Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 11:37:12724.
doi: 10.3389/ti.2024.12724. eCollection 2024.

Implications of High Sensitivity Troponin Levels After Lung Transplantation

Eduard Rodenas-Alesina #  1   2 , Adriana Luk #  1   2 , John Gajasan  3 , Anhar Alhussaini  1   2 , Genevieve Martel  4 , Cyril Serrick  4 , Karen McRae  5 , Chris Overgaard  6 , Marcelo Cypel  7   8 , Lianne Singer  8   9 , Jussi Tikkanen  8   9 , Shaf Keshavjee  7   8 , Lorenzo Del Sorbo  3   8   9
Affiliations

Implications of High Sensitivity Troponin Levels After Lung Transplantation

Eduard Rodenas-Alesina et al. Transpl Int. .

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.

Keywords: arrhythmia; lung transplant; mechanical ventilation; primary graft dysfunction; troponin.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Trends in troponin according to etiology of the underlying lung disease. COPD, chronic obstructive pulmonary disease; CI, confidence interval; ICU, intensive care unit.
FIGURE 2
FIGURE 2
Observed and predicted peak troponin levels using a 7-variable model including RV dysfunction, hypertension, eGFR, bilateral lung transplant, use of EVLP, length of intraoperative MCS and transfusion requirements (Pearson’s r = 0.604, p < 0.001).
FIGURE 3
FIGURE 3
(A) Violin plot showing peak troponin based on prolonged invasive mechanical ventilation for >3 days. (B) Temporal trends in troponin levels after LT based on prolonged ventilation, showing significantly higher initial troponin levels but similar kinetics and progressive decline on the third day in both groups.
FIGURE 4
FIGURE 4
Probability of the primary endpoint (invasive mechanical ventilation for more than 3 days) based on the peak troponin level modeled as a restricted cubic spline, with its 95% confidence interval.
FIGURE 5
FIGURE 5
(A) Distribution of peak troponin according to in-hospital mortality. (B) In-hospital mortality based on the best cut-off for peak troponin (7,840 ng/mL) selected by Youden’s index using ROC curve analysis. (C) Trends in troponin levels among patients who survived during admission and those who did not survive the index admission. After a similar increase at day 2 compared to day 1 among both groups (p = 0.778), peak troponin continued to rise in patients who died, whereas it declined for patients who survived (p = 0.008 for the slope).
See this image and copyright information in PMC

References

    1. Heuts S, Gollmann-Tepeköylü C, Denessen EJS, Olsthoorn JR, Romeo JLR, Maessen JG, et al. Cardiac Troponin Release Following Coronary Artery Bypass Grafting: Mechanisms and Clinical Implications. Eur Heart J (2023) 44(2):100–12. 10.1093/eurheartj/ehac604 - DOI - PMC - PubMed
    1. Erbel C, Taskin R, Doesch A, Dengler TJ, Wangler S, Akhavanpoor M, et al. High-Sensitive Troponin T Measurements Early After Heart Transplantation Predict Short and Long-Term Survival. Transpl Int Off J Eur Soc Organ Transpl (2013) 26(3):267–72. 10.1111/tri.12024 - DOI - PubMed
    1. Devereaux PJ, Chan MTV, Alonso-Coello P, Walsh M, Berwanger O, Villar JC, et al. Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA (2012) 307(21):2295–304. 10.1001/jama.2012.5502 - DOI - PubMed
    1. Lasocki S, Provenchère S, Bénessiano J, Vicaut E, Lecharny J-B, Desmonts J-M, et al. Cardiac Troponin I Is an Independent Predictor of In-Hospital Death After Adult Cardiac Surgery. Anesthesiology (2002) 97(2):405–11. 10.1097/00000542-200208000-00018 - DOI - PubMed
    1. Ma Q-L, Wang H-J, Shi M-N, An J-H, Ma J, Yu D, et al. Serum Troponin I Concentrations Assessed 18-24 Hours After Coronary Artery Bypass Grafting Are Significant Predictors of Early Patient Prognosis. Eur Rev Med Pharmacol Sci (2016) 20(19):4129–35. - PubMed