Raised plasma troponin, a diagnostic marker for myocardial infarction, usually occurs after cardiac surgery, leading to difficulties in diagnosing postoperative myocardial infarction. To ascertain whether the same processes influence troponin elevation in both conditions, a literature search was performed for plasma troponin elimination curves after myocardial infarction, myocardial infarction with reperfusion, and cardiac surgery. From 70 studies, 11 curves using the Stratus immunoassay kit were analyzed: 5 post-cardiac surgery (412 patients), 2 after myocardial infarction with reperfusion (169 patients), and 4 after myocardial infarction (640 patients). For each group, a new plot was formulated from the mean troponin level at each time interval. While the up-slope of the cardiac surgery curve was much steeper than that of myocardial infarction, resembling that of myocardial infarction with reperfusion, its down-slope was significantly more gentle than that of both other groups (−0.91 vs −5.31, t = 3.47, df = 8, p < 0.01). This suggests that postoperative troponin elevation involves enhanced cell permeability as seen after ischemia reperfusion rather than permanent cellular damage. The gentler down-slope may point to surgery-induced impaired troponin removal from the circulation. Due to the different mechanisms proposed, implications from post-myocardial infarction troponin levels may not be conferred on post-cardiac surgery patients.
TobacmanLS. Thin filament-mediated regulation of cardiac contraction. Annu Rev Physiol1996;58:447–81.
3.
BodorGSPorterfieldDVossEMSmithSAppleFS. Cardiac troponin-I is not expressed in fetal and healthy or diseased adult human skeletal muscle tissue. Clin Chem1995;41(12 pt 1):1710–5.
4.
MacGeochCBartonPJVallinsWJBhavsarPSpurrNK. The human cardiac troponin I locus: Assignment to chromosome 19p13.2–19q13.2. Hum Genet1991;88:101–4.
5.
AdamsJE3rdSchechtmanKBLandtYLadensonJHJaffeAS. Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I. Clin Chem1994;40(7 Pt 1):1291–5.
6.
BleierJVorderwinklerKPFalkensammerJMairPDapuntOPuschendorfB. Different intracellular compartmentations of cardiac troponins and myosin heavy chains: A causal connection to their different early release after myocardial damage. Clin Chem1998;44:1912–8.
7.
JaffeASLandtYParvinCAAbendscheinDRGeltmanEMLadensonJH. Comparative sensitivity of cardiac troponin I and lactate dehydrogenase isoenzymes for diagnosing acute myocardial infarction. Clin Chem1996;42:1770–6.
8.
KatrukhaAGBereznikovaAVEsakovaTVPetterssonKLovgrenTSeverinaME. Troponin I is released in bloodstream of patients with acute myocardial infarction not in free form but as complex. Clin Chem1997;43(8 Pt 1):1379–85.
9.
GiulianiIBertinchantJPGranierCLapradeMChocronSToubinG. Determination of cardiac troponin I forms in the blood of patients with acute myocardial infarction and patients receiving crystalloid or cold blood cardioplegia. Clin Chem1999;45:213–22.
10.
WuAHFengYJMooreRAppleFSMcPhersonPHBuechlerKF. Characterization of cardiac troponin subunit release into serum after acute myocardial infarction and comparison of assays for troponin T and I. American Association for Clinical Chemistry Subcommittee on cTnI Standardization. Clin Chem1998;44(6 Pt 1):1198–208.
11.
Di LisaFDe TullioRSalaminoFBarbatoRMelloniESiliprandiN. Specific degradation of troponin T and I by mu-calpain and its modulation by substrate phosphorylation. Biochem J1995;308(Pt 1):57–61.
12.
McDonoughJLArrellDKVan EykJE. Troponin I degradation and covalent complex formation accompanies myocardial ischemia/reperfusion injury. Circ Res1999;84:9–20.
13.
BodorGSOakeleyAEAllenPDCrimminsDLLadensonJHAndersonPA. Troponin I phosphorylation in the normal and failing adult human heart. Circulation1997;96:1495–500.
14.
KeaneNEQuirkPGGaoYPatchellVBPerrySVLevineBA. The ordered phosphorylation of cardiac troponin I by the cAMP-dependent protein kinase–structural consequences and functional implications. Eur J Biochem1997;248:329–37.
15.
al-HillawiEBhandariDGTrayerHRTrayerIP. The effects of phosphorylation of cardiac troponin-I on its interactions with actin and cardiac troponin-C. Eur J Biochem1995;228:962–70.
16.
BolliRMarbanE. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev1999;79:609–34.
17.
Van EykJEPowersFLawWLarueCHodgesRSSolaroRJ. Breakdown and release of myofilament proteins during ischemia and ischemia/reperfusion in rat hearts: Identification of degradation products and effects on the pCa-force relation. Circ Res1998;82:261–71.
18.
GaoWDAtarDLiuYPerezNGMurphyAMMarbanE. Role of troponin I proteolysis in the pathogenesis of stunned myocardium. Circ Res1997;80:393–9.
19.
Toyo-OkaTRossJJrCa2+ sensitivity change and troponin loss in cardiac natural actomyosin after coronary occlusion. Am J Physiol1981;240:H704–8.
20.
WestfallMVSolaroRJ. Alterations in myofibrillar function and protein profiles after complete global ischemia in rat hearts. Circ Res1992;70:302–13.
21.
MatsumuraYSaekiEInoueMHoriMKamadaTKusuokaH. Inhomogeneous disappearance of myofilament-related cytoskeletal proteins in stunned myocardium of guinea pig. Circ Res1996;79:447–54.
22.
HeinSScheffoldTSchaperJ. Ischemia induces early changes to cytoskeletal and contractile proteins in diseased human myocardium. J Thorac Cardiovasc Surg1995;110:89–98.
23.
GaoWDAtarDBackxPHMarbanE. Relationship between intracellular calcium and contractile force in stunned myocardium. Direct evidence for decreased myofilament Ca2+ responsiveness and altered diastolic function in intact ventricular muscle. Circ Res1995;76:1036–48.
24.
GorzaLMenaboRVitadelloMBergaminiCMDi LisaF. Cardiomyocyte troponin T immunoreactivity is modified by cross-linking resulting from intracellular calcium overload. Circulation1996;93:1896–904.
25.
GorzaLMenaboRDi LisaFVitadelloM. Troponin T cross-linking in human apoptotic cardiomyocytes. Am J Pathol1997;150:2087–97.
26.
EllisKDreisbachAWLertoraJL. Plasma elimination of cardiac troponin I in end-stage renal disease. South Med J2001;94:993–6.
27.
AppleFSHenryTDBergerCRLandtYA. Early monitoring of serum cardiac troponin I for assessment of coronary reperfusion following thrombolytic therapy. Am J Clin Pathol1996;105:6–10.
28.
GiraldiFGraziSGuazziMD. Early evaluation of results from systemic thrombolysis in acute myocardial infarct: The value of troponin I. Cardiologia1998;43:485–91.
29.
TanakaHAbeSYamashitaTArimaSSaigoMNakaoS. Serum levels of cardiac troponin I and troponin T in estimating myocardial infarct size soon after reperfusion. Coron Artery Dis1997;8:433–9.
30.
AntmanEMTanasijevicMJThompsonBSchactmanMMcCabeCHCannonCP. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med1996;335:1342–9.
31.
GalvaniMOttaniFFerriniDLadensonJHDestroABaccosD. Prognostic influence of elevated values of cardiac troponin I in patients with unstable angina. Circulation1997;95:2053–9.
32.
MentzerRMJrBirjiniukVKhuriSLoweJERahkoPSWeiselRD. Adenosine myocardial protection: Preliminary results of a phase II clinical trial. Ann Surg1999;229:643–50.
33.
FitchJCRollinsSMatisLAlfordBArankiSCollardCD. Pharmacology and biological efficacy of a recombinant, humanized, single-chain antibody C5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. Circulation1999;100:2499–506.
34.
TunerirBColakOAlatasOBesogulYKuralTAslanR. Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting. Ann Thorac Surg1999;68:2173–6.
35.
TomaiFDe PaulisRde PeppoPenta AColagrandeLCapraraEPoliscaP. Beneficial impact of isoflurane during coronary bypass surgery on troponin I release. G Ital Cardiol1999;29:1007–14.
36.
WendelHPHellerWMichelJMayerGOchsenfahrtCGraeterU. Lower cardiac troponin T levels in patients undergoing cardiopulmonary bypass and receiving high-dose aprotinin therapy indicate reduction of perioperative myocardial damage. J Thorac Cardiovasc Surg1995;109:1164–72.
37.
KohTWCarr-WhiteGSDeSouzaACFerdinandFDHooperJKempM. Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: Comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass. Heart1999;81:495–500.
38.
LoickHMSchmidtCVan AkenHJunkerRErrenMBerendesE. High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg1999;88:701–9.
39.
ChocronSAlwanKToubinGClementFKailiDTaberletC. Crystalloid cardioplegia route of delivery and cardiac troponin I release. Ann Thorac Surg1996;62:481–5.
40.
ChocronSAlwanKYanYToubinGKailiDAnguenotT. Warm reperfusion and myocardial protection. Ann Thorac Surg1998;66:2003–7.
41.
PichonHChocronSAlwanKToubinGKailiDFalcozP. Crystalloid versus cold blood cardioplegia and cardiac troponin I release. Circulation1997;96:316–20.
42.
ShiQLingMZhangXZhangMKadijevicLLiuS. Degradation of cardiac troponin I in serum complicates comparisons of cardiac troponin I assays. Clin Chem1999;45:1018–25.
43.
VermesEMesguichMHouelRSoustelleCLe BesneraisPHillionML. Cardiac troponin I release after open heart surgery: A marker of myocardial protection?Ann Thorac Surg2000;70:2087–90.
44.
OpfermannUTPeivandiAADahmMHilgenstockHHafnerGLoosA. Postoperative patterns and kinetics of cTnI, cTnT, CK-MB-activity and CK-activity after elective aortic valve replacement. Swiss Med Wkly2001;131:550–5.
45.
SadonyVKorberMAlbesGPodtschaskeVEtgenTTroskenT. Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg1998;13:57–65.
46.
BonnefoyEFilleySKirkorianGGuidolletJRorizRRobinJ. Troponin I, Troponin T, or creatine kinase-MB to detect perioperative myocardial damage after coronary artery bypass grafting. Chest1998;114:482–6.
47.
LuciaPCoppolaAManettiLLSebastianiMLColliardoACerroniF. Cardiac troponin I in acute coronary ischemic syndromes. Epidemiological and clinical correlates. Int J Cardiol2001;77:215–22.
48.
OhlmannPMonassierJPMichoteyMOBerengerNJacqueminLLavalG. Troponin I concentrations following primary percutaneous coronary intervention predict large infarct size and left ventricular dysfunction in patients with ST-segment elevation acute myocardial infarction. Atherosclerosis2003;168:181–9.
49.
AppleFSSharkeySWFalahatiAMurakamiMMithaNChristensenD. Assessment of left ventricular function using serum cardiac troponin I measurements following myocardial infarction. Clin Chim Acta1998;272:59–67.
50.
AppleFSChristensonRHValdesRJrAndriakAJBergADuhSH. Simultaneous rapid measurement of whole blood myoglobin, creatine kinase MB, and cardiac troponin I by the triage cardiac panel for detection of myocardial infarction. Clin Chem1999;45:199–205.
51.
FalahatiASharkeySWChristensenDMcCoyMMillerEAMurakamiMA. Implementation of serum cardiac troponin I as marker for detection of acute myocardial infarction. Am Heart J1999;137:332–7.
52.
DixonWJMasseyFJ. Introduction to statistical analysis. New York: McGraw-Hill, 1969:20811.
53.
GreensonNMacoviakJKrishnaswamyPMorriseyRJamesCCloptonP. Usefulness of cardiac troponin I in patients undergoing open heart surgery. Am Heart J2001;141:447–55.
54.
PeivandiAAHakeUDahmMOpfermannUTPeetzDHafnerG. Coronary revascularization: Off-pump versus on-pump—a comparison of behavior of biochemical cardiac ischemia markers. Z Kardiol2002;91:203–11.
55.
McDonoughJLLabuggerRPickettWTseMYMacKenzieSPangSC. Cardiac troponin I is modified in the myocardium of bypass patients. Circulation2001;103:58–64.
56.
PiperHMSchwartzPSpahrRHutterJFSpieckermannPG. Early enzyme release from myocardial cells is not due to irreversible cell damage. J Mol Cell Cardiol1984;16:385–8.
57.
WienenWKammermeierH. Intra- and extracellular markers in interstitial transudate of perfused rat hearts. Am J Physiol1988;254(4 Pt 2):H785–94.
58.
HeyndrickxGRAmanoJKennaTFallonJTPatrickTAMandersWT. Creatine kinase release not associated with myocardial necrosis after short periods of coronary artery occlusion in conscious baboons. J Am Coll Cardiol1985;6:1299–303.
59.
ZangrilloACrescenziGLandoniGBenussiSCrivellariMPappalardoF. The effect of concomitant radiofrequency ablation and surgical technique (repair versus replacement) on release of cardiac biomarkers during mitral valve surgery. Anesth Analg2005;101:24–9.
60.
HirschRDentCLWoodMKHuddlestonCBMendeloffENBalzerDT. Patterns and potential value of cardiac troponin I elevations after pediatric cardiac operations. Ann Thorac Surg1998:65;1394–9.
61.
PeivandiAADahmMVulcuSPeetzDHafnerGOelertH. Troponin I concentrations of shed blood might influence monitoring of myocardial injury after coronary operations. Transfus Apher Sci2001;25:157–62.
62.
ChenLW. Troponin I and autotransfusion of shed mediastinal blood in redo cardiac operation. Ann Thorac Surg1999;68:629–30.
63.
De PaulisRColagrandeLSeddioFPicicheMde PeppoPenta ABassanoC. Levels of troponin I and cardiac enzymes after reinfusion of shed blood in coronary operations. Ann Thorac Surg1998;65:1617–20.
64.
TateJRHeathcoteDRayfieldJHickmanPE. The lack of standardization of cardiac troponin I assay systems. Clin Chim Acta1999;284:141–9.
65.
AppleFS. Clinical and analytical standardization issues confronting cardiac troponin I. Clin Chem1999;45:18–20.
66.
MorrowDARifaiNTanasijevicMJWybengaDRde LemosJAAntmanEM. Clinical efficacy of three assays for cardiac troponin I for risk stratification in acute coronary syndromes: A Thrombolysis In Myocardial Infarction (TIMI) IIB Substudy. Clin Chem2000;46:453–60.
67.
LarueCDefacque-LacquementHCalzolariCLe NguyenDPauB. New monoclonal antibodies as probes for human cardiac troponin I: Epitopic analysis with synthetic peptides. Mol Immunol1992;29:271–8.
68.
NooraJRicciCHastingsDHillSCybulskyI. Determination of troponin I release after CABG surgery. J Card Surg2005;20:129–35.
