Irina MandelFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency, Russian Federation
Title: Diagnostic significance of highly sensitive troponins in cardiac surgery
Background: The level of troponins after cardiac surgery always exceeds the reference values, however, the interpretation of these changes is difficult. Aim: To determine the relationship between high-sensitivity cardiac troponin I and troponin T levels and the risk of developing heart failure (HF) within 24 hours after heart surgery.
Methods: A prospective, observational, single-center study included 70 patients undergoing elective heart surgery. Patients were retrospectively divided into two groups based on the development of HF in the first 12 hours after surgery.
Results: The levels of highly sensitive Troponin I (HsT I) in patients who underwent elective heart surgery without complications (n=57) were 61 times higher than the upper reference limit, with HF (n=13) ? 111 times higher than the upper reference limit. The levels of highly sensitive Troponin T (HsT T) are 25.5 and 51 times higher, respectively. The level of HsT I at the end of the surgery can be a predictor of the development of HF, regardless of the use of cardiopulmonary bypass (threshold value 1483 ng/l), as well as a predictor of the need for inotropic support for 2 days or more, regardless of the type ofoperation (threshold value 1573 ng/l). There was a direct moderate correlation of HsT I at the end of the operation and 6 hours after the operation with cumulative hemohydrobalance for 24 hours, which was 60% higher in patients with HF than in patients without complications.
Conclusion: In uncomplicated patients, the level of highly sensitive troponins T and I in the postoperative period is 25–61 times higher than the upper reference limit, and with the HF — 51–111 times. Highly sensitive troponins can be considered as predictors of the development of HF and the duration of inotropic support.
Irina A Mandel completed her Ph.D. dedicated to prophylaxis and treatment of gastrointestinal complications in cardiac surgery at the age of 32 years from Meshalkin National Medical Research Center (Novosibirsk, Russia). She is the leading researcher of the anesthesiology and intensive care department of Federal Scientific and Clinical Center. She has 75 publications that have been cited over 100 times. Her main field of interest is cardiovascular anesthesia, myocardial protection against ischemia-reperfusion injury, preconditioning with hypoxic, hyperoxic, nitric oxide gas mixtures, intensive care of cardiac patients.