Perioperative dynamics of highly sensitive troponin I in patients operated on the ascending and aortic arch. A comparative prospective study

Introduction. Patients with thoracic aortic pathology are one of the most difficult categories of patients, however, the informative value of high-sensitive troponin I during reconstruction of thoracic aorta needs to be investigated further.

Aim. To determine the correlation between the high-sensitive troponin I and risk of postoperative complications in patients operated on thoracic aorta.

Methods. A prospective observational single-center study, which included patients operated on the ascending aorta and aortic arch. Blood samples were taken for troponin I before the induction of anesthesia, at the end of the operation and 6 hours after the end.

Results. The study included 112 patients, 58 of them underwent surgery on ascending aorta and 54 on aortic arch. Correlation between growth of highly sensitive troponin I was observed with time of artificial circulation, myocardial ischemia both at the end of the operation (R = 0,4 p<0,001; R = 0,55 p<0,001) and after 6 hours (R = 0,43 p<0,001; R = 0,52 p<0,001). In the postoperative period, the need for inotropic support for ≥ 24 hours was observed in 8 patients in ascending aorta group and 7 patients in aortic arch group. ROC analysis for inotropic support showed cut-off levels for troponin I: at the end of surgery, more than 1,04 ng/ml (sensitivity 75 %, specificity 71,3 %, AUC 0,785), 6 hours after surgery, more than 1,565 ng/ml (sensitivity 81,3 %, specificity 71,6 %, AUC 0,794).

Conclusion. Highly sensitive troponin I is a significant predictor of inotropic support requirement in the postoperative period.

1. Akselrod B.A., Dymova O.V., Gubko A.V., Krasnoshchekova A.P., Guskov D.A., Goncharova A.V., Gladysheva V.G., Gubko K.V., Kulinchenko O.S. Role of Intraoperative Biomarkers in Prognosis of Perioperative Complications in Reconstructive Thoracic Aorta Surgery. Russian Journal of Cardiology, 2023, Vol. 28, № S2, рр. 55–65. (In Russ.). https://doi.org/10.15829/1560-4071-2023-5314

2. Yanovskaya I.M., Mandel I.A., klypa T.V., kolyshkina N.A., Marey I.S., Zotov A.S., Baklaushev V.P. Diagnostic significance of highly sensitive troponins in cardiac surgery. Klinicheskaya praktika, vol. 13 (3), рр. 32–42. (In Russ.) https://doi.org/10.17816/clinpract111002

3. Thygesen K., Alpert J.S., Jaffe A.S. et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC). American College of Cardiology (ACC). American Heart Association (AHA). World Heart Federation (WHF) task force for the universal definition of myocardial infarction. Fourth universal definition of myocardial infarction. J Am Coll Cardiol., 2018, № 72(18), рр. 2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038

4. Thygesen K., Mair J., Giannitsis E. et al. How to Use High-Sensitivity Cardiac Troponins in Acute Cardiac Care. Eur Heart J., 2012, № 33 (18), рр. 2252–2257 https://doi.org/10.1093/eurheartj/ehs154

5. Newby L.K., Jesse R.L., Babb J.D. et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol., 2012, № 11;60(23), рр. 2427–2463. https://doi.org/10.1016/j.jacc.2012.08.969

6. Chaulin A. Clinical use of highly sensitive troponins. The Scientific Heritage, 2020, Vol. (56–52), рр. 76–79. (In Russ.) https://doi.org/10.24412/9215-0365-2020-56-2-76-79

7. Thygesen K., Alpert J.S., Jaffe A.S. et al. Third Universal Definition of Myocardial Infarction. Circulation, 2012, № 126(16), рр. 2020–2035. https://doi.org/10.1161/CIR.0b013e31826e1058

8. Omran H., Deutsch M.A., Groezinger E., Zittermann A., Renner A., Neumann J.T., Westermann D., Myles P., Ramosaj B., Pauly M., Scholtz W., Hakim-Meibodi K., Rudolph T.K., Gummert J., Rudolph V. High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making. Eur Heart J., 2022, Jul 1; № 43(25), рр. 2388–2403. https://doi.org/10.1093/eurheartj/ehab918

9. Ahmed S.H., Pervez N., Rehan S.T., Shaikh T.G., Waseem S. Postoperative cardiac troponin I as an indicator of surgical outcomes: A systematic review. J Card Surg., 2022, Dec; № 37(12), рр. 5351–5361. https://doi.org/10.1111/jocs.17197

10. Gualandro D.M., Puelacher C., Lurati Buse G. et al. Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by highsensitivity cardiac troponin I. Clin Res Cardiol., 2021, № 110(9), рр. 1450–1463. https://doi.org/10.1007/s00392-021-01827-w

11. Munshi U.K., Brown M.M., Tauber K.A., Horgan M.J. Early Troponin I Levels in Newborns Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Residual Encephalopathy at Discharge. Am J Perinatol. 2022, Jul; № 39(10), рр. 1083–1088. https://doi.org/10.1055/s-0040-1721497

12. Liu X., Tooley J., Løberg E.M., Suleiman M.S., Thoresen M. Immediate hypothermia reduces cardiac troponin I after hypoxic-ischemic encephalopathy in newborn pigs. Pediatr Res., 2011, Oct; № 70(4), рр. 352– 356. https://doi.org/10.1203/PDR.0b013e31822941ee

13. Schwartz S.M., Duffy J.Y., Pearl J., Goins S., Wagner C.J., Nelson D.P. Glucocorticoids preserve calpastatin and troponin I during cardiopulmonary bypass in immature pigs. Pediatr Res., 2003, Jul; № 54(1), рр. 91–97. https://doi.org/10.1203/01.PDR.0000065730.79610.7D