POOR RENAL FUNCTION AND MYOCARDIAL NECROSIS

NDT
This is a very interesting study. One wonders whether if this increased level of myocardial necrosis associated with diminished renal function applies to global cardiac ischaemia that occurs in cardiac surgery. It is well known that any degree of renal dysfunction is associated with poorer outcomes after cardiac surgery. This phenomenon may explain why.
What is not known and what surely must be a good avenue for study is why does impaired renal function lead to increased myocardial necrosis?

IMPLICATIONS OF NEW ASSAY

Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome, March 23/30, 2011, Mills et al. 305 (12): 1210 — JAMA

Interesting paper in JAMA this week. Surely this strategy of using high sensitivity troponin assays will lead to a larger number of patients being admitted with NSTEMI and an increase in revascularisation procedures.

TROPONIN RE-INVENTED

Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older Adults, December 8, 2010, deFilippi et al. 304 (22): 2494 — JAMA

This and another article in a recent edition of JAMA illustrates the significance of the new, now commonly used,  high sensitivity troponin assays. With the old assay, one thought of troponin as essentially being present or not and when present, usually indicative of myocardial damage. These new assays have confirmed that troponin is and has always present in the circulating blood stream and that levels consistent with myocardial necrosis are now much higher. Does this mean that at any time there is always a 'turn over' of myocytes? These newly available assays are also good news for researchers of cardiac ischaemia re-perfusion and in the case of cardiac surgery for those who are trying to develop the 'perfect' cardioplegic solution. One is now able to detect smaller levels of myocardial damage and as confidence intervals for these assays are likely to be narrower, required number of individuals to show a significant difference will be smaller.

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