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

Author(s):Show less -

Hueb, Whady ^[1] ; Gersh, Bernard J. ^[2] ; Rezende, Paulo Cury ^[1] ; Garzillo, Cibele Larrosa ^[1] ; Lima, Eduardo Gomes ^[1] ; Vieira, Ricardo D'Oliveira ^[1] ; Rahmi Garcia, Rosa Maria ^[1] ; Favarato, Desiderio ^[1] ; Segre, Carlos Alexandre W. ^[1] ; Pereira, Alexandre Costa ^[1] ; Soares, Paulo Rogerio ^[1] ; Ribeiro, Expedito ^[1] ; Lemos, Pedro ^[1] ; Perin, Marco A. ^[1] ; Strunz, Celia Cassaro ^[1] ; Dallan, Luis A. O. ^[1] ; Jatene, Fabio B. ^[1] ; Stolf, Noedir A. G. ^[1] ; Hueb, Alexandre Ciappina ^[1] ; Dias, Ricardo ^[1] ; Gaiotto, Fabio A. ^[1] ; Alves da Costa, Leandro Menezes ^[1] ; Costa Oikawa, Fernando Teiichi ^[1] ; Vieira de Melo, Rodrigo Morel ^[1] ; Serrano Junior, Carlos Vicente ^[1] ; Rodrigues de Avila, Luiz Francisco ^[1] ; Villa, Alexandre Volney ^[1] ; Parga Filho, Jose Rodrigues ^[1] ; Nomura, Cesar ^[1] ; Ramires, Jose A. F. ^[1] ; Kalil Filho, Roberto ^[1] ; Grp, MASS-V Study

Affiliation

^[1] Univ Sao Paulo, Inst Heart, Sao Paulo - Brazil

^[2] Mayo Clin, Rochester, MN - USA

• Document type: Journal article
• Source: BMC CARDIOVASCULAR DISORDERS; v. 12, AUG 16 2012.
• Web of Science Citations: 5

Abstract

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. (AU)

• FAPESP's process: 11/20876-2 - Increase in biomarkers of myocardial necrosis after surgical or percutaneous revascularization in the absence of demonstrated myocardial infarction
• Grantee: Whady Armindo Hueb
• Support Opportunities: Regular Research Grants