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Troponin T elevation after permanent pacemaker implantation
Xueying Chen1, Ziqing Yu1, Jin Bai1
1Shanghai Institution of Cardiovascular Disease, Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Insights
Cardiac troponin T (CTNT) elevation occurs in 55.6% of patients after pacemaker implantation but is not linked to 1-year adverse outcomes. Gender, NT-pro-BNP, LVEF, eGFR, and fluoroscopy time predict CTNT elevation.
Area of Science:
- Cardiology
- Biomarkers
- Medical Devices
Background:
- Cardiac troponin T (CTNT) is a biomarker for myocardial injury.
- Pacemaker implantation is a common procedure for cardiac rhythm management.
- Understanding CTNT changes post-implantation is crucial for patient management.
Purpose of the Study:
- To investigate the incidence, significance, and predictive factors of CTNT elevation following pacemaker implantation.
- To assess the relationship between post-implantation CTNT levels and short-term cardiac complications and outcomes.
Main Methods:
- A prospective study included 374 patients undergoing pacemaker implantation with normal baseline CTNT.
- Serum CTNT levels were measured at baseline, 6 hours, and 24 hours post-procedure.
- Logistic regression analysis identified independent predictors of CTNT elevation.
Main Results:
- CTNT levels significantly increased post-implantation, with 55.6% of patients showing elevation at 6 hours.
- Elevated CTNT was not associated with a higher incidence of complications or adverse cardiac outcomes within 1 year.
- Independent predictors of CTNT elevation included gender, baseline NT-pro-BNP, LVEF, eGFR, and fluoroscopy time.
Conclusions:
- Pacemaker implantation frequently causes transient CTNT elevation, which is generally not associated with adverse cardiac events within one year.
- Factors such as gender, baseline NT-pro-BNP, LVEF, eGFR, and fluoroscopy time are independent predictors of CTNT elevation.
- These findings aid in interpreting CTNT levels in patients undergoing pacemaker procedures.
Purpose:
The objective of the study is to study the incidence, significance, and factors associated with cardiac troponin T (CTNT) elevation after pacemaker implantation.
Methods:
Three hundred seventy-four patients (104 single-chamber pacemakers or ICD, 243 dual-chamber pacemakers, and 27 cardiac resynchronization therapy/cardiac resynchronization therapy defibrillator) who had normal levels of CTNT at baseline and underwent implantation of a permanent pacemaker system were included in this study. Serum levels of CTNT were measured at baseline, 6 and 24 h after the implantation procedure.
Results:
The median of CTNT levels increased from 0.012 ng/mL at baseline to 0.032 and 0.019 ng/mL at 6 and 24 h after the procedure, respectively (all p < 0.0001). Elevated CTNT levels were noted in 208 patients (55.6%) at 6 h after the implantation, among which 29 patients (7.8%) had CTNT levels exceeding the range of minimal myocardial damage (>0.09 ng/mL). After 1-year follow-up, the incidence of complications including dislodgement of the lead, pocket infection, pneumothorax, hemothorax, and vein thrombus and cardiac outcomes including hospitalization of heart failure, coronary artery disease, arrhythmia, and cardiovascular mortality was not significantly different between the normal and elevated CTNT groups at 6 h after the procedure. By logistic regression analysis, gender, N-terminal pro-B type natriuretic peptide (NT-pro-BNP) at baseline, left ventricular ejection fractions (LVEF), estimated glomerular filtration rate (eGFR), and fluoroscopy time were independently associated with CTNT elevation after adjusted for age, pacemaker types, right ventricle lead location (RVA or RVOT), heart function, and left ventricular end systolic dimension.
Conclusions:
Pacemaker implantation was found to be accompanied with CTNT elevation in 55.6% of the patients at 6 h after the procedure, and its kinetics were fast, which might not be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, gender, NT-pro-BNP at baseline, LVEF, eGFR, and fluoroscopy time were found to be independent predictors of CTNT elevation.