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Rodenas-Alesina E, Luk A, Gajasan J, Alhussaini A, Martel G, Serrick C, McRae K, Overgaard C, Cypel M, Singer L, Tikkanen J, Keshavjee S, Del Sorbo L. Implications of High Sensitivity Troponin Levels After Lung Transplantation. Transpl Int 2024; 37:12724. [PMID: 38665474 PMCID: PMC11043535 DOI: 10.3389/ti.2024.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Trends in high-sensitivity cardiac troponin I (hs-cTnI) after lung transplant (LT) and its clinical value are not well stablished. This study aimed to determine kinetics of hs-cTnI after LT, factors impacting hs-cTnI and clinical outcomes. LT recipients from 2015 to 2017 at Toronto General Hospital were included. Hs-cTnI levels were collected at 0-24 h, 24-48 h and 48-72 h after LT. The primary outcome was invasive mechanical ventilation (IMV) >3 days. 206 patients received a LT (median age 58, 35.4% women; 79.6% double LT). All patients but one fulfilled the criteria for postoperative myocardial infarction (median peak hs-cTnI = 4,820 ng/mL). Peak hs-cTnI correlated with right ventricular dysfunction, >1 red blood cell transfusions, bilateral LT, use of EVLP, kidney function at admission and time on CPB or VA-ECMO. IMV>3 days occurred in 91 (44.2%) patients, and peak hs-cTnI was higher in these patients (3,823 vs. 6,429 ng/mL, p < 0.001 after adjustment). Peak hs-cTnI was higher among patients with had atrial arrhythmias or died during admission. No patients underwent revascularization. In summary, peak hs-TnI is determined by recipient comorbidities and perioperative factors, and not by coronary artery disease. Hs-cTnI captures patients at higher risk for prolonged IMV, atrial arrhythmias and in-hospital death.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - John Gajasan
- Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto, ON, Canada
| | - Anhar Alhussaini
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Genevieve Martel
- Perfusion Services, University Health Network, Toronto, ON, Canada
| | - Cyril Serrick
- Perfusion Services, University Health Network, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | | | - Marcelo Cypel
- Division of Thoracic Surgery, Faculty of Surgery, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Lianne Singer
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jussi Tikkanen
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Faculty of Surgery, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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