CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zangrillo, A.
Right arrow Articles by Pappone, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zangrillo, A.
Right arrow Articles by Pappone, C.
Canadian Journal of Anesthesia 52:336-337 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

A 20-joule electrical cardioversion applied directly to the heart elevates troponin I by at least 1.5 ng·mL–1

Alberto Zangrillo, MD, Giovanni Landoni, MD, Giuseppe Crescenzi, MD, Anna Mara Scandroglio, MD, Maria Grazia Calabrò, MD, Lorenzo Mantovani, MD, Annalisa Franco, MD and Carlo Pappone, PhD MD

Vita-Salute University of Milan, Milan, Italy, E-mail: landoni.giovanni{at}hsr.it

To the Editor:

There is increasing evidence that even mild elevations in cardiac troponin I (cTpI) may be associated with a decline in survival after cardiac surgery.1,2 Between June and July 2002 we investigated the role of intra-operative direct electrical cardioversion in 267 adult patients undergoing cardiac surgery. For the purposes of the analysis we used the peak cardiac marker level for each patient among samples drawn at the intensive care unit on arrival and four and 18 hr after surgery. Data were analyzed by linear regression analysis performed for the minimum cardiac marker level observed in each group of patients (receiving 0, 1, 2, 3, 4, ≥5 cardioversion) and for the five lowest values observed in each group. After cardiac surgery cTpI was detectable in all patients (peak value of 10 ± 8.8 ng·mL–1). The linear correlation between the number of electrical cardioversions and the peak cTpI level was statistically significant (r2 = 0.9, P < 0.0001) when the minimum value of cTpI for each class of cardioverted patients was considered (FigureGo). This strong association was maintained (r2 = 0.8, P < 0.0001) when the five lowest values of cTpI were analyzed.



View larger version (101K):
[in this window]
[in a new window]
  		FIGURE Linear correlation between the lowest levels of cTpI in patients receiving 0, 1, 2, 3, 4, ≥5 direct electrical cardioversions in 267 consecutive patients undergoing cardiac surgery.

 
Our most important result is that myocardial injury following direct electrical cardioversion can be quantified as the elevation by, at least, 1.5 ng·mL–1 of peak serum cTpI per shock. The originality of our study stands with the analysis of the minimum values: this statistical method, to the best of our knowledge, has never been applied before in medical practice, could be an alternative to multivariate analysis when predictive factors are not yet identified, their value is ≥0, their relative role is not comparable and they have different distributions. These conditions are definitely present regarding the release of cardiac biomarkers after cardiac surgery. Our method could be applied to other causes of cardiac biomarker release e.g., (cardiopulmonary bypass or aortic cross clamping).

Footnotes

No source of support or conflict of interest exist for this study. Only departmental funds have been used.

References

1 Lasocki S, Provenchere S, Benessiano J, et al. Cardiac troponin I is an independent predictor of in-hospital death after adult cardiac surgery. Anesthesiology 2002; 97: 405–11.[Medline]

2 Greenson N, Macoviak J, Krishnaswamy P, et al. Usefulness of cardiac troponin I in patients undergoing open heart surgery. Am Heart J 2001; 141: 447–55.[Medline]





This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zangrillo, A.
Right arrow Articles by Pappone, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zangrillo, A.
Right arrow Articles by Pappone, C.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS