High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery

A. Duma, C. Wagner, M. Titz, M. Maleczek, M. Hüpfl, V. B. Weihs, E. Samaha, H. Herkner, T. Szekeres, M. Mittlboeck, M. G. Scott, A. S. Jaffe, P. Nagele

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Abstract

Background: It is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking. Methods: In this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2–6 h, and 18–30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre−1; men >15 ng litre−1). Results: Amongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50–84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre−1, 12 patients (13%) between 2 and 4 ng litre−1, three patients between 4 and 6 ng litre−1, and one patient (1%) between 6 and 8 ng litre−1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9–5, inter-quartile range) ng litre−1 at baseline, 4 (3.9–5) ng litre−1 at 2–6 h after surgery, and 4 (3.9–5) ng litre−1 on postoperative day 1. Conclusions: One in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting. Clinical trial registration: NCT 02394288.

Original languageEnglish
Pages (from-to)291-298
Number of pages8
JournalBritish journal of anaesthesia
Volume120
Issue number2
DOIs
StatePublished - Feb 2018

Keywords

  • Heart
  • Surgery
  • Troponin

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    Duma, A., Wagner, C., Titz, M., Maleczek, M., Hüpfl, M., Weihs, V. B., Samaha, E., Herkner, H., Szekeres, T., Mittlboeck, M., Scott, M. G., Jaffe, A. S., & Nagele, P. (2018). High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery. British journal of anaesthesia, 120(2), 291-298. https://doi.org/10.1016/j.bja.2017.09.001