perioperative management, intensive care unit (ICU) course, and post-discharge follow-up. A 44-year-old female (body mass index = 26) presented for elective abdominal panniculectomy. Post-intubation, severe bronchospasm occurred that was non-responsive to nebulized albuterol and intravenous epinephrine...
February 2016: Middle East Journal of Anesthesiology
https://www.readbyqxmd.com/read/27354864/efficacy-of-atorvastatin-in-prevention-of-atrial-fibrillation-after-heart-valve-surgery-in-the-proface-trial-prophylaxis-of-postoperative-atrial-fibrillation-after-cardiac-surgery
#16
Yolanda Carrascal, Roman J Arnold, Luis De la Fuente, Ana Revilla, Teresa Sevilla, Nuria Arce, Gregorio Laguna, Pilar Pareja, Miriam Blanco
BACKGROUND: To evaluate the efficacy of perioperative atorvastatin administration for prophylaxis of postoperative atrial fibrillation (POAF) after heart valve surgery. METHODS: Our study included 90 patients with heart valve disease who were scheduled to undergo elective cardiac surgery. Cases with previous AF or preoperative beta-blocker therapy were excluded. Patients were randomized into the atorvastatin group, which included 47 patients who received 40 mg/day of atorvastatin 7 days before and after the surgery and the control group, which included 43 patients...
June 2016: Journal of Arrhythmia
https://www.readbyqxmd.com/read/27331782/perioperative-troponin-screening
#17
Daniel I Sessler, P J Devereaux
Myocardial injury is the most common cause of death during the 30 days after noncardiac surgery. Only 14% of patients who are experiencing a perioperative myocardial infarction will have chest pain, and 65% are entirely clinically silent, which means that they will go undetected without routine troponin screening. Although it is tempting to dismiss asymptomatic troponin elevation, mortality is similar with and without symptoms. Furthermore, mortality at 30 days in patients who have postoperative troponin elevation is a concerning 10%, which represents a 5-fold increase from background risk...
August 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27311391/plasma-levels-of-growth-differentiation-factor-15-are-associated-with-myocardial-injury-in-patients-undergoing-off-pump-coronary-artery-bypass-grafting
#18
Zhize Yuan, Haiqing Li, Quan Qi, Wenhui Gong, Cheng Qian, Rong Dong, Yi Zang, Jia Li, Mi Zhou, Junfeng Cai, Zhe Wang, Anqing Chen, Xiaofeng Ye, Qiang Zhao
Growth differentiation factor-15 (GDF-15) has recently emerged as a risk predictor in patients with cardiovascular diseases. We therefore aimed to investigate the role of GDF-15 in the occurrence of cardiac injury during off-pump coronary artery bypass grafting (OPCAB). 55 consecutive patients with coronary artery diseases were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively, 12 hours and 36 hours after surgery...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27257829/impact-of-subclinical-coronary-artery-disease-on-the-clinical-outcomes-of-carotid-endarterectomy
#19
Hyunwook Kwon, Dae Hyuk Moon, Youngjin Han, Jong-Young Lee, Sun U Kwon, Dong-Wha Kang, Suk Jung Choo, Tae-Won Kwon, Min-Ju Kim, Yong-Pil Cho
OBJECTIVE Controversy persists regarding the optimal management of subclinical coronary artery disease (CAD) prior to carotid endarterectomy (CEA) and the impact of CAD on clinical outcomes after CEA. This study aimed to evaluate the short-term surgical risks and long-term outcomes of patients with subclinical CAD who underwent CEA. METHODS The authors performed a retrospective study of data from a prospective CEA registry. They analyzed a total of 702 cases involving patients without a history of CAD who received preoperative cardiac risk assessment by radionuclide myocardial perfusion imaging (MPI) and underwent CEA over a 10-year period...
June 3, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27254026/effects-of-neoadjuvant-chemo-or-chemoradiotherapy-for-oesophageal-cancer-on-perioperative-haemodynamics-a-prospective-cohort-study-within-a-randomised-clinical-trial
#20
Mikael Lund, Jon A Tsai, Magnus Nilsson, Reidar Winter, Lars Lundell, Sigridur Kalman
BACKGROUND: Neoadjuvant chemoradiotherapy might improve oncological outcome compared with chemotherapy after surgery for oesophagus or gastrooesophageal junction cancer. However, radiotherapy may induce cardiovascular side-effects that could increase the risk of perioperative adverse effects and postoperative morbidity. OBJECTIVES: The aim of this study was to compare the perioperative haemodynamics in patients undergoing oesophagectomy following neoadjuvant chemotherapy or chemoradiotherapy for cancer...
September 2016: European Journal of Anaesthesiology
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