Markerii ischemiei miocardice în chirurgia cardiacă

Abstract

Background: The variations of the recovery time, complications and survival rates among the cardiac patients who have had a heart surgery are vast. Many formulas and theories are used to predict clinical outcome and recovery time. The identification of biomarkers that provide concrete, evidence supporting clinical outcomes has greatly affected such field of medicine as cardiology, helping the clinicians to predict a clinical course in acute ischemia. Recent studies have discovered the biomarkers that may be used as predictors of cardiac patients’ state after post-cardiothoracic surgery, besides, their applications are numerous. This study represents a review of widely recognized markers of myocardial ischaemia that are already included in guidelines and clinical protocols, as well as recently emerging markers for the diagnosis of acute coronary syndrome. A comparative analysis of the strength and weaknesses of the available markers, concerning to the detection of peri-operative ischaemia in cardiac surgery, has been made. Revealing of cardiac troponin (CTN), its isoforms CTN I and CTN T, being complemented by high-sensitivity CTN, have been accepted as a gold standard for detecting cardiac ischaemia. Conclusions: Developing sensitive methods for CTN suggests taking into account the false positive cases. Troponin determination results should be interpreted in a clinical context and can not be used in isolation. Multimarker approach would be useful in case of such opportunities. BNP appears to be one of the markers suitable for this approach to cardiac surgery. But further studies are needed to implement the new markers that are emerging on the market.