PMID- 29246240 OWN - NLM STAT- MEDLINE DCOM- 20180716 LR - 20220129 IS - 1749-8090 (Electronic) IS - 1749-8090 (Linking) VI - 12 IP - 1 DP - 2017 Dec 16 TI - Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. PG - 115 LID - 10.1186/s13019-017-0681-6 [doi] LID - 115 AB - BACKGROUND: Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction. METHODS: We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO). RESULTS: Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8] /s). Plasma hs-cTnI concentrations rose by >/=50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p < 0.01) but not systemic inflammation, myocardial inflammation or bypass time. CONCLUSION: Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations >10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations. FAU - Alam, Shirjel R AU - Alam SR AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. s.r.alam@sms.ed.ac.uk. FAU - Stirrat, Colin AU - Stirrat C AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Spath, Nick AU - Spath N AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Zamvar, Vipin AU - Zamvar V AD - Department of Cardiothoracic Surgery, Edinburgh Heart Centre, Edinburgh, UK. FAU - Pessotto, Renzo AU - Pessotto R AD - Department of Cardiothoracic Surgery, Edinburgh Heart Centre, Edinburgh, UK. FAU - Dweck, Marc R AU - Dweck MR AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Moore, Colin AU - Moore C AD - Department of Cardiothoracic Surgery, Edinburgh Heart Centre, Edinburgh, UK. FAU - Semple, Scott AU - Semple S AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. AD - Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK. FAU - El-Medany, Ahmed AU - El-Medany A AD - NHS Lothian, Edinburgh, UK. FAU - Manoharan, Divya AU - Manoharan D AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Mills, Nicholas L AU - Mills NL AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Shah, Anoop AU - Shah A AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Mirsadraee, Saeed AU - Mirsadraee S AD - Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK. FAU - Newby, David E AU - Newby DE AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. FAU - Henriksen, Peter A AU - Henriksen PA AD - BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK. LA - eng GR - FS/17/19/32641/BHF_/British Heart Foundation/United Kingdom GR - FS/14/78/31020/BHF_/British Heart Foundation/United Kingdom GR - R11/A135/Chest Heart and Stroke Scotland/ GR - FS/16/14/32023/BHF_/British Heart Foundation/United Kingdom GR - G1001339/MRC_/Medical Research Council/United Kingdom GR - Wellcome Trust/United Kingdom PT - Journal Article PT - Randomized Controlled Trial DEP - 20171216 PL - England TA - J Cardiothorac Surg JT - Journal of cardiothoracic surgery JID - 101265113 RN - 0 (Biomarkers) RN - 0 (Elafin) RN - 0 (Protease Inhibitors) RN - 0 (Troponin I) SB - IM MH - Aged MH - Biomarkers/blood MH - Coronary Artery Bypass/*adverse effects MH - Coronary Artery Disease/*surgery MH - Elafin/*administration & dosage MH - Female MH - Humans MH - *Intraoperative Complications MH - Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocardial Reperfusion Injury/blood/*etiology/prevention & control MH - Myocarditis/blood/*etiology/prevention & control MH - Protease Inhibitors/administration & dosage MH - Troponin I/*blood PMC - PMC5732376 OTO - NOTNLM OT - CABG OT - Inflammation OT - Myocardial infarction OT - Troponin OT - Type 5 COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The studies were undertaken with the approval of the Scotland A Research Ethics Committee and Lothian Local Research Ethics Committee 03 (REC 10/S1 103/50), who approved the use of the MRI contrast agent ferumoxytol (Feraheme, AMAG Pharmaceuticals) to investigate patients. The Elafin Myocardial Protection from Ischemia Reperfusion (EMPIRE) randomised controlled clinical trial was performed with the approval of the national research ethics committee (11/MRE00/5), under a Clinical Trial Authorization (27,586/0015/001-0001) from the Medicine and Healthcare products Regulatory Authority (MHRA, United Kingdom). The Medicines and Healthcare Products Regulatory Agency (MHRA) approved the use of the MRI contrast agent ferumoxytol (Rienso, Takeda; Feraheme, AMAG Pharmaceuticals) to investigate patients. All studies were conducted in accordance with the Declaration of Helsinki. CONSENT FOR PUBLICATION: All participants gave written informed consent for the trial and publication of results before participating in the study. An information sheet was provided and participants' general practitioners were informed in writing. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/12/17 06:00 MHDA- 2018/07/17 06:00 PMCR- 2017/12/16 CRDT- 2017/12/17 06:00 PHST- 2017/06/24 00:00 [received] PHST- 2017/12/01 00:00 [accepted] PHST- 2017/12/17 06:00 [entrez] PHST- 2017/12/17 06:00 [pubmed] PHST- 2018/07/17 06:00 [medline] PHST- 2017/12/16 00:00 [pmc-release] AID - 10.1186/s13019-017-0681-6 [pii] AID - 681 [pii] AID - 10.1186/s13019-017-0681-6 [doi] PST - epublish SO - J Cardiothorac Surg. 2017 Dec 16;12(1):115. doi: 10.1186/s13019-017-0681-6.