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Release of MB creatine kinase following coronary artery bypass grafting in the absence of myocardial infarction
ABSTRACTS
THE SIGNIFICANCE OF THE LATE FALL IN MYOCARDIAL pCO2 FOLLOWING ACUTE CORONARY OCCLUSION. Shukri F. Khuri, MD, Robert Kloner, MD, and Stephanie Karaffa, BS, West Roxbury V.A. Medical Center, Peter Bent Brigham Hospital, and Harvard Medical School, Boston, MA.
TUESDAY, MARCH 17, 1980 AM SURGERY IN CORONARY ARTERY 8:30- 12:00
Following coronary occlusion (CO) intramyocardial pCO2 (PmC02) rises, peaks and gradually falls. This study was performed to test the hypothesis that this late fall in PmC02 reflects a decrease in anaerobic metabolism (& produced by cells + bicarbonate buffereH2O+C02) due to progressive irreversible cell injury. I" 11 anesthetized open chest dogs, the anterior descending coronary artery was occluded for 3hrs (COA), reflow allowed for 45 minutes, and the occlusion reapplied (COB). PmC02 and intramyocardial [H+l were measured with a mass spectrometer (MS) and a new pH electrode. When P&02 peaked during COB, tissue adjacent to the MS probe was obtained and mean ischemic damage (MIS) scored O-4+ by morphometrics of 1~ histologic sections. Baseline PmC02 was 38+1.5 (mean?SEN) and peaked to 104i14 mmHg during COA; after 3hrs it fell to 6O-t17 mm Hg (P
RELEASE OF MB CREATINE KINASE FOLLOWING CORONARY ARTERY BYPASS GRAFTING IN THE ABSENCE OF MYOCARDIAL INFARCTION
THE EFFECT OF FIRST-DOSE ADRIAMYCIN ON THE CYCLIC NUCLEOTIDE LEVELS AND FUNCTION OF THE HUMAN MYOCAP.DIUM Donald V. Unverferth, MD; Richard H. Fertel, PhD; Raymond D. Magorien, MD; Stanley P. Balcerzak, MD; Robert L. Talley, MD, The Ohio State University College of Medicine, Columbus, Ohio. Adriamyci", (A) a" effective cancer chemotherapeutic agent often induces a2cardiomyopathy when the cumulative dose exceeds 550 mg/m . Animal studies suggest that large doses of A induce cardiomyopathy by inhibiting cardiac guanylate cyclase and lowering cyclic (c) GMP. This study investigates the CAMP and cGMP levels of human myocardium and relates the findings to measurements of myocardial function. Each of the 10 patients (average age = 48, normal cardiovascular examination) had a previously Systolic time intervals (PEP/LVET) and untreated tumor. echocardiograms (%aD) were performed at baseline (B) and 4 and 24 hours after the first $ose of intravenous bolus A (average dose = 50 + 6 mg/m ). An endomyocardial biopsy procedure was also performed at B, 4 and 24. Two samples from each procedure were analyzed for @MT' and The CAMP and cGMP (X f SEM) cGMP by radioimmunoassay. * = pCO.05 from B. are in fm/mcg protein. B 4 24 37.8 + 2.4 36.8 + 2.2 %All 34.2 + 2.0 ,325 T .018 .326 + .016* PEP/LVET .364 3 .021 2.5 +-0.6 CAMP 2.5 + 0.4 2.4 k-O.3 0.15+ 0.05* CGMP 0.16 + 0.05" 0.23 + 0.06 This study demonstrates that pharmacologic doses-of A cause a fall of human cardiac cGMP. Despite these early biochemical changes there was no deterioration of cardiac function. The inhibition of guanylate cyclase activity and fall of cGMP may be related to the chronic toxicity of A but this does not impair ventricular function in the first 24 hours.
416
February 1960
The American Journal of CARDIOLOGY
DISEASE
Dhun Sethna. MA. Richard Gray, M.D., FACC; William Shell M.D.; Carolyn Co&i", R.N.; Myles Lee, M.D.; Howard Feldman, M.D.; and Jack Matloff, M.D., FACC. Cedars-Sinai Medical Center, Los Angeles, California. Elevations of serum MB creatine kinase (MB-CK) activity in the immediate postoperative period in patients undergoing coronary artery bypass is usually associated with myocardial necrosis. However, enzyme elevations (18 f 2 IU/L, M f SE) were recently observed in 6 patients in the absence of EKG or scintigraphic (technetium 99 pyrophosphate) evidence of perioperative myocardial infarction. To test the hypothesis that surgical trauma of the atrium and aorta during cannulation for cardiopulmonary bypass may contribute to such elevated MB-CK levels, right atria1 appendage and aorta were biopsied at surgery and assayed for total CK (Rosalki technique) and MB-CK (column chromatography). The results are expressed in IU/lOO mg tissue protein: Total CK (N=9) Atrium Aorta
MB-CK
1068 l 143 18 f 6
(N=7)
215 f 42 3*1
% MB-CK 19.4 f 1.3 15.5 f 2.4
The results indicate that: 1) human atrium is a rich source of CK, the portion represeriting MB-CK being similar to that present in the ventricle (13%); 2) surgical manipulation of the atria may result in release of MB-CK causing elevated serum enzyme levels in the post coronary artery bypass patient in the absence 'of myocardial infarction.
RESTORATION OF MYOCARDIAL BLOOD FLOW RESERVE FOLLOWING REVASCULARIZATION. Donald H. Schmidt, M.D.; Fred M. Blau, M.S.; Linda L. Grzelak, B.S.; W. Dudley Johnson, M.D., FACC, University of Wisconsin-Mount Sinai Medical Center, Milwaukee, Wisconsin. Despite the controversy surrounding myocardial revascularization (MR), it has never been determined if its success is due directly to improving the supply of blood available to the myocardium during increased oxygen demand. In this study we have measured regional myocardial perfusion (RMP) at rest and following Isoproterenol (ISO) infusion in 15 patients (pts) prior to, and 8-10 days following MR. Results were compared to 10 pts with normal coronary arteries. RMP (ml/min/lOO q) "as measured with a multicrystal gamma camera from the myocardial washout of Xenon-133 following injection into a coronary artery or graft. P.MP was calculated in the region distal to a graft and compared to the same region in the preoperative study. After the control study, 4-8 uq/min IS0 "as infused to produce a heart rate (HR) increase of approximately 50%. To normalize RMP changes to the change in double product (DP= systolic BP x HR), a response index (RI= ARMP/ADP x 103) "as calculated, as well as coronary vascular resistance (CVR= MEAN BP/RMP). man results are as follo"s: *p<.o2 +p<.oo1 Normal (10) Pre-op (15) c post-op
HR 74 73 85
CONTROL RMP CVR 78 1.46 69 1.48 81
1.25
IS0 HR 118 106 +* 122
RMP 137 101 ++ 142
CVR .I3 1.07 +* .63
RI 10.4 5.9 +* 13.1
The results show a significant improvement in individual pts in HR, RMP, CVR, and RI with IS0 after MR. with values very close to normal. The results demonstrate that the success of MR is a direct result of improved myocardial flow reserve.
Volume 45
THE SIGNIFICANCE OF THE LATE FALL IN MYOCARDIAL pCO2 FOLLOWING ACUTE CORONARY OCCLUSION. Shukri F. Khuri, MD, Robert Kloner, MD, and Stephanie Karaffa, BS, West Roxbury V.A. Medical Center, Peter Bent Brigham Hospital, and Harvard Medical School, Boston, MA.
TUESDAY, MARCH 17, 1980 AM SURGERY IN CORONARY ARTERY 8:30- 12:00
Following coronary occlusion (CO) intramyocardial pCO2 (PmC02) rises, peaks and gradually falls. This study was performed to test the hypothesis that this late fall in PmC02 reflects a decrease in anaerobic metabolism (& produced by cells + bicarbonate buffereH2O+C02) due to progressive irreversible cell injury. I" 11 anesthetized open chest dogs, the anterior descending coronary artery was occluded for 3hrs (COA), reflow allowed for 45 minutes, and the occlusion reapplied (COB). PmC02 and intramyocardial [H+l were measured with a mass spectrometer (MS) and a new pH electrode. When P&02 peaked during COB, tissue adjacent to the MS probe was obtained and mean ischemic damage (MIS) scored O-4+ by morphometrics of 1~ histologic sections. Baseline PmC02 was 38+1.5 (mean?SEN) and peaked to 104i14 mmHg during COA; after 3hrs it fell to 6O-t17 mm Hg (P
RELEASE OF MB CREATINE KINASE FOLLOWING CORONARY ARTERY BYPASS GRAFTING IN THE ABSENCE OF MYOCARDIAL INFARCTION
THE EFFECT OF FIRST-DOSE ADRIAMYCIN ON THE CYCLIC NUCLEOTIDE LEVELS AND FUNCTION OF THE HUMAN MYOCAP.DIUM Donald V. Unverferth, MD; Richard H. Fertel, PhD; Raymond D. Magorien, MD; Stanley P. Balcerzak, MD; Robert L. Talley, MD, The Ohio State University College of Medicine, Columbus, Ohio. Adriamyci", (A) a" effective cancer chemotherapeutic agent often induces a2cardiomyopathy when the cumulative dose exceeds 550 mg/m . Animal studies suggest that large doses of A induce cardiomyopathy by inhibiting cardiac guanylate cyclase and lowering cyclic (c) GMP. This study investigates the CAMP and cGMP levels of human myocardium and relates the findings to measurements of myocardial function. Each of the 10 patients (average age = 48, normal cardiovascular examination) had a previously Systolic time intervals (PEP/LVET) and untreated tumor. echocardiograms (%aD) were performed at baseline (B) and 4 and 24 hours after the first $ose of intravenous bolus A (average dose = 50 + 6 mg/m ). An endomyocardial biopsy procedure was also performed at B, 4 and 24. Two samples from each procedure were analyzed for @MT' and The CAMP and cGMP (X f SEM) cGMP by radioimmunoassay. * = pCO.05 from B. are in fm/mcg protein. B 4 24 37.8 + 2.4 36.8 + 2.2 %All 34.2 + 2.0 ,325 T .018 .326 + .016* PEP/LVET .364 3 .021 2.5 +-0.6 CAMP 2.5 + 0.4 2.4 k-O.3 0.15+ 0.05* CGMP 0.16 + 0.05" 0.23 + 0.06 This study demonstrates that pharmacologic doses-of A cause a fall of human cardiac cGMP. Despite these early biochemical changes there was no deterioration of cardiac function. The inhibition of guanylate cyclase activity and fall of cGMP may be related to the chronic toxicity of A but this does not impair ventricular function in the first 24 hours.
416
February 1960
The American Journal of CARDIOLOGY
DISEASE
Dhun Sethna. MA. Richard Gray, M.D., FACC; William Shell M.D.; Carolyn Co&i", R.N.; Myles Lee, M.D.; Howard Feldman, M.D.; and Jack Matloff, M.D., FACC. Cedars-Sinai Medical Center, Los Angeles, California. Elevations of serum MB creatine kinase (MB-CK) activity in the immediate postoperative period in patients undergoing coronary artery bypass is usually associated with myocardial necrosis. However, enzyme elevations (18 f 2 IU/L, M f SE) were recently observed in 6 patients in the absence of EKG or scintigraphic (technetium 99 pyrophosphate) evidence of perioperative myocardial infarction. To test the hypothesis that surgical trauma of the atrium and aorta during cannulation for cardiopulmonary bypass may contribute to such elevated MB-CK levels, right atria1 appendage and aorta were biopsied at surgery and assayed for total CK (Rosalki technique) and MB-CK (column chromatography). The results are expressed in IU/lOO mg tissue protein: Total CK (N=9) Atrium Aorta
MB-CK
1068 l 143 18 f 6
(N=7)
215 f 42 3*1
% MB-CK 19.4 f 1.3 15.5 f 2.4
The results indicate that: 1) human atrium is a rich source of CK, the portion represeriting MB-CK being similar to that present in the ventricle (13%); 2) surgical manipulation of the atria may result in release of MB-CK causing elevated serum enzyme levels in the post coronary artery bypass patient in the absence 'of myocardial infarction.
RESTORATION OF MYOCARDIAL BLOOD FLOW RESERVE FOLLOWING REVASCULARIZATION. Donald H. Schmidt, M.D.; Fred M. Blau, M.S.; Linda L. Grzelak, B.S.; W. Dudley Johnson, M.D., FACC, University of Wisconsin-Mount Sinai Medical Center, Milwaukee, Wisconsin. Despite the controversy surrounding myocardial revascularization (MR), it has never been determined if its success is due directly to improving the supply of blood available to the myocardium during increased oxygen demand. In this study we have measured regional myocardial perfusion (RMP) at rest and following Isoproterenol (ISO) infusion in 15 patients (pts) prior to, and 8-10 days following MR. Results were compared to 10 pts with normal coronary arteries. RMP (ml/min/lOO q) "as measured with a multicrystal gamma camera from the myocardial washout of Xenon-133 following injection into a coronary artery or graft. P.MP was calculated in the region distal to a graft and compared to the same region in the preoperative study. After the control study, 4-8 uq/min IS0 "as infused to produce a heart rate (HR) increase of approximately 50%. To normalize RMP changes to the change in double product (DP= systolic BP x HR), a response index (RI= ARMP/ADP x 103) "as calculated, as well as coronary vascular resistance (CVR= MEAN BP/RMP). man results are as follo"s: *p<.o2 +p<.oo1 Normal (10) Pre-op (15) c post-op
HR 74 73 85
CONTROL RMP CVR 78 1.46 69 1.48 81
1.25
IS0 HR 118 106 +* 122
RMP 137 101 ++ 142
CVR .I3 1.07 +* .63
RI 10.4 5.9 +* 13.1
The results show a significant improvement in individual pts in HR, RMP, CVR, and RI with IS0 after MR. with values very close to normal. The results demonstrate that the success of MR is a direct result of improved myocardial flow reserve.
Volume 45