International Medical Journal, Vol. 23., Iss. 4, 2017, P. 72−78.
PROGNOSTIC SIGNIFICANCE OF MYOCARDIAL DAMAGE MARKERS IN THE PERIOPERATIVE PERIOD IN PATIENTS WITH ACUTE CORONARY SYNDROME AT CORONARY ARTERY BYPASS GRAFTING
Heart Institute of the Ministry of Health of Ukraine, Kyiv
Kharkiv National Medical University, Ukraine
Interventions with artificial circulation in patients with acute coronary syndrome are inevitably accompanied by ischemic damage to the myocardium, which leads to the appearance of cardiospecific enzymes and other biologically active substances in the blood, which are used as markers reflecting the degree of myocardial damage and severity of acute heart failure. To study the effect of levosimendan in the perioperative period on the level of markers of myocardial damage, the patients with acute coronary syndrome, who underwent coronary artery bypass graft were investigated. Hemodynamic indices were compared in patients who were applied a local protocol of anesthesia an intensive therapy and those who were additionally treated with levosimendan according to the following scheme: before induction to anesthesia 10 ?g/kg for 10 min, then at 0.1 ?g/kg/min up to 8 hours following the operation. The study was carried out at the following stages: 1) before surgery; 2) after cardiopulmonary bypass; 3) transfer to the intensive care unit; 4) transfer from the intensive care unit. At these stages, in addition to parameters of intracardiac and central hemodynamics, the levels of such markers of myocardial damage as TnI, СРK −− MB and NT proBNP were fixed. Analysis of the relationship between the baseline levels of myocardial damage markers and hemodynamic parameters at the end of the study suggests that elevated concentrations of the studied markers of myocardial damage allow to expect slowdown in the recovery of pumping function of the heart. That is, they can be considered as prognostic criteria. Although levosimendan optimizes the process of restoring blood circulation, it is impossible to control the initial disturbances completely with its help. In this case, TnI and СРK−MB can be called integral predictors of postoperative heart failure, since they are associated with СI, and the level of NT−proBNP primarily affects the ability of the myocardium to obey the Frank−Starling law. Our findings suggest that the levels of TnI, СРK−MB and NT−proBNP reflect the severity of heart failure and can be used as criteria for predicting the course of the early postoperative period. Levosimendan reduces the likelihood of exacerbation of both the initial and post−perfusion ischemic myocardial damage at acute coronary syndrome in patients undergoing coronary artery bypass graft.
Key words: levosimendan, myocardial damage markers, acute coronary syndrome, coronary artery bypass grafting, cardiopulmonary bypass.