Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Plasma protein a: is there diagnostic and prognostic value in coronary artery bypass surgery?

Authors: L.A. Bockeria, V.Yu. Merzlyakov, D.Sh. Samuilova, I.V. Klyuchnikov, L.S. Selimyan,  I.Yu. Sigaev, N.A. Darvish, A.I. Skopin

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russia

Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

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Abstract

Objective of the study is to evaluate the relationship between plasma protein-A level and the severity of vessel wall damage in coronary artery bypass graft surgery (CABG) and in combined coronary artery bypass graft surgery and endarectomy for brachiocephalic arteries, as well as the severity of systemic inflammatory response and the presence of postoperative complications. Material and methods. The study was conducted on 55 patients with a leading diagnosis of coronary artery disease. Patients were divided into three groups on the basis of the type of surgical procedure performed. Group 1 patients (n=22) underwent on-pump coronary artery bypass graft surgery (CABG with cardiopulmonary bypass) under conditions of chemical hypothermic cardioplegia, group 2 patients (n=23) – off-pump coronary artery bypass graft surgery, group 3 patients (n=10) – simultaneous off-pump coronary artery bypass surgery and carotid endarectomy with xenopericardial patch repair. The dynamic changes in PAPP-A (Pregnancy-Associated Plasma Protein A) levels were analyzed before and after surgery. The amount of cardiac troponin I (cTpI) was measured concurrently to control perioperative myocardial damage, and serum IL-6 levels were tested in order to evaluate postoperative systemic inflammatory response. Results. Serial measurement of PAPP-A levels in the early postoperative period didn't show any significant changes compared with preoperative values. Conclusion. The study of dynamic changes in PAPP-A levels didn't reveal any significant increase in the postoperative measurements of this indicator examined both within the groups and between the groups compared to those in preoperative period. There were no relationship determined between PAPP-A, сТрI and IL-6 levels, even in cases of large degree of discrepancy between the observed values and normal values of these indicators which characterize myocardial damage and systemic inflammatory response. The study found different levels of systemic inflammatory response (IL-6) in the examined patients associated with the presence of acute kidney injury in the immediate postoperative period. However, when patients were divided into study groups based on the presence or absence of acute kidney injury in the postoperative period there was no correlation with PAPP-A levels revealed either. Perhaps, this marker will be more relevant in patients with pre-existing acute coronary syndrome admitted for myocardial revascularization.

References

1. Thygesen K., Alpert J.S., Jaffe A.S., Simoons M.L., Chaitman B.R., White H.D. Third universal definition of myocardial infarction. Circul. 2012; 126 (16): 2020–35. 2. Jaffe A.S., Ravkilde J., Roberts R., Naslund U., Apple F.S., Galvani M. et al. It's time for a change to a troponin standard. Circul. 2000; 102 (11): 1216–20. 3. Tuman K.J. Perioperative myocardial infarction. Semin. Thorac. Cardiovasc. Surg. 1991; 3 (1): 47–52. 4. Libby P., Ridker P.M., Maseri A. Inflammation and atherosclerosis. Circul. 2002; 105 (9): 1135–43. 5. Чарная М.А., Дементьева И.И., Морозов Ю.А., Гладышева В.Г. Кардиоспецифические биомаркеры в кардиологии и кардиохирургии. Часть I. Общая характеристика биомаркеров. Кардиол. и серд.-сосуд. хир. 2010; 3: 26–33. 6. Чарная М.А., Дементьева И.И., Морозов Ю.А., Гладышева В.Г., Урюжников В.В. Маркеры повреждения миокарда в кардиологии и кардиохирургии. Часть II. Кардиол. и серд.-сосуд. хир. 2010; 4: 10–6. 7. Bayes-Genis A., Conover C.A., Overgaard M.T., Bailey K.R., Christiansen M., Holmes D. et al. Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. N. Engl. J. Med. 2001; 345 (14): 1022–9. 8. Blake G.J., Ridker P.M. Novel clinical markers of vascular wall inflammation. Circ. Res. 2001; 89 (9): 763–71. 9. Lawrence J.B., Oxvig C., Overgaard M.T., Sottrup-Jensen L., Gleich G.J., Hays L.G. et al. The insulin-like growth factor (IGF)-dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc. Natl. Acad. Sci. USA. 1999; 96 (6): 3149–53. 10. Overgaard M., Haaning J., Boldt H., Olsen I.M., Laursen L.S., Christiansen M. et al. Expression of recombinant human pregnancy-associated plasma protein-a and identification of the proform of eosinophil major basic protein as its physiological inhibitor. J. Biol. Chem. 2000; 275 (40): 31128–33. 11. Elesber A., Conover Ch., Denktas A., Lennon R.J., Holmes D.R. Jr, Overgaard M.T. et al. Prognostic value of circulating pregnancy-associated plasma protein levels in patients with chronic stable angina. Eur. Heart J. 2006; 27 (14): 1678–84. 12. Futterman L.G., Lemberg L. Novel markers in the acute coronary syndrome: BNP, IL-6, PAPP-A. Am. J. Crit. Care. 2002; 11 (2): 168–72. 13. Bruins P., de Velthuis H., Yazdanbakhsh A.P., Jansen P.G., van Hardevelt F.W., de Beaumont E.M. et al. Activation of the complement system during and after cardiopulmonary bypass surgery. Circul. 1997; 96 (10): 3542–8. 14. Levey A.S., Coresh J., Greene T., Stevens L.A., Zhang Y.L., Hendriksen S. et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann. Intern. Med. 2006; 145 (4): 247–54. 15. Mehta R.L., Kellum J.A., Shah S.V., Molitoris B.A., Ronco C., Warnock D.G. et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit. Care. 2007; 11 (2): R 31. 16. Шейман Дж. Патофизиология почки: Пер. с англ. М.: Бином; 2010. 17. Schwartz S.M., Virmani R., Rosenfeld M.E. The good smooth muscle cells in atherosclerosis. Curr. Athero. Rep. 2000; 2 (5): 422–9. 18. Loree H.M., Kamm R.D., Stringfellow R.G., Lee R.T. Effects of fibrous cap thickness on peak circumferential stress in model atherosclerotic vessels. Circ. Res. 1992; 71 (4): 850–8. 19. Schoenhagen P., Stone G.W., Nissen S.E., Grines C.L., Griffin J., Clemson B.S. et al. Coronary plaque morphology and frequency of ulceration distant from culprit lesions in patients with unstable and stable presentation. Arterioscler. Thromb. Vasc. Biol. 2003; 23 (10): 1895–900.

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