Diastolic dysfunction is a risk of perioperative myocardial injury assessed by high-sensitivity cardiac troponin T in elderly patients undergoing non-cardiac surgery

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Abstract

Background: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery. Methods and Results: In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65–32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341–6.84, P=0.008). Conclusions: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

Original languageEnglish
Pages (from-to)775-782
Number of pages8
JournalCirculation Journal
Volume82
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

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Troponin T
Wounds and Injuries
Odds Ratio
Confidence Intervals
Left Ventricular Dysfunction
Ambulatory Surgical Procedures
Pulmonary Embolism
Atrial Fibrillation
Observational Studies
Echocardiography
Cohort Studies
Multivariate Analysis
Heart Failure
Stroke
Myocardial Infarction
Incidence

Keywords

  • Diastolic dysfunction
  • High-sensitivity cardiac troponin T
  • Perioperative myocardial injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{3f744907d5384b4e907384b36e8ce809,
title = "Diastolic dysfunction is a risk of perioperative myocardial injury assessed by high-sensitivity cardiac troponin T in elderly patients undergoing non-cardiac surgery",
abstract = "Background: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery. Methods and Results: In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20{\%}. A total of 36 (23.8{\%}) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95{\%} confidence interval (CI) 2.65–32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95{\%} CI: 1.341–6.84, P=0.008). Conclusions: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.",
keywords = "Diastolic dysfunction, High-sensitivity cardiac troponin T, Perioperative myocardial injury",
author = "Hironobu Toda and Kazufumi Nakamura and Koji Nakagawa and Atsuyuki Watanabe and Toru Miyoshi and Nobuhiro Nishii and Kazuyoshi Shimizu and Masao Hayashi and Hiroshi Morita and Hiroshi Morimatsu and Hiroshi Itoh",
year = "2018",
month = "1",
day = "1",
doi = "10.1253/circj.CJ-17-0747",
language = "English",
volume = "82",
pages = "775--782",
journal = "Circulation Journal",
issn = "1346-9843",
publisher = "Japanese Circulation Society",
number = "3",

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TY - JOUR

T1 - Diastolic dysfunction is a risk of perioperative myocardial injury assessed by high-sensitivity cardiac troponin T in elderly patients undergoing non-cardiac surgery

AU - Toda, Hironobu

AU - Nakamura, Kazufumi

AU - Nakagawa, Koji

AU - Watanabe, Atsuyuki

AU - Miyoshi, Toru

AU - Nishii, Nobuhiro

AU - Shimizu, Kazuyoshi

AU - Hayashi, Masao

AU - Morita, Hiroshi

AU - Morimatsu, Hiroshi

AU - Itoh, Hiroshi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery. Methods and Results: In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65–32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341–6.84, P=0.008). Conclusions: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

AB - Background: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery. Methods and Results: In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65–32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341–6.84, P=0.008). Conclusions: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

KW - Diastolic dysfunction

KW - High-sensitivity cardiac troponin T

KW - Perioperative myocardial injury

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U2 - 10.1253/circj.CJ-17-0747

DO - 10.1253/circj.CJ-17-0747

M3 - Article

C2 - 29151453

AN - SCOPUS:85042476544

VL - 82

SP - 775

EP - 782

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 3

ER -