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Ann Thorac Surg 2001;72:1799
© 2001 The Society of Thoracic Surgeons

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Correspondence

Bypass prime and plasma expander can interfere with cardiac troponin I assay

^a Department of Anesthesiology and Critical Care, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany

e-mail: hjdieter{at}med.uni-tuebingen.de

To the Editor

With great interest I read the article by Franke and co-workers [1] comparing retrograde versus antegrade crystalloid cardioplegia in coronary artery bypass grafting. They used levels of cardiac troponin I (cTnI) as a sensitive and specific marker for detection of minor differences in myocardial ischemia after operative procedures with cardiopulmonary bypass. Hydroxyethyl starch (HES) as a colloid solution is a safe and inexpensive alternative to human albumin. It is used as an intravenous volume replacement solution during cardiac surgical procedures, [2] as well as part of the cardiopulmonary bypass prime [3]. However, Lagneau and colleagues [4] pointed out that HES (and modified fluid gelatin, available as a plasma expander only in Europe) can interfere with cTnI immunoassays. They described a positive interference in cTnI levels by HES: the higher the real initial cTnI concentration in serum, the greater the interference. If there was no cTnI in the sample, the measured concentration in the presence of HES was also zero.

The interference of HES with cTnI immunoassays should be considered if HES is assumed as intravenous volume replacement or cardiopulmonary bypass prime in cardiac surgical procedures. In discussions of cTnI as an indicator of myocardial ischemia, the use of HES should be mentioned. Perhaps more studies are needed to evaluate the sensitivity and the specifity of cTnI if HES is used for any reason during cardiac operations.

References

1. Franke U., Wahlers T., Cohnert T.U., et al. Retrograde versus antegrade crystalloid cardioplegia in coronary surgery: value of troponin-I measurement. Ann Thorac Surg 2001;71:249-253.[Abstract/Free Full Text]
2. Boldt J., Lehmann A., Römpert R., Haisch G., Isgro F. Volume therapy with a new hydroxyethyl starch solution in cardiac surgical patients before cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000;14:264-268.[Medline]
3. Keyser E.J., Latter D.A., Morin J.E., Murshid A.A., Denis F., De Varennes B. Pentastarch versus albumin in cardiopulmonary bypass prime: impact on blood loss. J Cardiac Surg 1999;14:279-286.[Medline]
4. Lagneau F., Beyne P., Letteron P., Laperche T., Marty J. Fluid therapy directly interferes with immunoassay for cardiac troponin I. Intensive Care Med 1999;25:625-627.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dieterich, H.-J. Search for Related Content PubMed PubMed Citation Articles by Dieterich, H.-J. Related Collections Myocardial protection Related Article