Hypotheses, rationale, design, and methods for prognostic evaluation of cardiac biomarker elevation after percutaneous and surgical revascularization in the absence of manifest myocardial infarction. A comparative analysis of biomarkers and cardiac magnetic resonance. The MASS-V Trial

BMC Cardiovascular Disorders

Roberto Kalil Filho²  José AF Ramires²  César Nomura²  José Rodrigues Parga Filho²  Alexandre Volney Villa²  Luiz Francisco Rodrigues de Ávila²  Carlos Vicente Serrano²  Rodrigo Morel Vieira de Melo²  Fernando Teiichi Costa Oikawa²  Leandro Menezes Alves da Costa²  Fabio A Gaiotto²  Ricardo Dias²  Alexandre Ciappina Hueb²  Noedir AG Stolf²  Fabio B Jatene²  Luis AO Dallan²  Célia Cassaro Strunz²  Marco A Perin²  Pedro Lemos²  Expedito Ribeiro²  Paulo Rogério Soares²  Alexandre Costa Pereira²  Carlos Alexandre W Segre²  Desiderio Favarato²  Rosa Maria Rahmi Garcia²  Ricardo D'Oliveira Vieira²  Eduardo Gomes Lima²  Cibele Larrosa Garzillo²  Paulo Cury Rezende²  Bernard J Gersh¹  Whady Hueb³ 

[1] Mayo Clinic, Rochester, MN, USA;From the Heart Institute of the University of São Paulo, São Paulo, Brazil;Av. Dr. Enéas de Carvalho Aguiar 44 AB - 114 Cerqueira César, São Paulo-SP, 05403-000, Brazil

关键词: CABG;    PCI;    Myocardial infarction;    Necrosis markers;    Cardiopulmonary bypass;   

Others  :  1084475
DOI  :  10.1186/1471-2261-12-65

 received in 2012-05-15, accepted in 2012-08-01,  发布年份 2012

【 摘 要 】

Background

Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis.

Methods/Design

The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR.

Discussion

The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.

【 授权许可】

   
2012 Hueb et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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