High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery
1Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria.
Insights
Postoperative cardiac-troponin increases in healthy adults may be physiological, not pathological myocardial injury. This study found troponin elevations in one in four patients, but without evidence of ischemia, suggesting a normal surgical response.
Area of Science:
- Cardiovascular Medicine
- Surgical Outcomes
- Biomarker Analysis
Background:
- The pathological significance of isolated postoperative cardiac-troponin elevation (myocardial injury) is uncertain due to a lack of control studies in healthy adults.
- Distinguishing physiological troponin changes from pathological myocardial injury post-surgery requires further investigation in well-defined populations.
Purpose of the Study:
- To investigate the incidence and characteristics of postoperative cardiac-troponin T (cTnT) elevations in young, healthy adults undergoing elective orthopedic surgery.
- To determine if postoperative cTnT increases in this population represent pathological myocardial injury or a normal physiological response.
Main Methods:
- A single-center, prospective observational cohort study involving 95 young, healthy adults undergoing elective orthopedic surgery.
- Serial plasma concentrations of high-sensitivity cardiac troponin T (hscTnT) were measured pre-operatively, 2-6 hours post-operatively, and 18-30 hours post-operatively.
- Defined endpoints included hscTnT increases exceeding analytical and biological variability, and myocardial injury defined by elevation above the 99th percentile upper reference limit.
Main Results:
- No significant hscTnT increase (≥20%) was detected in 73% of patients; elevations within 20-84% were observed in 18% and 7% of patients, respectively.
- Only one patient (1%) was diagnosed with myocardial injury, defined as hscTnT elevation above the 99th percentile upper reference limit.
- Median hscTnT concentrations showed no increase post-operation, remaining stable across all measured time points.
Conclusions:
- A postoperative hscTnT increase occurred in approximately 25% of young adult patients without cardiovascular disease, but without exceeding the 99th percentile URL or indicating myocardial ischemia.
- These findings suggest that postoperative cardiac-troponin elevations in some surgical patients may represent a normal physiological response rather than pathological myocardial injury.
- The results necessitate a re-evaluation of the definition and clinical interpretation of postoperative myocardial injury in the context of surgical stress.
Background:
It is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking.
Methods:
In this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2-6 h, and 18-30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre-1; men >15 ng litre-1).
Results:
Amongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50-84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre-1, 12 patients (13%) between 2 and 4 ng litre-1, three patients between 4 and 6 ng litre-1, and one patient (1%) between 6 and 8 ng litre-1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9-5, inter-quartile range) ng litre-1 at baseline, 4 (3.9-5) ng litre-1 at 2-6 h after surgery, and 4 (3.9-5) ng litre-1 on postoperative day 1.
Conclusions:
One in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting.
Clinical Trial Registration:
NCT 02394288.
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