جستجوی مقالات مرتبط با کلیدواژه « troponin » در نشریات گروه « پزشکی »

Assessment of cardio-protective potential of celastrol against sepsis-induced cardiac injury in mice.

A twenty- four Swiss albino mice aged between 6-8 wks., weighted between 20-30 g were included in this study. They were randomly divided into 4 groups, each of 6:Sham group: laparotomy without cecal ligation and puncture( CLP), Sepsis group: (laparotomy with CLP), Vehicle group: Treated with equivalent volume of DMSO i.p. 1 hr. before CLP, Celastrol treated group: treated with 2 mg/kg  i.p. 1 hr before CLP. Animals were sacrificed after 24 hrs. Blood samples then aspirated for assessment of cardiac troponin and CK-MB by spectrophotometric assay. Part of cardiac tissue was used for assessment of the levels of TNF, IL6, IL10, F2-Isoprostane, and TLR4 by ELISA method, another part was used  for assessment of the degree of cardiac tissue damage by histo-pathological analysis.

Significant cardiac damage was noticed in sepsis group (P≤ 0.05) as compared with sham group manifested by significant elevation in inflammatory markers( TNF, IL6, TLR4) and oxidative stress marker( F2-Isoprostane) as well as cardiac troponin and CK-MB, with significant reduction in IL10.
Pretreatment with celastrol was resulted in significant reduction in TNF,IL6, TLR4,  F2-Isoprostane, troponin,  and CK-MB with significant elevation in IL10 as compared to sepsis group.
In the same manner significant histological damage was encountered in sepsis group as compared to sham, while celastrol treated group exhibit minor histological damage as compared to sepsis group.

Celastrol have a cardio-protective effects against cardiac injury induced by endotoxemia.

 Myocardial infarction (MI) is one of the highest leading causes of death worldwide. Many biomarkers are universally accepted in clinical practice as crucial diagnostic biomarkers in acute MI. The current study aims to introduce new sensitivity biomarkers to aid the diagnosis and to facilitate faster decision-making in the emergency department.

 A total of 50 patients, diagnosed with acute myocardial infarction, in Nasiriyah Heart Center, and 30 age-matched healthy individuals were studied. Serum Cardiac Troponin I (cTnI), Myoglobin (MYO), Creatine kinase (CK-MB), Procalcitonin (PCT), Heart-type fatty acid binding protein (H-FABP), Lipoprotein-associated phospholipase A2 (Lp-PLA2), High sensitive C reactive protein (hsCRP), were determined by electro-chemiluminescence immunoassay. Blood sugar and serum total cholesterol, triglycerides, LDL, VLDL, and HDL were determined by using Cobas C311 photometric assays. Serum IL-6 was assayed by electro-chemiluminescence immunoassay, while, IL-9, IL-1β, and TNF-α were assayed by ELISA.

 In comparison with healthy control, patients with acute MI showed significant elevation of the serum levels of cTnI, CK-MB, MYO, CRP, H- FABP, PCT, TNF-α, IL-1β, IL-9, and IL-6.

 The present study suggests that, in addition to cTnI, CK-MB, and MYO, many other mediators such as CRP, H-FABP, PCT, and cytokines are sensitive to the diagnosis of MI. Furthermore, using human monoclonal antibodies that selectively neutralize cytokines may provide additional insight into cytokines-targeted therapies.

 The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran.

 The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records.

 The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development.

 ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses.

To investigate the level of troponin I and its association with mortality in patients with sepsis, severe sepsis, and septic shock.

In general, 148 patients with sepsis, severe sepsis, and septic shock admitted to Kowsar hospital of Semnan in 2017-2019 were recruited in this study. Serum troponin levels were measured during the first 24 hours of admission. The second measurement was done in the next 48 hours, which aimed at increasing the likelihood of positive troponin over time. However, if the troponin was positive just once, the patient would be in the category of positive troponin. In addition, the patient’s prognosis was recorded within 30 days.

Based on the results, 27.7% had troponin levels higher than normal. The mortality rate in patients with normal and abnormal levels of troponin was 5.6% and 17.1%, respectively, which was a significant difference. The age of dead patients was significantly higher than the age of the living patients and the results showed that among the variables of gender, normal or abnormal level of troponin, age, and type of underlying infection, only age had a significant relationship with patients’ vital status.

High levels of troponin were not effective in determining the prognosis of patients with sepsis, and only age had a significant relationship with patients’ vital status while the confirmation or rejection of this hypothesis will need further studies.

Deaths associated with the Acute Coronary Syndrome (ACS) remain high among Cardiac/Coronary Care Unit (CCU) and post-CCU patients. Recently, researchers have looked for inexpensive and reliable prognostic indicators as alternatives to the expensive pro-Brain Natriuretic Peptide (proBNP) in ACS patients to predict adverse outcomes. We retrieved the Complete Blood Count (CBC) records of ACS patients and calculated values for plateletcrit (PCT), Mean Platelet Volume (MPV), and Neutrophil-to-Lymphocyte Ratio (NLR). We also recorded ACS diagnostic methods, duration of hospital stays (CCU and post-CCU), and therapeutic modalities. We considered outcomes such as death, positive or negative troponin, ST-elevation, ejection fraction <45, and history of arrhythmia. The multivariate model using forward stepwise logistic regression showed that the history of arrhythmia (OR=124.052, p= 0.001), positive troponin (OR=47.545, p=0.002), hospitalization period (OR=2.376, p=0.001), C-reactive protein (CRP) (OR=1.359, p=0.001), and PCT (OR=2.018, p=0.001) are independent predictors of mortality. CRP and PCT are considered independent predictors of mortality among CCU and post-CCU patients diagnosed with ACS. However, the prognostic significance of NLR and MPV needs to be confirmed by further investigations.

General anesthesia and tracheal intubation activate the sympathetic nervous system that might affect the innervation of the heart. The aim of study is to look for the incidence of myocardial injury (MI) in intubated adult patients in the Intensive Care Unit (ICU).

This cross-sectional study was conducted on all intubated patients during four months in Imam AL Sadeq Teaching Hospital's ICU, from January 2022 to May 2022. Patients were‎ selected by the census sampling method. Electrocardiograms (ECG), echocardiograms (echo), blood pressure monitoring, other vital signs, and high-sensitivity serum troponin I testing were used to detect myocardial damage. Patients were divided to normal and high troponin groups. Primary diagnosis of admission to ICU was recorded.  Patients were followed after 60 days by visits or phone call.

This study included 40 patients with a mean age of 56.6±7.3 years. There were 17 (42.5%) cases of new MI in the ICU. Troponin levels were found to be significantly associated with age, hypertension, and atrial fibrillation (p<0.05), but not with gender or the type of illness. Patients with elevated troponin levels were three times more likely to experience mortality within 60 days compared to those with normal levels (0.0247). Logistic regression analysis confirmed a significant positive association between troponin levels and mortality, controlling for age, hypertension, and atrial fibrillation (odds ratio=5.49, 95% CI= 1.15-27.15, p=0.033). Age, hypertension, and atrial fibrillation were not significant predictors of mortality.

In conclusion, our study showed a high rate of MI in non-cardiac ICU patients and also a significant association between elevated troponin levels and increased mortality within 60 days in ICU patients. The findings of this study show the importance of monitoring troponin levels as a prognostic indicator in critically ill patients.

Cardiac troponins T and I as markers of specific myocardial injury have been associated with acute ischemic stroke. Several mechanisms have been proposed as the possible cause of myocardial damage in stroke patients. The level of troponin and its association with electrocardiogram has not been studied yet among Kurdish population.

The present study evaluated troponin’s level and compliance with electrocardiogram findings among Kurdish patients with acute ischemic stroke.

Positive troponin was investigated among all acute ischemic stroke patients who were admitted to Imam Reza Hospital in Kermanshah from 21 March 2018 to 20 March 2019. Comprehensive electrocardiography examinations were performed and interpreted by a cardiologist and a neurologist. The presence of Q wave, T wave inversion, and ST-segment elevation or depression as evidence of coexisting cardiac ischemia were compared between patients with positive and a randomly selected group of patients with negative troponin.

A total of 13.2% of participants (n = 21) had atrial fibrillation (AF). One patient with positive troponin and 13.4% (n = 20) of patients with negative troponin had AF in their ECGs (P = 0.67). The frequency of other disorders, including T wave inversion, left branch bundle block, ST-segment elevation, and the presence of pathological Q wave, was 6.3% (n = 10), 5.7% (n = 9), 5% (n = 8), and 5% (n = 5), respectively. The results showed no significant relationship between positive (increase) or negative troponin with electrocardiogram abnormalities (P > 0.05).

Since routine ECGs are obtained from all acute stroke patients, routine troponin measurementsmaynot be necessary for all patients and can be limited to those with electrocardiographic abnormalities.

Pulmonary thromboembolism (PTE) is one of the most prevalent medical disorders, with a no-table annual fatality rate. This study aimed to evaluated the accuracy of serum pro-BNP and troponin I levels inPTE diagnosis.

This cross-sectional study was implemented on 267 patients with suspected PTE (sud-den chest pain or sudden dyspnea) in Imam Reza Hospital in Mashhad, Iran. All patients underwent pulmonarycomputed tomography (CT) angiography (as the gold standard test) and their serum levels of troponin I andpro-BNP were measured. The screening performance characteristics of pro-BNP in detection of PTE cases weremeasured and reported using receiver operating characteristic (ROC) curve analysis.

Two-hundred-sixty-seven patients with a mean age of 67.7 ±11.5 years were evaluated (60.1% male). PTE was confirmed via CTangiography in 121 patients. The area under the ROC curve of troponin I and pro-BNP in detection of PTE was0.501 ng/mL and 0.972 pg/mL, respectively. The sensitivity and specificity of proBNP at the best cut-off point(100 pg/ml) were 85.4% and 80.2%, respectively. The sensitivity and specificity of troponin I at the best cut-offpoint (0.005 ng/ml) were 65.5% and 42%, respectively.

Due to the comparatively good sensitiv-ity and specificity of proBNP in diagnosis of pulmonary thromboembolism, it can be employed as a diagnosticdeterminant in patients with suspected pulmonary thromboembolism along with other laboratory tests.

Dental treatments may have adverse effects on patients with a previous history of coronary heart disease and lead to cardiac complications. Different biomarkers have been investigated to assess the relationship between dental treatments and cardiovascular complications. The present study was conducted to evaluate the troponin changes before and after dental surgery in patients with a history of ischemic heart disease.  

This cross-sectional study was conducted on 25 patients referred for dental surgery with a history of ischemic heart disease. The patients' demographic information including their age and gender was collected, and serum levels of troponin were measured before surgery and at 4 hours after surgery, and the results were compared. The study data were entered into SPSS version 23 and analyzed by the Student t-test and McNemar test.

In the present study, 25 patients including 11 males and 14 females with a mean age of 44.78 years were evaluated. The mean level of troponin was 8.01±5.94 before surgery and 6.16±4.84 after surgery. Statistically, no significant difference was found
between troponin levels before and after surgery in patients (P=0.274).

based on the results of the present study, no significant change was noted in troponin levels of patients with a previous history of ischemic heart disease at 4 hours after dental surgery.

Coronavirus disease 2019 (COVID-19) is an infection which can present itself bythe involvement of various organs, but the most common manifestations are respiratorysymptoms, fever and dyspnea with a high mortality rate. In order to study the prognosis ofpatients and also to determine the treatment plan, we need non-invasive methods whichcan be easily used in the triage of patients. In this study, we investigated the diagnosticvalue of electrocardiographic (ECG) changes and troponin levels in patients with thisdisease. This is a descriptive study. Confirmed COVID-19 patients participated in thepresent study. Data were collected by taking history and referring to medical records. Weanalyzed data by using chi square, t test and logistic regression through SPSS softwareversion 22. One hundred and five patients with COVID-19 disease were examined. Mostpatients were men (53.3%) and the mean age was 54.53 years. The most common underlyingdiseases were hypertension and diabetes mellitus. Ninety-five patients had abnormalelectrocardiography including eleven with long QT; seven with arrhythmia; 78 with sinustachycardia; 7 with hemi-block; 1 with hemi-block and first degree atrioventricular block;4 with abnormal axis and 28 with ischemic changes. Eleven patients (10.5%) had positivetroponin level, whose length of hospital stay was higher (12.73 vs. 12.07 days). Furthermore,their mean length of intensive care unit (ICU) stay was also higher. In addition, among thetroponin-positive group, 100% had abnormal electrocardiography. The findings of the present study showed that ECG abnormalities and troponinlevels could provide good information about the prognosis of patients. Moreover, it seemsthat ECG changes in COVID-19 patients, whether indicative of underlying heart disease orresulted from infection, can affect the prognosis of patients. Therefore, considering ECGfindings and troponin levels can help select patients at a higher risk for triage.

The relationship between cardiac enzyme release following coronary endarterectomy (CE) and morbidity and mortality is unclear. Therefore, the present study aimed to investigate the association of cardiac enzymes with morbidity and mortality of patients undergoing CE surgery.

This was a single-center retrospective cohort study of 475 patients who had undergone off-pump coronary artery bypass graft (OPCABG). The patients were followed up for a mean of 72.99 ± 14.60 months.

Among 475 patients undergoing OPCABG, 39 (8.2%) were non-survivors. Non-survivors were younger and had a fewer ejection fraction (EF). Comorbidities were similar in survivors and non-survivors. The crude Cox regression analysis showed that creatine kinase-myocardial band (CK-MB) had a protective effect against mortality, but when adjusted with age, sex, diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, smoking, family history, body mass index (BMI), left main disease (LMD), and EF, this effect disappeared. Troponin in crude and adjusted analysis did not have any significant effect.

There is no association between CK-MB and troponin and mortality in patients undergoing coronary artery bypass graft (CABG).

COVID-19 was introduced by the World Health Organization (WHO) as a global pandemic. The spectrum of symptoms of the disease ranges from a mild cold to death. It has a higher mortality rate in people with a history of comorbidities, including cardiovascular disease (CVD) and can also contribute to cardiac injury. This study was conducted to evaluate the relationship between troponin levels as a cardiac marker and adverse outcomes in this disease.

The study sample included 438 patients hospitalized with COVID-19; however, the troponin data of 6 patients were not available. The need to be admitted to the intensive care unit (ICU), and death were considered the adverse outcome in patients with COVID-19. Troponin levels were checked in all patients on day 1 and day 3 of hospitalization. Multiple logistic regression analysis was performed to determine whether there was an independent association between the adverse outcomes and troponin enzyme in hospitalized patients with COVID-19.

The mean age of patients was 61.29 ± 15.84 years. Among the 432 patients tested on day 1 of hospitalization, 24 patients (5.6%) tested positive (Troponin 1), and among the 303 patients tested on day 3, 13 patients (4.3%) tested positive (Troponin 2). Based on our results, Troponin 1 showed an independent association with both death (3.008 [95%CI = 1.091-8.290]; P = 0.033) and need for ICU admission (8.499 [95%CI = 3.316-21.788]; P < 0.001) in multiple logistic regression analysis. Moreover, the status of Troponin 2 had an independent significant association with both death (4.159 [95%CI = 1.156-14.961]; P = 0.029) and ICU admission (7.796 [95%CI = 1.954-31.097]; P = 0.004).

Troponin showed a significant association with adverse outcomes in people who were hospitalized with COVID-19. The serial assessment of this enzyme from the time of hospitalization may improve the clinical decision making of clinicians.

Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is syndrome with clinical evidence of acute MI (AMI) with normal coronary arteries. This study reports the case of a 23‑year‑old single woman referring to the hospital with clinical manifestations of MI, with electrocardiography findings of slow ventricular tachycardia or accelerated idioventricular rhythm and atrioventricular dissociation, and high troponin levels, which was admitted with the diagnosis of MINOCA due to mental stress (grief) and was discharged after 4 days of monitoring and following stabilization of conditions and absence of symptoms. Other causes of MINOCA ruled out through imaging studies. Mental stress can lead to MINOCA.

Perinatal asphyxia/ischemia is an interruption in the availability of oxygen supply to the myocardium. We sought to assess myocardial function among asphyxiated and non-asphyxiated neonates using echocardiography.
 
The present case-control study was undertaken at the neonatal intensive care unit (NICU) of a tertiary care hospital. Neonates with asphyxia who were admitted to the NICU were included in the study. The diagnosis of asphyxia was established on the basis of the APGAR score at 1 and 5 minutes. Myocardial function was assessed in terms of serum cardiac troponin I (CTnI) and different echocardiographic parameters such as M-Mode, Doppler flow parameters, and tissue Doppler imaging.
 
Thirty asphyxiated (the case group) and 30 non-asphyxiated (the control group) term neonates were enrolled in the study. The asphyxia group had significantly lower (P < 0.001) 1- and 5-minute APGAR scores than the controls. The asphyxia group had a higher serum CTnI value. The differences between the 2 groups concerning M-Mode parameters in the first 12 hours of life were statistically significant (P < 0.001). The case and control groups were also statistically significantly different regarding left atrial pressure at 48 hours following birth, calculated as a ratio of E/e’ (P < 0.001). The differences between the 2 study groups at 24 hours after birth as regards tissue Doppler parameters, including left ventricular ejection time and left ventricular Tei index, were also statistically significant (P < 0.001). The case and control groups also showed statistically meaningful differences concerning right ventricular ejection period/ ejection time at 24 hours after birth (P < 0.002).
 
It can be concluded that the myocardial function assessment using CTnI and different echocardiographic techniques is the most sensitive and specific method in the detection of ischemic cardiac injury in asphyxiated newborns. (Iranian Heart Journal 2021; 22(1): 91-99)

To date, the mechanisms of post-exercise cardiac troponin elevation are debatable. Previous studies have reported that oxidative stress happens after extended exercise.

This study purposed to establish the association between the elevation of malondialdehyde (MDA), which is a marker of oxidative stress, and cardiac troponin-I (cTn-I) after prolonged cycling.

Ninety-two males in Indonesian cycling tours participated in the present study. Baseline and post-exercise blood specimens were obtained to define MDA and cTn-I levels. The elevations of MDA and cTn-I were determined as positive differences of post-cycling MDA and cTn-I levels to the baseline, respectively.

Eighty-eight participants (age, mean = 45.3 years old, [SD]:11.47; body mass index (BMI), mean=24.2 kg/m2 , [SD]: 3.03) finished the cycling tours. Subjects’ characteristics were comparable based on the touring category, except for the family history of coronary artery disease, high-density lipoprotein cholesterol level, neutrophil count, resting heart rate, exercise intensity, and cTn-I elevation. MDA significantly escalated at the level of 210.90 µmol/mL at post-exercise, from 190.18 µmol/mL at baseline. cTn-I also increased at the level of 13.65 ng/dL from 5.16 ng/dL. The elevation of MDA was related to the elevation of cTn-I. Elevation of cTn-I after prolonged cycling was contributed by elevation of MDA and exercise intensity.

The present findings support existing confirmation that cTn-I elevation after prolonged exercise is related to oxidative stress and exercise intensity

 Breast cancer is the most frequent cancer among women. In line with the survival improvement of patients with cancer, the issue of treatment-induced toxicities becomes more important.

 This study aimed at evaluating acute radiation-induced cardiac damage.

 Between 2016 and 2019, women with histologically-confirmed early-stage left-sided breast cancer or ductal carcinoma in-situ (DCIS) without prior chemotherapy, who were candidates for adjuvant whole breast radiotherapy, entered the study. The radiation-induced cardiotoxicity was assessed, using a rise in high-sensitivity cardiac troponin I (hscTnI) over the radiotherapy. Likewise, the association between the percentage of heart receiving at least 25Gy (V25Gy) and the rise in hscTnI was evaluated as the secondary endpoint.

 A total of 22 women were included in this study. Mean ± standard deviation (SD) hscTnI for the whole study population was 12 ± 2 ng/L before and 15 ± 2 ng/L after radiotherapy. The median (interquartile range [IQR]) V25Gy was 8.05% (6.95% - 8.95%). The difference between hscTnI levels before and after radiotherapy was significant (P = 0.001). There was no correlation between V25Gy and the rise in hscTnI (P = 0.18).

 hscTnI is a sensitive marker to detect early radiation-induced cardiotoxicity. There is no association between V25Gy and the rise in hscTnI over radiotherapy.

Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels.

We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death).

Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20).

Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for longterm cardiac complications of this infection.

Coronary Artery Bypass Grafting (CABG) has been considered as the complete treatment of Ischemic Heart Disease (IHD). Cardioplegic (extracellular and intracellular) solutions have been suggested to reduce the cross-clamping duration. It was hypothesized that the combination of the two intra- and extra-cellular solutions, namely Del Nido (DN) and custodiol, could result in beneficiary clinical and economic outcomes.

The present study aimed to compare the myocardial protection of custodiol alone and in combination with modified DN in patients undergoing cardiac surgery.

This prospective, double-blind, clinical trial was conducted on 50 patients undergoing redo CABG surgery. Aortic clamping was performed using custodiol (20 cc/kg) in group A. In group B, custodiol 1000 cc was combined with 15 cc/kg cold DN and was injected using the antigrade method. The two groups were compared regarding the levels of Creatinine Kinase-MB (CK-MB) and troponin at the time of anesthesia induction and two hours and 48 hours after the surgery, intraoperative and postoperative variables, and 48–hour mortality rate.

The results showed similar CK-MB levels in the two groups at the induction time (P = 0.12). However, a significant difference was observed between the two groups in this regard two hours (P = 0.018) and 48 hours after the surgery (P = 0.021). Within-group comparisons revealed significant changes in CK-MB and troponin levels in both groups, with a steep increase from induction until two hours after the surgery and a decrease from two hours until 48 hours after the surgery (P < 0.001). The results indicated no significant difference between the two groups regarding CK-MB and troponin levels, frequency of intraoperative and postoperative dysrhythmia, need for intraoperative defibrillation, ischemic time, and 48-hour mortality rate (P > 0.05). However, the costs were two-folds higher in group A than in group B (P < 0.001).

The present study findings showed that the selected solution was appropriate in terms of clinical aspects for the patients undergoing CABG surgery with long surgical duration or low Ejection Fraction (EF) and reduced the costs to half. Considering the significant difference in the CK-MB level and the lower troponin level in the combined group (not statistically significant), further studies are required to confirm the clinical priority of the combined solution.