射频消融术后心肌肌钙蛋白的变化

Influence of radiofrequency catheter ablation on cardiac troponin

目的 观察射频消融术患者术前、术后血清心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶 (CK MB)及心功能的变化 ,评价cTnI、CK MB在诊断心肌微小损伤中的灵敏性 ,探讨心肌损伤程度与消融因素的相关性。方法 选择行射频消融术 (RFCA)的阵发性室上性心动过速 (PSVT)患者 80例。每例患者均于术前及术后测定血清cTnI、CK MB水平及超声心动图。结果 术后 4～ 2 4小时cTnI及CK MB较术前明显增高 ,cTnI及CK MB升高倍数与消融能量无线性关系 (r =0 .2 0 ,P >0 .0 5 ;r =0 .2 6 ,P >0 .0 5 ) ,与消融时间、消融次数呈正相关 (r =0 .5 6 ,r =0 .4 2,P均 <0 .0 5 ;r =0 .37,r =0 .4 8,P均 <0 .0 5 )。心室侧消融术后 4～ 2 4小时cTnI的升高倍数和术后 4～ 2 4小时数值均显著高于心房侧消融 (P <0 .0 5 )。旁道组术后cTnI和CK MB升高倍数高于双径路组。RFCA术后左室射血分数 (LVEF)、左室短轴缩短率 (LVFS)、二尖瓣舒张早期最大流速 (E)及二尖瓣舒张晚期最大流速 (A)的比值 (E/A)与术前比较差异无统计学意义 (P >0 .0 5 )。结论 RFCA所造成的心肌损伤为小范围的损伤 ,不影响心脏的整体功能。检测这种微小损伤 ,cTnI的灵敏度较CK MB高。这种损伤与放电时间、放电次数、消融部位有关 ,而与放电能量无关。

Objective To observe the changes of cardiac troponin I (cTnI), creatine kinase isoenzyme(CK-MB), heart function before and after radiofrequency catheter ablation(RFCA), and estimate the sensitivity of cTnI, CK-MB in minor myocardial damage and to investigate the correlation between the degree of myocardial injury and the factor of RFCA. Methods 80 patients with supraventricular tachycardia undergoing successful RFCA were included in this study. Blood samples were taken for measuring concentrations of cTnI and CK-MB before and after RFCA, and the UCG was recorded too in the same time. Results cTnI, CK-MB level significantly elevated 4-24 hours after RFCA. The times they increased were not correlated with the power released in RFCA(r= 0.20, P> 0.05;r= 0.26, P> 0.05), but correlated with the numbers of application, total time of the radiofrequency application(r= 0.56 r= 0.42 ,P< 0.05;r= 0.37 r= 0 .48,P< 0.05). The times they increased application from ventricle were significantly higher than those of atrium(P< 0.05),and those higher in AVNRT group than in accessory pathway group too. There were no significant differences between the levels of LVEF, LVFS, E/A after RFCA compared with those of preoperation (P> 0.05). Conclusion RFCA may result in minor myocardial damage, which has no affection on heart function. To estimate minor myocardial damage, cTnI is more sensitive than CK-MB. The damage is correlated with the numbers of application, total time of the radiofrequency application, position of application but not the total power released in RFCA.