(717) Prognostic Significance of Serial Troponin Measurement after Lung Transplantation
Serial troponins are generally measured following lung transplantation (LTx), yet the clinical utility and significance remains unclear. We sought to evaluate troponin kinetics, understand determinants of troponin rise post-surgery and determine the clinical value of serial measurements post LTx. Co...
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| Published in: | The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S317 - S318 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Inc
01-04-2023
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| Online Access: | Get full text |
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| Summary: | Serial troponins are generally measured following lung transplantation (LTx), yet the clinical utility and significance remains unclear. We sought to evaluate troponin kinetics, understand determinants of troponin rise post-surgery and determine the clinical value of serial measurements post LTx.
Consecutive adult patients receiving a LTx from October 2015-May 2017 with at least 1 troponin measurement after LTx were retrospectively included. Troponin I levels were collected at 0-24h, 24-48 and 48-72h after LTx. The primary outcome was mechanical ventilation (IMV) for >3 days.
206 patients received a LTx (median age 58 years old, 35.4% women), of which 79.6% were bilateral LTx, 9.2% were bridged with extracorporeal life support (ECLS) and 32% received lungs after ex-vivo lung perfusion (EVLP). Intra-operative ECLS was used in 42.9% cases and cardiopulmonary bypass (CPB) in 6.8%. Median peak troponin was 4820 (2894, 7331) ng/ml, which would meet criteria for postoperative myocardial infarction in 99.5% patients. Peak troponin was associated with duration of IMV for >3 days (p<0.001; Figure 1), new onset of atrial arrhythmias (p=0.008), but not with primary graft dysfunction ISHLT grade 3 at day 3 (p=0.087). Peak troponin was also correlated with right ventricular dysfunction, >1 unit of red blood cells transfused, bilateral vs. single LTx, use of EVLP, kidney dysfunction at admission and intraoperative ECLS/CPB time. In-hospital mortality occurred in 13 (6.3%) patients, who displayed greater troponin levels at baseline and failed to demonstrate a decrease in troponin levels at 72h after LTx with an optimal cut-off using Youden's index of >7840 ng/ml and AUC of 0.794.
Patients receiving LTx have higher troponin levels in the immediate post-operative phase. Several risk factors for troponin elevation were identified. High peak troponin (>7840 ng/ml) with failure to normalize by 72h could help identify patients at higher risk of adverse outcomes such as prolonged ventilation and death. |
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| ISSN: | 1053-2498 1557-3117 |
| DOI: | 10.1016/j.healun.2023.02.731 |