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Postoperative serum troponin T concentration in patients undergoing aortic valve replacement does not predict early
Magda Lucyna Piekarska, Bartosz Szurlej, Tomasz Latusek
1Medical University of Silesia in Katowice. mdeja@sum.edu.pl.
Insights
Postoperative cardiac troponin T (cTnT) levels are frequently elevated after aortic valve replacement (AVR). However, elevated cTnT is a poor predictor of patient outcomes and should not guide postoperative care decisions.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Serum cardiac troponin T concentration (cTnT) measurement after aortic valve replacement (AVR) can indicate myocardial damage.
- Prognostic value of postoperative cTnT levels is under investigation.
Purpose of the Study:
- To determine if elevated troponin levels correlate with patient outcomes after AVR.
- To assess the predictive capability of postoperative cTnT for adverse events.
Main Methods:
- Seventy-nine patients undergoing AVR were studied for patient outcomes and postoperative cTnT levels.
- Serum cTnT was measured within 24 hours post-AVR.
- Adverse events included need for intra-aortic balloon pump (IABP), inotropic support, prolonged ICU stay, or in-hospital death.
Main Results:
- Postoperative cTnT levels significantly increased compared to preoperative values and correlated with surgical times.
- 44% of patients experienced at least one adverse event, with 46% requiring inotropic support.
- No statistically significant difference in postoperative cTnT levels was found between patients with and without adverse events.
- Logistic regression identified diabetes, age, and low ejection fraction as independent predictors of adverse events, not cTnT levels.
Conclusions:
- Serum cTnT concentration is commonly elevated following AVR.
- Postoperative serum troponin T levels are not reliable predictors of patient outcomes after AVR.
- Reliance on first-day postoperative cTnT levels for planning patient care is not recommended.
Background:
The measurement of serum cardiac troponin T concentration (cTnT) after aortic valve replacement (AVR) provides the opportunity to assess the degree of myocardial damage and may have some prognostic value.
Aim:
To determine whether elevated troponin level is related to patient outcome.
Methods:
We investigated patient outcome and postoperative serum concentration of troponin T in 79 patients who underwent AVR. Serum levels of cTnT were measured within 24 h of AVR. We searched for the occurrence of subsequent adverse events i.e. requirement for intraaortic ballon pump (IABP) or inotropic support, prolonged Intensive Care Unit (ICU) stay, and in-hospital death.
Results:
Serum concentration of cTnT after AVR increased significantly compared to the preoperative value. We found significant positive correlations between aortic cross-clamp time (r = 0.23, p = 0.04), cardiopulmonary bypass time (r = 0.4,p = 0.00029), duration of the surgery (r = 0.30, p = 0.008), and postoperative cTnT level. Three (4%) patients required IABP support, 37 (46%) patients required inotropic support, and 11 (14%) patients had a prolonged ICU stay (> 48 h). Thirty eight (48%) patients required either inotropic support or IABP insertion. At least one adverse event occurred in 44 (56%) patients. Median postoperative serum cTnT concentration was 0.31 ng/mL (interquartile range 0.23-0.60 ng/mL). We failed to find a statistically significant difference in postoperative cTnT level between patients with and without adverse events. According to multiple logistic regression analysis, the postoperative serum level of troponin T was not independently associated with adverse patient outcome. Diabetes mellitus, patient age and left ventricular ejection fraction below 50% were significant independent predictors of adverse events after AVR. The area under receiver operating curve (AUROC) for postoperative serum troponin T concentration as a determinant of various adverse outcomes was never significantly different from 0.50.
Conclusions:
Serum cTnT concentration is frequently - if not universally - elevated after AVR. Serum level of troponin T measured on the first postoperative morning is a poor predictor of patient outcome after AVR and should not be relied on when planning postoperative care.
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