Elevated cardiac troponin T in cirrhotic patients with emergency care admissions: Associations with mortality

Elnegouly, Mayada; Umgelter, Katrin; Safi, Wajima; Hapfelmeier, Alexander; Schmid, Roland M.; Umgelter, Andreas

doi:10.1111/jgh.13902

Cited by 8 publications

(4 citation statements)

References 43 publications

(63 reference statements)

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“…Previously published series have reported that abnormally elevated pretransplant troponin levels were associated with a higher risk of posttransplant cardiac events and mortality in single-center LT populations. [12][13][14] These observations suggest that pretransplant troponin isoform testing may be an attractive pretransplant test for the detection of underlying cardiac risk in LT patients.…”

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confidence: 95%

“…Elevated troponin levels have also been reported in cohorts of patients with cirrhosis and acute liver failure and are prognostic for adverse outcomes, including in LT populations. [12][13][14][15] Occult elevations in cardiac troponin appear to be associated with cirrhotic cardiomyopathy (CCM), a spectrum of cardiac abnormalities related to underlying advanced liver disease. The CCM diagnosis includes abnormal troponin as one of the supporting diagnostic criteria.…”

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confidence: 99%

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Utility of preoperative troponin I to predict mortality in adult liver transplant recipients: Revisiting pretransplant cardiac risk in the current MELD‐allocation era

Wray,

Xia,

Ershoff

et al. 2023

Clinical Transplantation

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BackgroundPreoperative risk assessment in liver transplant (LT) candidates, particularly related to cardiac risk, is an area of intense interest for transplant clinicians. Various cardiac testing methods are employed by transplant centers to characterize cardiac risk. Serum troponin is an established method for the detection of myocardial injury in a wide variety of clinical settings. Preoperative troponin screening has been reported to predict postoperative cardiac events and mortality in various surgical patient populations, however, the utility of preoperative troponin to predict posttransplant outcomes in current LT candidate populations requires further investigation.MethodsWe performed a prospective blinded study in a cohort of 275 consecutive LT recipients at a single transplant center to determine if preoperative serum troponin I (TnI) was predictive for postoperative 1‐year mortality.ResultsAbnormal preoperative TnI levels (>.1 ng/mL) were found in 38 patients (14%). One‐year mortality occurred in 19 patients (7%). There was no significant difference in mortality between patients with normal and abnormal troponin levels. Additionally, we found that there was no significant difference in early postoperative major adverse cardiac events between patient groups.ConclusionsContrary to previous reports, elevated preoperative TnI was not significantly predictive of posttransplant mortality in LT recipients at our institution.

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confidence: 95%

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confidence: 99%

Utility of preoperative troponin I to predict mortality in adult liver transplant recipients: Revisiting pretransplant cardiac risk in the current MELD‐allocation era

Wray,

Xia,

Ershoff

et al. 2023

Clinical Transplantation

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“…Further studies have suggested that elevated troponin values occur in critically ill patients without initial cardiac disease and have a negative impact on prognosis, albeit not as an independent prognostic factor [ 9 , 10 ]. Moreover, in a trial from 1976, more than 90% of ALF patients examined showed cardiac abnormalities, 25% of whom suffered sudden cardiac death [ 11 ].…”

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confidence: 99%

Acute myocardial injury secondary to severe acute liver failure: A retrospective analysis supported by animal data

et al. 2021

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To investigate whether acute liver failure (ALF) leads to secondary acute myocardial injury, 100 ALF patients that were retrospectively identified in a single center based on ICD 10 codes and 8 rats from an experimental study that died early after bile duct ligation (BDL) were examined. Creatine kinase (CK), creatine kinase-MB isoenzyme (CKMB) and cardiac troponin-I (cTnI) were analyzed as markers of myocardial injury. For histological analysis, hematoxylin-eosin (HE), elastic Van Gieson (EVG), CD41 and myeloperoxidase were used to stain rat hearts. Major adverse cardiac events (MACEs) were a critical factor for mortality (p = 0.037) in human ALF. Deceased patients exhibited higher levels of CKMB than survivors (p = 0.023). CKMB was a predictor of mortality in ALF (p = 0.013). Animals that died early after BDL exhibited increased cTnI, CKMB, tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) levels compared to controls (cTnI: p = 0.011, CKMB: p = 0.008, TNFα: p = 0.003, IL-6: p = 0.006). These animals showed perivascular lesions and wavy fibers, microthrombi and neutrophilic infiltration in the heart. MACEs are decisive for mortality in human ALF, and elevated CKMB values indicate that this might be due to structural myocardial damage. Accordingly, CKMB was found to have predictive value for mortality in ALF. The results are substantiated by data from a rat BDL model demonstrating diffuse myocardial injury.

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“…Thus, we performed emergent coronary arteriography showing no luminal narrowing. Finally, we determined that acute decompensation of liver cirrhosis with a hyperdynamic state after total hip arthroplasty [ 4 , 5 ] led to an increase in serum hs-cTnI levels [ 6 ] and ECG changes due to Aslanger’s sign ( Fig. 1 ).…”

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confidence: 99%

Aslanger’s sign in 12-lead electrocardiogram

Takahashi

Morioka

Uemura

et al. 2023

Oxford Medical Case Reports

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Elevated cardiac troponin T in cirrhotic patients with emergency care admissions: Associations with mortality

Abstract: A large proportion of cirrhotic patients in the ED have elevated levels of cTnT even if there is no evidence of cardiac disease. Elevated cTnT is associated with increased mortality during 1 year after correcting for Model for End-stage Liver Disease and CLIF-C-ACLF scores.

Cited by 8 publications

References 43 publications

Utility of preoperative troponin I to predict mortality in adult liver transplant recipients: Revisiting pretransplant cardiac risk in the current MELD‐allocation era

Utility of preoperative troponin I to predict mortality in adult liver transplant recipients: Revisiting pretransplant cardiac risk in the current MELD‐allocation era

Acute myocardial injury secondary to severe acute liver failure: A retrospective analysis supported by animal data

Aslanger’s sign in 12-lead electrocardiogram

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