High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery
| Autor: | Mitchell G. Scott, Andreas Duma, Michael Hüpfl, Eslam Samaha, C. Wagner, Thomas Szekeres, Mathias Maleczek, M. Titz, Peter Nagele, M. Mittlboeck, Allan S. Jaffe, Harald Herkner, V.B. Weihs |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Cardiac troponin 030204 cardiovascular system & hematology Clinical Practice 03 medical and health sciences Electrocardiography Young Adult 0302 clinical medicine Postoperative Complications Troponin T 030202 anesthesiology Internal medicine medicine Humans Orthopedic Procedures Prospective Studies Young adult Pathological biology business.industry Troponin Clinical trial Anesthesiology and Pain Medicine Treatment Outcome Non cardiac surgery Cardiology biology.protein Population study Female business Biomarkers Cohort study |
| Zdroj: | British journal of anaesthesia. 120(2) |
| ISSN: | 1471-6771 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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