BACKGROUND

The aim of the present study was to determine relationship of ischemia-modified albumin (IMA) level, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) to appendicitis in children.

METHODS

Study included total of 63 patients who presented at hospital between May 2015 and November 2015. Of these, 30 were cases of appendicitis, and 33 were healthy control subjects. The groups were statistically similar in age and gender.

RESULTS

Receiver operating characteristic curve was evaluated for IMA, CRP, ESR, WBC, MPV, NLR, and PLR values in patients with appendicitis, and IMA was determined to have highest area under the curve value (0.991), followed by NLR (0.946), CRP (0.808), PLR (0.779), ESR (0.767), WBC (0.749), and MPV (0.583).

CONCLUSIONS

Use of NLR, PLR, IMA, and ESR values may be helpful in diagnosis of appendicitis, in addition to WBC and CRP values, lower right quadrant abdominal pain, and ultrasonography signs commonly used.

The aim of this study was to determine the diagnostic and prognostic significance of ischemia modified albumin (IMA) levels in patients with Crimean-Congo hemorrhagic fever (CCHF). This retrospective study was conducted with patients with CCHF. IMA levels in patients with CCHF were determined using the rapid colorimetric method. IMA levels of CCHF patients were significantly higher compared with the control group (P = 0.0001). At an IMA cut-off point of 0.555 ABSU (absorbance units), sensitivity was 65.1%, specificity 82.5%, positive predictive values (PPV) 82.5%, and negative predictive values (NPV) 65.1%. IMA levels of patients with hemorrhage were significantly higher compared with patients without hemorrhage (P = 0.005). IMA has been validated as both a new and sensitive ischemia and oxidative stress biomarker. In addition to its diagnostic significance, IMA investigated in CCHF patients at time of arrival may be an important marker with its prognostic role in determining in the early stage whether the disease will follow a hemorrhagic course.

BACKGROUND

The purpose of our study was to examine the role of cobalt-albumin binding assay (CABA) for the early diagnosis of abdominal compartment syndrome (ACS).

METHODS

Twenty-four anesthetized and ventilated rabbits were randomly assigned to four groups as 1 to 4, with each group comprised of six animals. Intraabdominal hypertension of 25 mmHg was induced for 15, 30, 45, and 60 minutes by insufflation in the four groups, respectively. Five ml of blood was drawn from each animal before the animals were sacrificed. A CABA test was performed on the samples and results were compared with pathologic diagnosis of intestinal samples shown as a score of damage severity values.

RESULTS

Ischemia-modified albumin (IMA) in Group 4 was significantly higher than in Group 1 and Group 2 (0.65 ± 0.16, 0.60 ± 0.25 and 0.61 ± 0.14, respectively; p < 0.05). However, there was no significant difference between the IMA of Group 3 and Group 4. Score of damage severity values reached statistically significant levels in Group 4 compared with Group 1 and Group 2 (p < 0.004 and 0.006, respectively) and in Group 3 compared with Group 1 (p < 0.004). There was also a statistically significant difference between Groups 1 and 2 (p < 0.004).

CONCLUSIONS

CABA plays an important role in the early diagnosis of ACS at the beginning of intestinal ischemia.

Varicocele is the most common and surgically correctible cause of male infertility in men attending to infertility clinics. Infertility affects 15% of all couples and male factor is the primary or contributing cause in 40% to 60% of cases. Varicocele has been shown to cause male infertility in about 15% of infertile couples. Molecular mechanisms responsible from varicocele induced testicular dysfunction and male infertility have not been completely unknown. Recent years have witnessed a huge amount of scientific works devoted to the mechanism of varicocele associated male infertility and rapid progress in research on its cellular and molecular mechanisms, including apoptosis and oxidative stress of germ cells. Here we evaluated internal spermatic vein and brachal vein ischemia modified albumin (IMA) level in 40 adult male patients with varicocele. IMA level was analyzed using albumin cobalt-binding test. Spermatic vein and brachial vein IMA levels were 0.381 ± 0.135 ABSU (absorbance units) and 0.385 ± 0.131 ABSU, respectively. There was no statistically significant difference between the two areas. IMA levels in the internal spermatic vein of patients with varicocele should not be used as a marker of hypoxia.

OBJECTIVE

To investigate the emphasis of oxidative stress in the pathogenesis of vitiligo through an evaluation of ischemia-modified albumin (IMA). Results/methodology: IMA was of higher statistical significance in patients than in the control group (IMA: 0.57 ± 0.2 vs 0.52 ± 0.2 ΔABSU; p < 0.0001). IMA (p < 0.0001; OR: 8.9; 95% CI = 3.1-26.1) was found as an independent predictor of oxidative stress. Increases in affected body surface area and age were found to be independent risk factors for IMA. The sensitivity, specificity and positive and negative predictive values and capacity of IMA were higher than other studied biomarkers.

CONCLUSIONS

IMA can be detected in the condition of oxidative stress in vitiligo; it has great potential as a biomarker of said condition, when compared with other studied biomarkers.

OBJECTIVE

To evaluate ischemia-modified albumin (IMA) in women who had been pregnant with a child suffering from neural tube defect.

METHODS

Samples from 50 women who had been pregnant with an affected child (25 spina bifida, 25 anencephaly) and 25 controls matched for age, gestational age, and body mass index were studied. We measured serum IMA by enzyme-linked immunosorbent assay.

RESULTS

Serum IMA was significantly higher in the study group compared to normal pregnancies (p < 0.05). The area under the receiver operating curve was 0.858 for IMA (95% CI, 0.769-0.947), whereas the optimal threshold value of IMA to discriminate between affected children and controls was 0.409 (sensitivity 88%, specificity 80%). The risk for increased IMA in mothers who have conceived a fetus with neural tube defect is 24.5 times higher than in the control group (rr = 24.5, 6.9-86.9, 95% CI) (p = 0.001).

CONCLUSIONS

This study indicates that serum IMA in women who have conceived a fetus with neural tube defect is significantly higher than that in normal pregnant women.

Objective: No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED.

Methods: This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance.

Results: This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667-0.791] vs. 0.681 [0.613-0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613-0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762-0.867) and 0.806 (0.754-0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00-1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02-1.11; P=0.002).

Conclusion: Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.

Keywords: Biomarkers; Ischemia-modified albumin; Sepsis; Shock, septic.

It is important to determine the grade of the coronary collateral circulation (CCC) in patients with stable coronary artery disease.

In this study, we aimed to investigate the relationship between the ischaemia-modified albumin (IMA) level and good CCC.

A total of 95 patients with coronary angiography and at least one epicardial coronary artery obstruction were included in the study. The Rentrop classification was used with CCC grading, where 0 and 1 were defined as poor collateral, and 2 and 3 were defined as good collateral. The IMA level of the patients was measured using an enzyme-linked immunosorbent assay (ELISA). The receiver-operating characteristic curve was used to show the sensitivity and specificity of IMA levels and the optimal cut-off value for predicting good CCC.

The multiple logistic regression analysis revealed that the IMA level in the good CCC group was higher (p < 0.045). Conversely, the high-sensitivity C-reactive protein level was lower in the good CCC group (p < 0.023). We found an IMA cut-off value (4.7 ng/mL) that indicated good CCC level, and this shows good CCC with 70.2% sensitivity and 60.3% specificity.

The IMA level could serve as a simple and useful predictor of well-developed CCC.

BACKGROUND

Although Ranson score is the most commonly used prognostic model in the severity of acute pancreatitis (AP), ischemia-modified albumin (IMA) has been reported as a novel biomarker of various ischemia-based diseases in recent years. The aim of the present study is to investigate the correlation between Ranson score and IMA in patients with AP.

METHODS

Forty-three patients with AP were included in the study. All patients were classified as mild and severe AP. Plasma IMA level was measured after diagnosis and before treatment. The correlation between IMA level and amylase level, Ranson score, and disease severity was evaluated.

RESULTS

Twenty-nine (67.4%) patients were diagnosed as mild AP; the remaining 14 (32.6%) patients had moderately severe or severe form of disease, and were classified as severe AP. There was no significant difference in the IMA levels between the patient groups (p=0.737). No correlation between IMA levels and amylase levels (p=0.470), Ranson score (p=0.664), and disease severity (p=0.741) was found.

CONCLUSIONS

According to the results from the study, IMA does not seem as a useful marker in earlier prediction of disease severity in AP. Despite important disadvantages, Ranson score still indicates the disease severity more accurately.

OBJECTIVE

Previous reports have demonstrated that the serum levels of vascular endothelial growth factor (VEGF) are reduced after intravitreal injections of bevacizumab. This study aimed to determine the serum levels of ischemia-modified albumin (IMA), a marker of ischemia, and VEGF following intravitreal injections of bevacizumab.

METHODS

This was a prospective study. Blood samples were drawn prior to injection and at 1, 7, and 30 days after injection.

RESULTS

A total of 11 patients participated in this study. Mean serum IMA levels were lower than baseline during follow-up, with statistically significant differences compared to baseline levels at day 1 and day 30 (preinjection: 49.82 ± 15.28 ng/mL; 44.57 ± 12.01 ng/mL, p = 0.007, and 43.71 ± 13.82 ng/mL, p = 0.001, respectively). Mean serum VEGF levels were lower than baseline throughout the follow-up period (from 307.45 ± 273.45 pg/mL at baseline to 159.55 ± 120.68 pg/mL at day 30). Mean serum VEGF levels were significantly lower compared to baseline levels at day 1 and day 7 (147.09 ± 106.08 pg/mL, p = 0.014; 72.91 ± 50 pg/mL, p = 0.011, respectively).

CONCLUSIONS

In this study, mean serum IMA and VEGF levels were lower following intravitreal bevacizumab injections.

OBJECTIVE

Myocardial perfusion scintigraphy (MPS) is a diagnostic tool commonly used to detect significant coronary lesion. However equivocal, false negative or positive results can be yielded. Controversial findings regarding the role of ischemia-modified albumin (IMA) in MPS evaluation persist. The aim of the present study was to examine the role of serum IMA in the assessment of MPS results.

METHODS

MPS using technetium (99mTc) sestamibi and transthoracic echocardiography was performed on 62 consecutive subjects prospectively enrolled. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia. During MPS performance, blood samples for serum IMA were obtained at 3 times: at pre-exercise, at the peak of ETT, and 6 hours after ETT. Patients were classified into 3 groups according to MPS results (normal, equivocal, and ischemia).

RESULTS

Sixty-two patients (23 normal, 20 equivocal, 19 with ischemia) were included. Pre- and peak-exercise IMA values were similar among the groups (p=0.706 and 0.904). Post-exercise IMA values of the normal and equivocal groups were similar (p=0.733), while that of the ischemia group was significantly higher than the values of either the normal (p<0.001) or equivocal groups (p<0.001). ΔIMA (the difference between post-exercise and peak-exercise IMA) of the ischemia group was significantly higher than that of either the normal (p<0.001) or equivocal groups (p<0.001).

CONCLUSIONS

Serum IMA was found to be significantly increased in cases of ischemia on MPS. Subjects with normal and equivocal MPS had a similar pattern during the test. IMA may be used in differentiation of equivocal results from false positive results.

Our aim was to explore the existence of a possible relationship of sperm motility with serum 25-hydroxyvitamin D3 (25-OH VD) levels and with ischaemia-modified albumin (IMA) levels in infertile Turkish men. A total of 30 men with nonobstructive azoospermia (no spermatozoa in ejaculate), 30 men with oligospermia (total progressive motile sperm count (TPMSC) <15 × 10⁶ /ml) and 33 fertile men with normospermia (with at least one child, as the control group) were enrolled in the study. The mean 25-OH VD levels for groups 1, 2 and 3 were 9.31 ± 6.46, 19.71 ± 12.80 and 30.52 ± 12.49 respectively (p < .05). There was a statistically significant difference in serum IMA levels among the groups (479.32 ± 307.56 vs. 296.37 ± 127.27 vs. 150.04 ± 81.05, respectively; p < .05). A positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels were determined. Infertile men had lower serum 25-OH VD and higher IMA levels than fertile men, with a positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels. Vitamin D supplementation may increase the sperm motility.

BACKGROUND

Oxidative stress plays an important role in promoting proliferation and metastases of cancer, which can be represented by ischemia-modified albumin (IMA). The purpose of this study was to evaluate serum IMA level in patients with operable advanced gastric cancer and analyze its prognostic significance.

METHODS

A total of 274 patients with primary stage III gastric cancer underwent curative operation were enrolled in this study. Serum IMA level was measured within 24 hours before surgery, comparing with 112 healthy donors. The correlation between serum IMA level and survival outcome was analyzed by the Kaplan-Meier with Log-Rank test and Cox's regression methods, respectively.

RESULTS

Serum IMA level from gastric cancer was higher than healthy control (0.41 ± 0.12 VS 0.23 ± 0.08; P< 0.001). Finally, 173 and 181 patients out of all 274 patients studied had died and recurrent, respectively. All patients were stratified into two groups using the optimal cutoff value (0.45) of IMA level using a sensitivity of 92.5% and a specificity of 65.2% as optimal conditions from receiver operating curve analysis. Patients with a IMA ⩾ 0.45 had poorer mean overall survival (44.68 months VS 30.94 months, P= 0.010) and mean recurrence free survival (42.36 months VS 28.82 months, p= 0.01) than patients with a IMA < 0.45 in univariate analysis and IMA also been confirmed as independent predictor for survival for GC patients in multivariate analysis (OR, 0.731; 95% CI: 0.329-1.282; p= 0.023).

CONCLUSIONS

Serum IMA level can be considered as an independent prognostic factor for operable and advanced gastric cancer.

BACKGROUND

The Braunwald classification and TIMI (Thrombolysis In Myocardial Infarction) risk score are used to stratify cardiovascular risk in patients with unstable angina (UA). However, these scores have a limited capacity in the practice of cardiology.

OBJECTIVE

This study sought to develop a new score, based on blood biomarkers and coronary computed tomographic angiography (CCTA) characteristics, for patients with UA.

METHODS

The study group consisted of 201 patients with confirmed UA. Follow-up time was 1 year; major adverse cardiac events (MACEs) included cardiovascular death, recurrent acute coronary syndrome (ACS), and re-admission to hospital. Blood biomarkers including high-sensitivity cardiac troponin T (Hs-cTnT), high-sensitivity C-reactive protein (Hs-CRP), myeloperoxidase (MPO) N-terminal pro-B-type natriuretic peptide (NT-proBNP), and ischemia-modified albumin (IMA) were measured. CCTA characteristics such as stenosis, plaque, epicardial fat volume (EFV), and calcification were evaluated. After analysis of relationships, the novel risk BETTER (BiomarkErs and compuTed Tomography scorE on Risk stratification) score was assessed in 201 patients.

RESULTS

In all, 25 MACEs (12.44 %) occurred: 2 cardiac deaths (1.00 %), 13 non-fatal myocardial infarctions (6.47 %), 10 recurrent ACS and re-admission in hospital (4.96 %). Serum levels of MPO, NT-proBNP, Hs-TnT, Hs-CRP, and IMA were correlated with MACEs (r = 0.20, r = 0.40, r = 0.18, r = 0.24, p < 0.01, respectively; r = 0.12, p>> 0.05). CCTA characteristics of stenosis, plaque, EFV, and calcification were significantly correlated with MACEs (r = 0.53, r = 0.57, r = 0.42, and r = 0.52, all p < 0.01 respectively) and were significantly higher in the MACEs group than in the non-MACEs group. Thus, a new risk score was created combining biomarkers and CCTA statistics into a Cox multivariable for risk prediction of 1-year MACEs: BETTER risk score = MPO•0.1 + Hs-TnT•50 + Hs-CRP•0.4 + stenosis•9 + plaque•13 + EFV•0.2. The areas under the curve (AUC) for the prediction by Hs-cTnT, Hs-CRP, and MPO were 0.536 (95 % CI 0.409-0.662), 0.745 (95 % CI 0.641-0.850), and 0.650 (95 % CI 0.541-0.760), respectively. The AUC for the prediction of CCTA characteristics of stenosis, plaque, and EFV were 0.905 (95 % CI 0.860-0.950), 0.912 (95 % CI 0.867-0.957), and 0.835 (95 % CI 0.752-0.917), respectively. In addition, the AUC was 0.621 (95 % CI 0.492-0.750) for the Braunwald classification and 0.680 (95 % CI 0.559-0.801) for the TIMI score. The AUC for the BETTER risk score was 0.937 (95 % CI 0.902-0.972).

CONCLUSIONS

The BETTER risk score is new tool specifically developed for patients with UA. The score displays higher prediction accuracy in terms of discrimination and calibration than other currently available scores for risk stratification.

OBJECTIVE

To study the role and mechanism of myocardial apoptosis after short-term and long-term exercise preconditioning.

METHODS

Forty-eight male SD rats were randomly divided into control group (C), exhaust group (E), short-exercise preconditioning (S-EP) and long-term exercise preconditioning group (L-EP). Short-term and long-term exercise preconditioning were conducted for 3 days and 3 weeks of repeated intermittent swimming training program. The changes of myocardial cells were observed under light microscope. The serum levels of ischemia-modified albumin(IMA) and creatine kinase-isoenzyme(CK-MB) were detected by ELISA. Real time fluorescence quantitative PCR and Western blot were used to detect the expressions of tumor necrosis factor-α(TNF-α),Caspase-8, Caspase-3 genes and proteins in myocardial tissue. The apoptosis of cardiomyocytes was observed by TUNEL method.

RESULTS

Compared with group C, group E had serious myocardial injury. The levels of serum IMA, CK-MB and the expressions of TNF-α, Caspase-8 and Caspase-3 in myocardium were increased (P<0.05). Compared with group E, serum CK-MB and TNF-α and Caspase-8 mRNA in S-EP group were significantly lower than those in group E (P<0.05), but there was no significant difference in serum IMA and Caspase-3 mRNA and protein (P>0.05). The levels of serum IMA, CK-MB and TNF-α, Caspase-8 and Caspase-3 mRNA in L-EP group were significantly lower than those in control group (P<0.05). The apoptosis of cardiomyocytes in group E was obvious. Short-term and long-term exercise preconditioning could inhibit apoptosis. Compared with S-EP group, the apoptosis of L-EP group was significantly decreased.

CONCLUSIONS

Short-term and long-term exercise preconditioning can reduce myocardial injury after exhaustive exercise, but short-term exercise preconditioning does not alter the expression of Caspase protease. Long-term exercise preconditioning significantly inhibits Caspase-8, 3 mRNA expression and reduces protein synthesis. The inhibitive effects of long-term exercise preconditioning on myocardial cell apoptosis were stronger than those of short-term exercise preconditioning.

OBJECTIVE

In patients with acute chest pain, we derived a cutpoint for ischaemia-modified albumin (IMA) and prospectively validated this cutpoint to predict 30-day major adverse cardiac events (MACEs).

METHODS

We prospectively recruited a derivation cohort (18-month period) to establish a serum IMA cutpoint targeting 80% sensitivity. This was followed by a prospective validation cohort study of emergency department patients with acute chest pain at two university hospitals over a 3-month period. A MACE was defined as myocardial infarction, revascularisation or death at 30-day follow-up.

RESULTS

In the derivation cohort of 151 patients, the IMA cutpoint that achieved 80% sensitivity for MACEs was 75 KU/litre. The sensitivity was prospectively validated in 171 patients consecutively enrolled, of whom 106 underwent multiple-biomarker analysis (19.8% MACE rate, 81% sensitivity of IMA). Furthermore, IMA by itself (81%, p<0.01) and in combination with initial highly sensitive cardiac troponin T (hsTnT) (90%, p<0.001) had significantly higher sensitivity than initial hsTnT (29%) for prediction of MACEs.

CONCLUSIONS

We prospectively validated the sensitive IMA cutpoint of 75 KU/litre with 80% sensitivity for MACEs in patients with acute chest pain. Our data suggest that IMA alone and in combination with initial hsTnT are more sensitive than the initial hsTnT for MACEs.

OBJECTIVE

The purpose of this study was to evaluate the effects of dexmedetomidine (DEX) on patients with hypertensive myocardial hypertrophy.

METHODS

Fifty four patients with hypertensive myocardial hypertrophy were enrolled in the study and were randomly divided into two groups (n=27). Patients in groupD were pretreated with DEX (1 μg/kg) before induction and then maintain with 0.5 μg/(kg·h) DEX. Patients in group C were pretreated with saline at the same time. All patients were connected with holter recorder 2 h before anesthesia and were continuously recorded for 24 h. Blood sample were collected to measure ischemia modified albumin(IMA) and serum cardiac troponin I (cTnI) at the time of T0 (before induction), T1(1 h after surgery), T2(4 h after surgery), T3(12 h after surgery) and T4(24 h after surgery). The surgery time, blood loss and side effect of two groups were recorded at the same time.

RESULTS

The serum IMA level in group D was lower than that of group C at the time of T1, T2 and T3 (P<0.05). The serum cTnI in group C was higher than that of group D at the time of T1, T2, T3 and T4 (P<0.05). Changes of ST and complicated ventricular arrhythmias ingroup D were lower than those of group C (P<0.05).

CONCLUSIONS

DEX could reduce the incidence of myocardial damage, changes of ST and complicated ventricular arrhythmias in patients with hypertensive myocardial hypertrophy.

BACKGROUND

Antegrade cerebral perfusion in aortic surgery is a well-established brain protection method. Open distal anastomosis during aortic surgery has some well-known advantages. Antegrade cerebral perfusion allows repair to some extent of the aortic arch, even in isolated ascending aortic aneurysm. The present study aims to investigate the adequacy of contralateral perfusion with novel oxidative stress parameters during unilateral antegrade cerebral perfusion.

METHODS

The study included 30 consecutive patients undergoing thoracic aortic surgery with unilateral antegrade cerebral perfusion (uACP) under moderate hypothermia (28° C). Blood samples from right and left jugular vein were obtained at four time intervals during surgery (after the anaesthetic induction - Phase 1, at the beginning of cardiopulmonary bypass - Phase 2, 15th minute of uACP - Phase 3 and after weaning from cardiopulmonary bypass - Phase 4). Novel oxidative stress parameters (advanced oxidation protein products, sialic acid, thiol reagents and ischaemia-modified serum albumin), blood gas analysis, and serum glucose and lactate levels were measured. In addition, intraoperative and early postoperative follow-up parameters were recorded.

RESULTS

Mean unilateral antegrade cerebral perfusion time was observed to be 16.4±5.9min (9 - 46min). No significant differences between right and left hemispheres were observed in novel oxidative parameters or biochemical values. There was only one temporary neurological deficit (3.3%) in the patient group.

CONCLUSIONS

The present study demonstrated that open distal anastomosis for hemiarch repair can be performed safely with unilateral antegrade cerebral perfusion under moderate hypothermia with both clinical outcome and novel biomarkers.

OBJECTIVE

To evaluate the value of human fatty acid binding protein (h-FABP) in predicting myocardial ischemia and injury in the perioperative period of cardiac surgery, we observed the dynamic changes of h-FABP in perioperative period of patients underwent coronary artery bypass grafting and ventricular septal defects repairing surgery, and evaluated the relationship of h-FABP and ischemia modified albumin (IMA), CK-MB, cTnI.

METHODS

Patients underwent coronary artery bypass grafting (n=30) and ventricular septal defect repairing (n=30) surgery between February 2008 and December 2008 were included in this study. Venous blood sample was obtained at preoperative, aortic clamping, aortic unclamping of 10 min, 2 h, 6 h, 12 h, 24 h for the measurements of h-FABP, IMA, cTnI and CK-MB.

RESULTS

h-FABP and IMA changed in the same way at various examined time points, h-FABP changes also paralleled cTnI and CK-MB changes, h-FABP peaked early during myocardial ischemia and injury and returned to baseline level at 2 h post myocardial ischemia and injury. Linear correlation analysis showed that the peak value of h-FABP was positively correlated with IMA, CK-MB and cTnI in both CABG group (r = 0.948, 0.964 and 0.961, P < 0.05) and in the VSD group (r = 0.986, 0.978 and 0.957).

CONCLUSIONS

h-FABP is an early diagnostic parameter reflecting perioperative myocardial ischemia and injury in cardiac surgery. Quantitative h-FABP monitoring could predict the severity of myocardial ischemia and injury early during cardiac surgery.

Acute coronary syndrome is a set of symptoms interpreted as being the result of cardiac ischemia. The subtypes of acute coronary syndrome, depending on the degree of cardiac ischemia, include unstable angina and two forms of myocardial infarction. Determination of serum cardiac markers plays a key role in the diagnosis of acute myocardial infarction. Serum markers such as aspartate transaminase, lactate dehydrogenase, and creatine kinase are no longer used because they lack cardiac specificity and sensitivity. According to the NACB (National Academy of Clinical Biochemistry) recommendations, two serum cardiac markers need to be determined for routine diagnosis of acute myocardial infarction, i.e. one showing early elevation in serum (up to six hours after chest pain), and the other, late marker that is elevated six to nine hours after chest pain, has high sensitivity and specificity for detection of myocardial injury, and remains elevated for several days of the symptom onset. In current clinical practice, myoglobin, CKMB mass (improved diagnostic sensitivity in relation to CKMB activity) and cardiac troponins are commonly determined. CKMB mass is a cardiospecific marker, but can also be elevated in skeletal muscle damage. Myoglobin is not cardiospecific, but has high early sensitivity (fast and reliable exclusion of acute myocardial infarction) and the possibility of rapid assessment of the success of thrombolytic therapy. Cardiac troponins are late markers for the diagnosis of myocardial injury. They are markers with highest specificity and sensitivity for acute myocardial infarction. New markers such as ischemia modified albumin, heart fatty acid binding protein, glycogen phosphorylase isoenzyme BB, carboanhydrase 3, and new tehnologies are under investigation to advance our knowledge about heart disease.