RML and high cardiac markers:
One interesting observation from the study was that despite using a
higher cut off value for CK to define RML (to account for the myocardial
injury associated with cardiac surgery); we observed a significantly
higher value of troponin in the RML group. This was not associated with
other signs of myocardial damage as evidenced by an insignificant
difference in inotropic requirements (Table 2). This difference could be
explained by the fact that in RML, cardiac enzymes may be elevated
unrelated to the degree of muscle damage23.24,.25. Yet
another explanation could be the higher incidence of AKI in the RML
group. AKI is known to be associated with delayed clearance of troponins
as reported in the previous study from our center26.