Volume 3 Supplement 1

ESICM LIVES 2015

Open Access

Highly sensitive troponin t (hstnt) profile for outcome prediction after cardiac surgery

  • AS Omar1, 2,
  • S Sudarsanan3,
  • S Hanoura3,
  • H Osman3,
  • P Sivadasan3,
  • Y Shouman3,
  • AK Tuli3,
  • R Singh4 and
  • A Al Khulaifi3
Intensive Care Medicine Experimental20153(Suppl 1):A108

https://doi.org/10.1186/2197-425X-3-S1-A108

Published: 1 October 2015

Introduction

Changes in cardiac mediators remain a subject of research interest. Instantly obtainable biomarkers that are performed routinely, are inexpensive and are characterized by linkages to outcome in cardiac surgery settings are optimum. Post-operative conventional cardiac troponins are linked to short- and middle-length outcomes [1] but highly sensitive troponin T (hsTnT) has not been extensively evaluated in the same settings.

Objectives

To assess the ability of hsTnT to prognosticate outcomes in cardiac surgery.

Methods

We conducted a single-center, prospective observational study over 2 years. We analyzed the data from all patients who underwent cardiac surgery. We recruited 413 patients with a mean age of 54.9 ± 10.9 years. The patients were divided into two groups based on hsTnT level, which is analogous to creatine kinase MB (CK-MB) and indicates myocardial injury (with and without myocardial infarction) [2]. The receiver operator curve (ROC) was used to determine this relation, retrieving a level of 2309 ng/L and showing an 80% sensitivity and an 86% specificity (figure). We used a t-test to compare variables and multivariate analysis was conducted for significant variables.
Figure 1

ROC for hsTnT associated with a high CK-MB.

Results

Two groups (group A (372 patients) and group B (41 patients)) were both matched for age, body mass index, diabetes mellitus association, serum creatinine, Euroscore, aortic cross clamp and cardiopulmonary bypass time, and total length of anesthesia. Patients with hsTnT levels of 2309 ng/L or lower had a better outcome in terms of inotropes need, lengths of ventilation (LOV), ICU and hospital stay, and post-operative complications. Multivariate analysis revealed significant relations of the given level with operative emergency (p = 0.001); the level was a predictor for a longer duration of mechanical ventilation (p = 0.01) and post-operative atrial fibrillation (POAF) (p = 0.003) (Table 1). Moreover, 9 patients (21.9%) in group B had perioperative myocardial infarctions.
Table 1

Multivariate logistic regression for hsTnT.

Variable

Adjusted OR

95% CI

P-Value

Operation emergency

10.21

2.5-41.3

0.001

LOV

1.01

1.00-1.02

0.01

AKI

0.84

0.32-2.20

0.72

POAF

4.79

1.7-13.5

0.003

Mortality

3.71

0.4-32.9

0.24

CI: confidence interval; LOV: length of ventilation; AKI: acute kidney injury; POAF: post-operative atrial fibrillation

Conclusions

Outcome prediction in cardiac surgery in terms of PMI, LOV and POAF could be enhanced by using a set level of hsTnT; this profile serves as a powerful laboratory marker to identify high-risk patients.

Grant Acknowledgment

We thank all members of cardiothoracic surgery department and the medical research center of Hamad medical corporation.

Authors’ Affiliations

(1)
Hamad Medical Corporation
(2)
Faculty of Medicine, Critical Care Medicine
(3)
Hamad Medical Corporation, Cardiothoracic Surgery-Heart Hospital
(4)
Hamad Medical Corporation, Medical Research Center, Biomedical Statistics

References

  1. Buse GAL, Koller MT, Grapow M, et al: The prognostic value of troponin release after adult cardiac surgery. A meta-analysis. Eur J Cardiothorac Surg. 2010, 37 (2): 399-406.Google Scholar
  2. Thygesen K, Alpert JS, Jaffe , et al: Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Third universal definition of myocardial infarction. Eur Heart J. 2012, 33 (20): 2551-67. 10.1093/eurheartj/ehs184.PubMedView ArticleGoogle Scholar

Copyright

© Omar et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.