Associated Factors for Non-Ischemic Serum Myoglobin Release After Cardiac Surgical Procedures
DOI:
https://doi.org/10.1532/HSF98.2014331Abstract
Background: Myoglobin has become established as a serum marker of myocardial injury. However, myoglobin levels can increase exponentially without any correlation to postoperative clinical ischemia symptoms. In this retrospective study, we analyzed the associated factors for a non-ischemic myoglobin release.
Methods: We performed a data analysis from 532 consecutive cardiac surgery patients (2010 to 2011, 73% males; age 65 ± 11 years). Non-ischemic myoglobin elevation was defined as CK-MB <50 U/l and/or the absence of any ischemic clinical events (eg, myocardial infarction, mesenteric vascular occlusion).
Results: Using a multifactorial model, predictive elements and associated factors for non-ischemic myoglobin increase were male sex, ejection fraction < 30%, BMI > 30 and transfusions. Serum myoglobin was not significantly different in patients with high muscle mass.
Conclusions: A non-ischemic serum myoglobin release is rare, but could be associated in subgroups of patients. Further investigations should focus on clinical targets, for example, concomitant medications for which our study was not powered.
References
Benedetto U, Angeloni E, Luciani R et al. 2010. Acute kidney injury after coronary artery bypass grafting: does rhabdomyolysis play a role? J Thorac Cardiovasc Surg 140(2):464-70.nBöhm A, Heitmann BL. 2013. The use of bioelectrical impedance analysis for body composition in epidemiological studies. Eur J Clin Nutr 67 Suppl1:S79-85.nCruz RJ Jr, Dew MA, Myaskovsky L et al. 2013. Objective Radiologic Assessment of Body Composition in Patients with End-Stage Liver Disease: Going Beyond the BMI. Transplantation 95(4):617-622.nCziraky MJ, Willey VJ, McKenney JM et al. 2013. Risk of hospitalized rhabdomyolysis associated with lipid-lowering drugs in a real-world clinical setting. J Clin Lipidol 7(2):102-8.nde Freitas Carvalho DA, Valezi AC, de Brito EM, de Souza JC, Masson AC, Matsuo. 2006. Rhabdomyolysis after bariatric surgery. Obes Surg 16(6):740-4.nHofmann D, Buettner M, Rissner F, Wahl M, Sakka SG. 2007. Prognostic value of serum myoglobin in patients after cardiac surgery. J Anesth 21(3):304-10.nHuerta-Alardín AL, Varon J, Marik PE. 2005. Bench-to-bedside review: Rhabdomyolysis - an overview for clinicians. Crit Care 9(2):158-69.nJackson AW, Lee DC, Sui X et al. 2010. Muscular strength is inversely related to prevalence and incidence of obesity in adult men. Obesity 18(10):1988-95.nJanssen I, Heymsfield SB, Wang ZM, Ross R. 2000. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol 89(1):81-8.nKarimi S, Hough A, Beckey C, Parra D. 2010. Results of a safety initiative for patients on concomitant amiodarone and simvastatin therapy in a Veterans Affairs medical center. J Manag Care Pharm 16(7):472-81.nKiessling AH, Grohmann F, Stock UA, Bingold T, Beiras-Fernandez A, Moritz A. 2013. Impact of muscle mass on non-ischemic myoglobin serum levels in patients undergoing cardiac surgery Thorac cardiovasc Surg 61 - SC48.nMikkelsen TS, Toft P. 2005. Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiologica Scandinavica 6, p. 859-864.nMiller CC 3rd, Villa MA, Achouh P et al. 2008. Intraoperative skeletal muscle ischemia contributes to risk of renal dysfunction following thoracoabdominal aortic repair. Eur J Cardiothorac Surg 33(4):691-4.nMunjal DD, McFadden JA, Matix PA, Coffman KD, Cattaneo SM. 1983. Changes in serum myoglobin, total creatine kinase, lactate dehydrogenase and creatine kinase MB levels in runners. Clin Biochem 16(3):195-9.nRamarapu S. 2011. Acute kidney injury after coronary artery bypass grafting: does rhabdomyolysis play a role? J Thorac Cardiovasc Surg 141(2):601.nSlater MS, Mullins RJ. 1998. Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. J Am Coll Surg 186(6):693-716.nWigfield CH, Lindsey JD, Muñoz A, Chopra PS, Edwards NM, Love RB. 2006. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40. Eur J Cardiothorac Surg 29(4):434-40.n
