High-sensitivity troponin T as a biomarker for the development of atrial fibrillation after cardiac surgery
Autor: | Ana I. Romero-Aniorte, Luis Caballero, Rubén Jara-Rubio, Esteban Orenes-Piñero, Gregory Y.H. Lip, Francisco Marín, Arcadio García-Alberola, Diana Hernández-Romero, Jose M. Arribas, Mariano Valdés, Álvaro Lahoz, Juan Antonio Vílchez |
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Rok vydání: | 2013 |
Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty Body Mass Index law.invention Coronary artery bypass surgery Postoperative Complications Troponin T Risk Factors law Internal medicine Atrial Fibrillation medicine Cardiopulmonary bypass Humans Prospective Studies Cardiac Surgical Procedures Aged business.industry Atrial fibrillation General Medicine Perioperative Middle Aged medicine.disease Cardiac surgery medicine.anatomical_structure ROC Curve Cardiology Biomarker (medicine) Female Surgery Cardiology and Cardiovascular Medicine business Biomarkers |
Zdroj: | European Journal of Cardio-Thoracic Surgery. 45:733-738 |
ISSN: | 1873-734X 1010-7940 |
Popis: | Atrial fibrillation (AF) occurs in ∼ 30% of patients undergoing coronary artery bypass grafting (CABG) and in 40% of patients after valve surgery. High-sensitivity cardiac troponin T (hsTnT) is a specific and high-sensitivity marker of myocardial injury, while N-terminal proB-type natriuretic peptide (NT-proBNP) is an established biomarker for wall remodelling. We investigated whether hsTnT and NT-proBNP levels could be used as valuable biomarkers for AF occurrence after cardiac surgery.We included consecutive haemodynamically stable patients undergoing programmed cardiac surgery with cardiopulmonary bypass pump. We determined hsTnT and NT-proBNP levels before and after cardiac surgery and recorded AF development by prolonged electrocardiogram monitoring.We included 100 patients with predominantly aortic valve (n = 42) or ischaemic heart (n = 58) diseases. Twenty-nine patients (29%) developed post-surgical AF. Patients developing AF had a longer hospital stay (P = 0.005). hsTnT levels increased after surgery [P0.001], indicating perioperative myocardial injury, with higher presurgery levels in patients who developed AF [P = 0.015]. Body mass index and EuroSCORE risk scale were independently associated with higher hsTnT levels presurgery. On univariate analysis, age (P = 0.048), male sex (P = 0.031), indexed left atrial volume (P = 0.042), β-blockers treatment (P = 0.024), type of surgery (valve surgery vs CABG; P = 0.034), EuroSCORE risk scale (P = 0.025) and higher preoperative hsTnT levels (P = 0.009) were predictors of AF development, but NT-proBNP did not reach statistical significance (P = 0.060). hsTnT levels in blood samples obtained the day after surgery were not associated with post-surgical AF development (P = 0.165). In a multivariate model, only higher hsTnT levels before cardiac surgery (11.87 ng/l) [Odds Ratio, OR; (95% Confidence interval, CI) 4.27 (1.43-12.77), P = 0.009] and male sex [OR 5.10 (1.72-15.13), P = 0.003)] were independently associated with the occurrence of post-surgical AF.High presurgical hsTnT levels were independently predictive of patients developing AF after cardiac surgery. hsTnT levels determined post-surgery suggest that cardiac perioperative myocardial injury is not associated with postoperative AF development. NT-proBNP did not reach statistical significance as a biomarker for AF prediction. |
Databáze: | OpenAIRE |
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