Selected Publication:
Mahla, E; Tiesenhausen, K; Rehak, P; Fruhwald, S; Pürstner, P; Metzler, H.
Perioperative myocardial cell injury: the relationship between troponin T and cortisol.
J Clin Anesth. 2000; 12(3):208-212
Doi: 10.1016/S0952-8180(00)00150-1
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- Leading authors Med Uni Graz
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Mahla Elisabeth
- Co-authors Med Uni Graz
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Fruhwald Sonja
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Metzler Helfried
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Pürstner Peter
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Rehak Peter
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Tiesenhausen Kurt
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- Abstract:
- STUDY OBJECTIVE: To investigate whether there is an association between Troponin T (TnT), reflecting myocardial cell injury, and cortisol, reflecting the degree of surgical trauma and associated stress, in light of our recent evaluation of TnT as a marker of perioperative myocardial cell injury.DESIGN: Prospective, cohort study.PATIENTS: 70 patients (67.4 +/- 8.7 yrs) with definite or at-risk coronary artery disease (CAD) undergoing elective noncardiac surgery (vascular n = 38, abdominal n = 21, orthopedic n = 8) with general (n = 63) or regional (n = 4) anesthesia with postoperative on-demand analgesia.MEASUREMENTS AND MAIN RESULTS: Morning blood samples for TnT (upper limit of normal: <0.2 ng/mL), CK-MB (reference range =12 U/L), and cortisol (normal morning range 7-25 mcg/dL) were taken on the day before surgery, on the morning of surgery before induction of anesthesia, and on the first 5 postoperative days. Data were compared by analysis of variance. Three patients were excluded from the study because of incomplete blood samples of TnT or cortisol. Preoperative mean cortisol levels (mcg/dL +/- SD) were within the normal range and equal in TnT positive (n = 13) and negative (n = 54) patients (16.1 +/- 4.5 vs. 15.6 +/- 5.8). On the 1st postoperative day, there was a substantial increase of cortisol in the TnT positive group (35.7 +/- 26.9). Cortisol remained high until the 5th postoperative day (24.7 +/- 9. 4). There was a significant difference in the cortisol concentration in TnT-positive compared to TnT-negative patients (p < 0.001), a significant difference in the perioperative cortisol concentration over time (p < 0.05), and a significant interaction (p < 0.001). But there was no consistent temporal relationship between the increase of TnT and the increase of cortisol.CONCLUSIONS: The significant relationship between a highly sensitive and specific marker of myocardial cell injury and a marker of stress suggests that cardiac-risk patients undergoing stressful surgical procedures might benefit from close perioperative TnT monitoring with early recognition of myocardial cell injury.
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Aged -
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Cohort Studies -
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Coronary Disease - etiology
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Creatine Kinase - blood
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Female - blood
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Humans - blood
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Hydrocortisone - blood
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Isoenzymes - blood
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Male - blood
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Middle Aged - blood
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Myocardium - pathology
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Postoperative Complications - etiology
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Prospective Studies - etiology
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Stress - blood
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Troponin T - blood
- Find related publications in this database (Keywords)
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cortisol
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perioperative period
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surgery
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noncardiac
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troponin