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Biomarker cardiac injury postoperative

W F Kok, J Koerts, O Tucha, T W L Scheeren, A R Absalom
Biomarkers of neurological injury can potentially predict postoperative cognitive dysfunction. We aimed to identify whether classical neuronal damage-specific biomarkers, including brain fatty acid-binding protein, neuron-specific enolase and S100 calcium-binding protein β, as well as plasma-free haemoglobin concentration as a measure of haemolysis, could be used to predict the risk of long-term cognitive decline after coronary artery bypass grafting with or without cardiopulmonary bypass. We assessed cognitive function using the CogState brief computerised cognitive test battery at 3 months and at 15 months after surgery...
December 17, 2016: Anaesthesia
Per Ederoth, Edgars Grins, Alain Dardashti, Björn Brondén, Carsten Metzsch, André Erdling, Shahab Nozohoor, Arash Mokhtari, Magnus J Hansson, Eskil Elmér, Lars Algotsson, Stefan Jovinge, Henrik Bjursten
INTRODUCTION: Acute kidney injury (AKI) after cardiac surgery is common and results in increased morbidity and mortality. One possible mechanism for AKI is ischaemia-reperfusion injury caused by the extracorporeal circulation (ECC), resulting in an opening of the mitochondrial permeability transition pore (mPTP) in the kidneys, which can lead to cell injury or cell death. Ciclosporin may block the opening of mPTP if administered before the ischaemia-reperfusion injury. We hypothesised that ciclosporin given before the start of ECC in cardiac surgery can decrease the degree of AKI...
December 15, 2016: BMJ Open
Christian Ortega-Loubon, Manuel Fernández-Molina, Yolanda Carrascal-Hinojal, Enrique Fulquet-Carreras
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication resulting with the higher morbid-mortality after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3-8-fold, length of stay in the Intensive Care Unit and hospital, and costs of care. Early diagnosis is critical for an optimal treatment of this complication. Just as the identification and correction of preoperative risk factors, the use of prophylactic measures during and after surgery to optimize renal function is essential to improve postoperative morbidity and mortality of these patients...
October 2016: Annals of Cardiac Anaesthesia
Peter A McCullough, Elliott Bennett-Guerrero, Lakhmir S Chawla, Thomas Beaver, Ravindra L Mehta, Bruce A Molitoris, Ann Eldred, Greg Ball, Ho-Jin Lee, Mark T Houser, Samina Khan
BACKGROUND: Patients undergoing cardiac surgeries with cardiopulmonary bypass (on-pump) have a high risk for acute kidney injury (AKI). We tested ABT-719, a novel α-melanocyte-stimulating hormone analog, for prevention of AKI in postoperative cardiac surgery patients. METHODS AND RESULTS: This phase 2b randomized, double-blind, placebo-controlled trial included adult patients with stable renal function undergoing high-risk on-pump cardiac surgery in the United States and Denmark...
August 20, 2016: Journal of the American Heart Association
Shay P McGuinness, Rachael L Parke, Kate Drummond, Tim Willcox, Michael Bailey, Cornelius Kruger, Megan Baker, Keri-Anne Cowdrey, Eileen Gilder, Lianne McCarthy, Thomas Painter
BACKGROUND: Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one of the most common forms of major surgery. Cardiac surgery-associated multiorgan dysfunction (CSA-MOD) is well recognized and includes acute kidney injury (AKI), hepatic impairment, myocardial damage, and postoperative neurologic deficit. Pathophysiology of CSA-MOD involves numerous injurious pathways linked to the use of CPB including oxidative stress and formation of reactive iron species. During cardiac surgery with CPB, arterial return blood is oxygenated to supranormal levels...
September 2016: Anesthesiology
Candice Torres de Melo Bezerra Cavalcante, Klébia Magalhães Castelo Branco, Valdester Cavalcante Pinto Júnior, Gdayllon Cavalcante Meneses, Fernanda Macedo de Oliveira Neves, Nayana Maria Gomes de Souza, Kiarelle Lourenço Penaforte, Alice Maria Costa Martins, Alexandre Braga Libório
OBJECTIVE: Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury. METHODS: We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery...
July 2016: Journal of Thoracic and Cardiovascular Surgery
Takahiro Moriyama, Shintaro Hagihara, Toko Shiramomo, Misaki Nagaoka, Shohei Iwakawa, Yuichi Kanmura
BACKGROUND: Acute kidney injury (AKI) is a serious complication after cardiac surgery, being associated with a high mortality. We assessed three urinary biomarkers, L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and angiotensinogen, which are elevated through different mechanisms, and investigated which of these biomarkers was the earliest and most useful indicator of AKI after cardiac surgery. METHODS: This study was a prospective observational study conducted at a single-institution university hospital...
2016: Journal of Intensive Care
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
Oruç Alper Onk, Didem Onk, Fatih Ozcelik, Murat Gunay, Kultigin Turkmen
INTRODUCTION: Acute kidney injury (AKI) is an important complication of cardiac surgery due to its high mortality. The aim of the present study was to detect the factors leading to AKI in patients who underwent coronary artery bypass surgery (CABS) and also to determine the optimal timing for detecting AKI using the biomarker neutrophil gelatinase-associated lipocalin (NGAL). MATERIALS AND METHODS: The records of 375 patients who underwent CABS were reviewed in this case-control study...
May 2016: Cardiorenal Medicine
Chirag R Parikh, Dennis G Moledina, Steven G Coca, Heather R Thiessen-Philbrook, Amit X Garg
The use of novel biomarkers of acute kidney injury (AKI) in clinical trials may help evaluate treatments for AKI. Here we explore potential applications of biomarkers in simulated clinical trials of AKI using data from the TRIBE-AKI multicenter, prospective cohort study of patients undergoing cardiac surgery. First, in a hypothetical trial of an effective therapy at the time of acute tubular necrosis to prevent kidney injury progression, use of an indirect kidney injury marker such as creatinine compared to a new direct biomarker of kidney injury reduces the proportion of true acute tubular necrosis cases enrolled...
June 2016: Kidney International
Zhe Zheng, Raja Jayaram, Lixin Jiang, Jonathan Emberson, Yan Zhao, Qi Li, Juan Du, Silvia Guarguagli, Michael Hill, Zhengming Chen, Rory Collins, Barbara Casadei
BACKGROUND: Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. METHODS: We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration...
May 5, 2016: New England Journal of Medicine
Jin Ha Park, Jae-Kwang Shim, Jong-Wook Song, Sarah Soh, Young-Lan Kwak
PURPOSE: Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have the potential to reduce acute kidney injury (AKI) after cardiac surgery through their pleiotropic properties. Here we studied the preventive effect of atorvastatin on AKI after valvular heart surgery. METHODS: Two-hundred statin-naïve patients were randomly allocated to receive either statin or placebo. Atorvastatin was administered orally to the statin group according to a dosage schedule (80 mg single dose on the evening prior to surgery; 40 mg on the morning of surgery; three further doses of 40 mg on the evenings of postoperative days 0, 1, and 2)...
September 2016: Intensive Care Medicine
Kate N Thomas, James D Cotter, Michael J A Williams, André M van Rij
INTRODUCTION: Routine measurement of cardiac biomarkers such as troponin T (TnT) is recommended perioperatively, especially in high-risk vascular surgery. Long-term prognosis is worse even in those with nonspecific perioperative myocardial injury. However, a clear understanding of these biomarker profiles and how they should affect patient management is lacking. METHODS: We examined the perioperative profile of high-sensitivity TnT (hsTnT) release in 85 patients undergoing elective major vascular surgery...
May 2016: Vascular and Endovascular Surgery
Bingjue Li, Xiabing Lang, Luxi Cao, Yuchen Wang, Yingying Lu, Shi Feng, Yi Yang, Jianghua Chen, Hong Jiang
It is currently controversial whether remote ischemic preconditioning (RIPC) reduces the incidence of acute kidney injury (AKI) in patients undergoing cardiovascular interventions. The main objective of this meta-analysis was to investigate whether RIPC provides renal protection for patients undergoing cardiac or vascular surgery. We searched the PubMed database (1966-Oct 2015), Embase database (1966-Oct 2015), Google Scholar, Cochrane Library, ClinicalTrials Database and Open Grey. Then we conducted a meta-analysis of the randomized controlled trials that met the inclusion criteria of our study...
April 18, 2016: Journal of Nephrology
Jalal Moludi, Seyedali Keshavarz, Ali Sadeghpour Tabaee, Saeid Safiri, Reza Pakzad
INTRODUCTION: Coronary artery bypass surgery (CABG) is associated with ischemia-reperfusion injury and tissue damage. CoQ10 as an antioxidant has an important role and may have cardio-protective effects after myocardial dysfunction and CABG. We aimed to evaluate whether CoQ10 has a myocardial cardio protective impact on cardiac biomarkers after CABG. METHODS: In this double-blind study, 80 patients with coronary artery disease (CAD) who underwent CABG surgery were divided into intervention and control groups and received Q10 supplement or placebo, respectively...
2016: Journal of Cardiovascular and Thoracic Research
Vishal Jain, Yatin Mehta, Abhinav Gupta, Reetesh Sharma, Arun Raizada, Naresh Trehan
OBJECTIVE: Acute kidney injury (AKI) is a commonly encountered postoperative complication after cardiac surgery especially in high risk patients. AKI though seen more commonly after conventional on pump coronary artery bypass surgery (CCABG), is not uncommon after off pump coronary bypass surgery (OPCAB). Various biomarkers have shown promise over last one decade as an early marker for predicting AKI postoperatively. NGAL is one such biomarker whose concentration is increased in urine after any nephrotoxic and ischemic insult...
April 2016: Annals of Cardiac Anaesthesia
Emilie P Belley-Côté, Chirag R Parikh, Colleen R Shortt, Steven G Coca, Amit X Garg, John W Eikelboom, Peter Kavsak, Eric McArthur, Heather Thiessen-Philbrook, Richard P Whitlock
OBJECTIVE: Acute kidney injury is common after cardiac surgery and associated with postoperative mortality. Perioperative cardiac biomarkers may predict acute kidney injury and mortality. We evaluated whether cardiac biomarkers were associated with severe acute kidney injury, defined as a doubling in serum creatinine or requiring renal replacement therapy during hospital stay after surgery, and mortality. METHODS: In a prospective multicenter cohort of adults undergoing cardiac surgery, we measured the following biomarkers in preoperative and postoperative banked plasma: high-sensitivity troponin T, cardiac troponin I, creatine kinase-MB, and N-terminal prohormone of brain natriuretic peptide...
July 2016: Journal of Thoracic and Cardiovascular Surgery
Songlin Du, Jun Ai, Xiangzhen Zeng, Jun Wan, Xu Wu, Jianxing He
This study was designed to test the hypothesis that whether the plasma level of advanced oxidant protein products (AOPPs) would be useful for the clinical diagnosis of acute lung injury (ALI) following cardiac surgery with the technique of cardiopulmonary bypass (CPB). In this prospective study, seventy consecutive adults undergoing open heart surgery with CPB were included and assigned into the ALI (n = 18) and non-ALI (n = 52) groups according to the American-European Consensus Criteria. Plasma concentrations of AOPPs were measured at baseline, postoperative 1 h, 12 h, 24 h, and 48 h...
2016: SpringerPlus
Meyeon Park, Michael G Shlipak, Heather Thiessen-Philbrook, Amit X Garg, Jay L Koyner, Steven G Coca, Chirag R Parikh
BACKGROUND: Acute kidney injury is a risk factor for death in cardiac surgical patients. Plasma cystatin C and creatinine have different temporal profiles in the postoperative setting, but the associations of simultaneous changes in both filtration markers compared with change in only one marker with prognosis after hospital discharge are not well described. METHODS: This is a longitudinal study of 1,199 high-risk adult cardiac surgical patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization...
April 2016: Annals of Thoracic Surgery
Katja M Gist, Jonathan Kaufman, Eduardo M da Cruz, Robert H Friesen, Sheri L Crumback, Megan Linders, Charles Edelstein, Christopher Altmann, Claire Palmer, Diana Jalal, Sarah Faubel
OBJECTIVES: Renal near-infrared spectroscopy is known to be predictive of acute kidney injury in children following cardiac surgery using a series of complex equations and area under the curve. This study was performed to determine if a greater than or equal to 20% reduction in renal near-infrared spectroscopy for 20 consecutive minutes intraoperatively or within the first 24 postoperative hours is associated with 1) acute kidney injury, 2) increased acute kidney injury biomarkers, or 3) other adverse clinical outcomes in children following cardiac surgery...
April 2016: Pediatric Critical Care Medicine
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