Postoperative high-sensitivity troponin T predicts 1-year mortality and days alive and out of hospital after orthotopic heart transplantation

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Abstract

Background

Orthotopic heart transplantation (HTX) is the gold standard to treat end-stage heart failure. Numerous risk stratification tools have been developed in the past years. However, their clinical utility is limited by their poor discriminative ability. High sensitivity troponin T (hsTnT) is the most specific biomarker to detect myocardial cell injury. However, its prognostic relevance after HTX is not fully elucidated. Thus, this study evaluated the predictive value of postoperative hsTnT for 1-year survival and days alive and out of hospital (DAOH) after HTX.

Methods

This retrospective cohort study included patients who underwent HTX at the University Hospital Duesseldorf, Germany between 2011 and 2021. The main exposure was hsTnT concentration at 48 h after HTX. The primary endpoints were mortality and DAOH within 1 year after surgery. Receiver operating characteristic (ROC) curve analysis, logistic regression model and linear regression with adjustment for risk index for mortality prediction after cardiac transplantation (IMPACT) were performed.

Results

Out of 231 patients screened, 212 were included into analysis (mean age 55 ± 11 years, 73% male). One-year mortality was 19.7% (40 patients) and median DAOH was 298 days (229–322). ROC analysis revealed strongest discrimination for mortality by hsTnT at 48 h after HTX [AUC = 0.79 95% CI 0.71–0.87]. According to Youden Index, the cutoff for hsTnT at 48 h and mortality was 1640 ng/l. After adjustment for IMPACT score multivariate logistic and linear regression showed independent associations between hsTnT and mortality/DAOH with odds ratio of 8.10 [95%CI 2.99–21.89] and unstandardized regression coefficient of −1.54 [95%CI −2.02 to −1.06], respectively.

Conclusion

Postoperative hsTnT might be suitable as an early prognostic marker after HTX and is independently associated with 1-year mortality and poor DAOH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40001-022-00978-4.

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Most cited references 30

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Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery.

P Devereaux, Matthew T V Chan, Pablo Alonso-Coello … (2012)

Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days. To determine the relationship between the peak fourth-generation troponin T (TnT) measurement in the first 3 days after noncardiac surgery and 30-day mortality. A prospective, international cohort study that enrolled patients from August 6, 2007, to January 11, 2011. Eligible patients were aged 45 years and older and required at least an overnight hospital admission after having noncardiac surgery. Patients' TnT levels were measured 6 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We undertook Cox regression analysis in which the dependent variable was mortality until 30 days after surgery, and the independent variables included 24 preoperative variables. We repeated this analysis, adding the peak TnT measurement during the first 3 postoperative days as an independent variable and used a minimum P value approach to determine if there were TnT thresholds that independently altered patients' risk of death. A total of 15,133 patients were included in this study. The 30-day mortality rate was 1.9% (95% CI, 1.7%-2.1%). Multivariable analysis demonstrated that peak TnT values of at least 0.02 ng/mL, occurring in 11.6% of patients, were associated with higher 30-day mortality compared with the reference group (peak TnT ≤ 0.01 ng/mL): peak TnT of 0.02 ng/mL (adjusted hazard ratio [aHR], 2.41; 95% CI, 1.33-3.77); 0.03 to 0.29 ng/mL (aHR, 5.00; 95% CI, 3.72-6.76); and 0.30 ng/mL or greater (aHR, 10.48; 95% CI, 6.25-16.62). Patients with a peak TnT value of 0.01 ng/mL or less, 0.02, 0.03-0.29, and 0.30 or greater had 30-day mortality rates of 1.0%, 4.0%, 9.3%, and 16.9%, respectively. Peak TnT measurement added incremental prognostic value to discriminate those likely to die within 30 days for the model with peak TnT measurement vs without (C index = 0.85 vs 0.81; difference, 0.4; 95% CI, 0.2-0.5; P < .001 for difference between C index values). The net reclassification improvement with TnT was 25.0% (P < .001). Among patients undergoing noncardiac surgery, the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality.

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STROBE Reporting Guidelines for Observational Studies.

Amir Ghaferi, Todd Schwartz, Timothy Pawlik (2021)

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Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization

Christian Puelacher, Giovanna A Lurati Buse, Daniela Seeberger … (2017)

Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening.

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Author and article information

Contributors

Sebastian Roth: Sebastian.Roth@med.uni-duesseldorf.de

Journal

Journal ID (nlm-ta): Eur J Med Res

Journal ID (iso-abbrev): Eur J Med Res

Title: European Journal of Medical Research

Publisher: BioMed Central (London )

ISSN (Print): 0949-2321

ISSN (Electronic): 2047-783X

Publication date (Electronic): 9 January 2023

Publication date PMC-release: 9 January 2023

Publication date Collection: 2023

Volume: 28

Electronic Location Identifier: 16

Affiliations

[1 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, , Heinrich-Heine-University Duesseldorf, ; Duesseldorf, Germany

[2 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, , Heinrich-Heine-University Duesseldorf, ; Duesseldorf, Germany

[3 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, , Heinrich-Heine-University Duesseldorf, ; Duesseldorf, Germany

[4 ]Department of Anesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany

Article

Publisher ID: 978

DOI: 10.1186/s40001-022-00978-4

PMC ID: 9827673

PubMed ID: 36624515

SO-VID: 2bead8ae-4fd1-41c9-aa6b-18cbed724c16

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 16 November 2022

Date accepted : 30 December 2022

Funding

Funded by: Universitätsklinikum Düsseldorf. Anstalt öffentlichen Rechts (8911)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: heart failure,heart transplantation,impact score,risk prediction,patient-centered outcomes

Data availability:

ScienceOpen disciplines: Medicine

Keywords: heart failure, heart transplantation, impact score, risk prediction, patient-centered outcomes

Postoperative high-sensitivity troponin T predicts 1-year mortality and days alive and out of hospital after orthotopic heart transplantation

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Abstract

Background

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Supplementary Information

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Most cited references 30

Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery.

STROBE Reporting Guidelines for Observational Studies.

Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization

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