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Perioperative ST-segment depression and troponin T release. Identification of patients with highest risk for
1Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Mannheim, University of Heidelberg, Germany.
Insights
Major vascular surgery patients may experience silent ST segment changes on ECG. Elevated cardiac troponin T, a marker of myocardial damage, was observed in some patients with prolonged ST depression, indicating potential heart injury.
Area of Science:
- Cardiology
- Vascular Surgery
- Cardiac Monitoring
Background:
- Major vascular surgery poses a significant risk for perioperative myocardial complications, including myocardial infarction.
- Early detection of myocardial damage is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between ST segment changes detected by Holter monitoring and the release of cardiac troponin T in patients undergoing major vascular surgery.
Main Methods:
- Twenty patients undergoing elective aortic resection were monitored using Holter ECG with ST segment analysis from pre-surgery to the third postoperative day.
- Serum cardiac troponin T levels were measured at eight time points during the monitoring period.
Main Results:
- 40% of patients (8/20) exhibited significant ST depressions without clinical symptoms.
- Elevated cardiac troponin T levels were detected in 3 of these 8 patients, correlating with repetitive ST depression episodes.
- No troponin T release or cardiac events were observed in the remaining patients.
Conclusions:
- ST segment changes during ECG ST analysis indicate ischemic burden in vascular surgery patients.
- Prolonged ST depression exceeding a critical threshold may signify structural myocardial damage, verifiable by elevated cardiac troponin T.
- Determination of cardiac troponin T is recommended for patients with prolonged ST depression.
Background:
Patients undergoing major vascular surgery are at constant risk of developing perioperative myocardial complications, especially myocardial infarction. The following study was performed to answer the question whether ST segment changes, analysed by Holter monitoring and ST segment analysis, are accompanied by release of cardiac troponin T, a highly specific marker of myocardial damage.
Methods:
Twenty patients undergoing elective aortic resection were studied by performing Holter ECG, including ST segment analysis, beginning on the evening before surgery until the third postoperative day. Within this period serum levels of cardiac troponin T were determined at 8 timepoints.
Results:
A total of 8/20 of the patients (40%) showed significant ST depressions (range -0.17/-0.68 mV), without any clinical symptom, with a median of 9 episodes (range 2-24). In 3 of the 8 patients, each with repetitive periods of ST depression, elevated troponin T levels were found (0.45/0.52/1.69 micrograms/l). No troponin T release nor cardiac events were noticed in the remaining patients. No dependency could be found between troponin T release and the magnitude of ST depression or the number of ST depression episodes.
Conclusion:
Haemodynamic changes, oxygen imbalance and stress during major vascular surgery frequently lead to an ischaemic burden, which is indicated by ST segment changes during ECG ST analysis. Longlasting ST depression reaching an individual critical cut-off limit followed by structural myocardial damage may be verified by elevated levels of cardiac troponin T. Prolonged periods of ST depression should be followed by determination of cardiac troponin T.