Perioperative Levels and Changes of High-Sensitivity Troponin T Are Associated With Cardiovascular Events in Vascular Surgery Patients*

Gillmann, H; Meinders, Antje; Grohennig, Anika; Larmann, Jan; Bünte, Christoph; Calmer, Simone; Sahlmann, Bianca; Rustum, Saad; Aper, Thomas; Lichtinghagen, Ralf; Koch, Armin; Teebken, Omke E.; Theilmeier, Gregor

doi:10.1097/ccm.0000000000000249

Cited by 70 publications

(86 citation statements)

References 32 publications

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“…These results differ from our study, which may be explained by the fact that they calculated postoperative troponin changes in relation to preoperative troponin levels, while we only studied postoperative troponin values. Furthermore, Gillmann and colleagues reported that absolute TnT changes were superior to relative TnT changes for perioperative risk prediction, which is in concordance with our finding that relative changes were not related to mortality [18].…”

Section: Literaturesupporting

confidence: 82%

“…They reported that half of the patients with postoperative troponin elevation had a relative change in TnT > 85% as compared to the preoperative TnT level, and one in four patients had a relative TnT change > 242%. Gillmann and colleagues studied both absolute and relative changes in patients undergoing vascular surgery, and found that an absolute change in TnT of as small as 6 ng/L, as compared to the preoperative TnT level, was independently associated with major adverse cardiac events, and that adding the TnT absolute change to clinical risk factors improved the predictive accuracy for major adverse cardiac events [18]. These results differ from our study, which may be explained by the fact that they calculated postoperative troponin changes in relation to preoperative troponin levels, while we only studied postoperative troponin values.…”

Section: Literaturementioning

confidence: 99%

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Kinetics of troponin I in patients with myocardial injury after noncardiac surgery

Waes

Peelen

Kemperman

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: Myocardial injury after noncardiac surgery, as measured by troponin elevation, is strongly associated with mortality. However, it is unknown in which patients prognosis can be improved. The presence of kinetic changes of troponin may be associated with a worse prognosis and warrant more aggressive management. Therefore, we aimed to study the kinetics of troponin in patients with postoperative myocardial injury, and to determine the added predictive value of kinetic changes of troponin on mortality. Methods: This cohort study included patients with myocardial injury after noncardiac surgery. Troponin I (TnI) was measured on the first three postoperative days. The primary outcome was all-cause 1-year mortality. We studied both absolute and relative TnI changes, and determined the delta TnI that was associated with mortality to distinguish a rise-and-fall TnI pattern from a stable TnI pattern. Next, we determined the added predictive value of a rise-and-fall TnI pattern for mortality. Results: In total, 634 patients were included. The risk ratio (RR) for mortality increased significantly with an absolute

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Section: Literaturesupporting

confidence: 82%

Section: Literaturementioning

confidence: 99%

Kinetics of troponin I in patients with myocardial injury after noncardiac surgery

Waes

Peelen

Kemperman

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Gillmann et al reported that a preoperative hs-cTnT ≥0.018 ng/mL and a perioperative increase in hs-cTnT ≥0.006 ng/mL were independently associated with major adverse cardiac events in vascular surgery patients. 24 Noordzij et al suggested that a relative change in hs-cTnT >50% from baseline value seemed to be appropriate for diagnosis of myocardial injury. 21 Eggers et al tested the best cutoff value to diagnose acute myocardial infarction among changes in hs-cTnT ≥20%, ≥50%, or ≥100% from baseline.…”

Section: Incidence Of Composite Of In-hospital Cardiovascular Eventsmentioning

confidence: 99%

“…23, 24 Eggers et al reported that the universal definition of acute myocardial infarction, together with ≥20% change in cardiac troponin I (cTnI) appears to improve the discrimination of acute from chronic causes of cTnI release. 25 The National Academy of Clinical Biochemists recommends that ≥20% change is indicative of Study Endpoints (Definition of PMI) The primary outcome was the incidence of PMI, but currently, there is no accepted definition of PMI.…”

Section: Study Protocolmentioning

confidence: 99%

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Toda

Nakamura

Nakagawa

et al. 2018

Circ J

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“…A diagnosis of myocardial infarction requires larger changes and the presence of symptoms and/or changes in ECG. However, even small increases might be associated with major adverse cardiac events in the further course of the disease, as shown in a post-surgery study [14].…”

Section: Discussionmentioning

confidence: 99%

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

Wajdlich

Podlejska²,

Rosół³

et al. 2017

Arterial Hypertension

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Effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of high sensitive troponin T Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T AbstractIntroduction. High sensitivity troponin T (TnT-hs) is biomarker of myocardial damage and ischemia. Despite its elevation troponin still preserve its usefulness as a marker of the cardiovascular risk and mortality in chronic kidney disease. Variations of hydration status between and during hemodialysis exert significant hemodynamic effects, which may negatively affect cardiovascular system and blood pressure and lead to myocardial damage. The aim of the study was to access the effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of TnT-hs, in chronic hemodialysis patients. Material and methods. In 50 chronic hemodialysis patients (35M, 15F, mean age 64 ± 12 years) blood pressure and heart rate were monitored noninvasively during HD session. Serum concentration of TnT-hs and hydration status were assessed before and after hemodialysis.Results. TnT-hs concentration was above normal range in 98% patients before, and in all after hemodialysis. Median TnT-hs level was 82 ng/L before and 84 ng/L after hemodialysis, which comprised 586% and 600% of the upper limit of normal range. There was a small 2.4%, intradialytic increase of TnT-hs (p = 0.004). TnT-hs levels correlated positively with mean interdialytic weigh gain, before HD (r = 0.43, p = 0.02) and after HD (r = 0.5, p = 0.003).There was also a positive correlation between TnT-hs concentration and mean heart rate (r = 0.37, p = 0.008) and with mean systolic blood pressure during HD, before HD (r = 0.3, p = 0.026) and after HD (r = 0.3, p = 0.031). Conclusions. Hemodialysis can be a risk factor of myocardial injury, especially in overhydrated patients. Key words: hemodialysis, overhydration, troponin T, TnT-hs Arterial Hypertens. 2017, vol. 21, no. 4, pages: 186-194 DOI: 10.5603 StreszczenieWstęp. Wysokoczuła troponina T (TnT-hs) jest przydatnym klinicznie wskaźnikiem uszkodzenia komórek mięśnia sercowego. Stężenia TnT-hs u pacjentów z przewlekłą chorobą nerek są wyższe niż w populacji ogólnej, co wiąże się ze zwiększonym ryzykiem incydentów sercowo-naczyniowych oraz zgonu. Znaczne zmiany stopnia nawodnienia w czasie zabiegu hemodializy mogą niekorzystnie oddziaływać na układ sercowo-naczyniowy i ciśnienie tętnicze, co w efekcie może prowadzić do uszkodzenia kardiomiocytów. Celem pracy była ocena wpływu stanu nawodnienia, zmian częstości rytmu serca (HR) i ciśnienia tętniczego (BP) w trakcie hemodializy (HD) na zmiany stężeń TnT-hs powodowane zabiegiem hemodializy u pacjentów długotrwale hemodializowanych. Materiał i metody. U 50 pacjentów (35M, 15K, średnia wieku 64 ± 12 lat) z rozpoznaniem schyłkowej niewydolności nerek, długotrwale hemodializowanych, nieinwazy...

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Perioperative Levels and Changes of High-Sensitivity Troponin T Are Associated With Cardiovascular Events in Vascular Surgery Patients*

Cited by 70 publications

References 32 publications

Kinetics of troponin I in patients with myocardial injury after noncardiac surgery

Kinetics of troponin I in patients with myocardial injury after noncardiac surgery

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

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