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Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value
BACKGROUND AND AIM OF THE STUDY: Implications of Cardiac troponin (cTnI) release after cardiac transplantation are still unclear. This study disclosed risk factors and prognostic implication of cTnI early levels in a single centre cohort operated on between January 1999 and December 2010. METHODS: D...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420471/ https://www.ncbi.nlm.nih.gov/pubmed/25942400 http://dx.doi.org/10.1371/journal.pone.0120813 |
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author | De Santo, Luca Salvatore Torella, Michele Romano, Gianpaolo Maiello, Ciro Buonocore, Marianna Bancone, Ciro Della Corte, Alessandro Galdieri, Nicola Nappi, Gianantonio Amarelli, Cristiano |
author_facet | De Santo, Luca Salvatore Torella, Michele Romano, Gianpaolo Maiello, Ciro Buonocore, Marianna Bancone, Ciro Della Corte, Alessandro Galdieri, Nicola Nappi, Gianantonio Amarelli, Cristiano |
author_sort | De Santo, Luca Salvatore |
collection | PubMed |
description | BACKGROUND AND AIM OF THE STUDY: Implications of Cardiac troponin (cTnI) release after cardiac transplantation are still unclear. This study disclosed risk factors and prognostic implication of cTnI early levels in a single centre cohort operated on between January 1999 and December 2010. METHODS: Data on 362 consecutive recipients (mean age: 47.8±13.7, 20.2% female, 18.2% diabetics, 22.1% with previous cardiac operations, 27.6% hospitalized, 84.9±29.4 ml/min preoperative glomerular filtration rate) were analyzed using multivariable logistic regression modeling. Target outcomes were determinants of troponin release, early graft failure (EGF), acute kidney injury (AKI) and operative death. RESULTS: Mean cTnI release measured 24 hours after transplant was 10.9±11.6 μg/L. Overall hospital mortality was 10.8%, EGF 10.5%, and AKI was 12.2%. cTnI release>10 μg/L proved an independent predictor of EGF (OR 2.2; 95% CI, 1.06–4.6) and AKI (OR 1.031; 95% CI, 1.001-1.064). EGF, in turn, proved a determinant of hospital mortality. Risk factors for cTnI>10 μg/L release were: status 2B (OR 0.35; 95% CI, 0.18-0.69, protective), duration of the ischemic period (OR 1.006; 95% CI, 1.001-1.011), previous cardiac operation (OR 2.9; 95% CI, 1.67-5.0), and left ventricular hypertrophy (OR 3.3; 95% CI, 1.9-5.6). CONCLUSIONS: Myocardial enzyme leakage clearly emerged as an epiphenomenon of more complicated clinical course. The complex interplay between surgical procedure features, graft characteristics and recipient end-organ function highlights cTnI release as a risk marker of graft failure and acute kidney injury. The search for optimal myocardial preservation is still an issue. |
format | Online Article Text |
id | pubmed-4420471 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44204712015-05-12 Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value De Santo, Luca Salvatore Torella, Michele Romano, Gianpaolo Maiello, Ciro Buonocore, Marianna Bancone, Ciro Della Corte, Alessandro Galdieri, Nicola Nappi, Gianantonio Amarelli, Cristiano PLoS One Research Article BACKGROUND AND AIM OF THE STUDY: Implications of Cardiac troponin (cTnI) release after cardiac transplantation are still unclear. This study disclosed risk factors and prognostic implication of cTnI early levels in a single centre cohort operated on between January 1999 and December 2010. METHODS: Data on 362 consecutive recipients (mean age: 47.8±13.7, 20.2% female, 18.2% diabetics, 22.1% with previous cardiac operations, 27.6% hospitalized, 84.9±29.4 ml/min preoperative glomerular filtration rate) were analyzed using multivariable logistic regression modeling. Target outcomes were determinants of troponin release, early graft failure (EGF), acute kidney injury (AKI) and operative death. RESULTS: Mean cTnI release measured 24 hours after transplant was 10.9±11.6 μg/L. Overall hospital mortality was 10.8%, EGF 10.5%, and AKI was 12.2%. cTnI release>10 μg/L proved an independent predictor of EGF (OR 2.2; 95% CI, 1.06–4.6) and AKI (OR 1.031; 95% CI, 1.001-1.064). EGF, in turn, proved a determinant of hospital mortality. Risk factors for cTnI>10 μg/L release were: status 2B (OR 0.35; 95% CI, 0.18-0.69, protective), duration of the ischemic period (OR 1.006; 95% CI, 1.001-1.011), previous cardiac operation (OR 2.9; 95% CI, 1.67-5.0), and left ventricular hypertrophy (OR 3.3; 95% CI, 1.9-5.6). CONCLUSIONS: Myocardial enzyme leakage clearly emerged as an epiphenomenon of more complicated clinical course. The complex interplay between surgical procedure features, graft characteristics and recipient end-organ function highlights cTnI release as a risk marker of graft failure and acute kidney injury. The search for optimal myocardial preservation is still an issue. Public Library of Science 2015-05-05 /pmc/articles/PMC4420471/ /pubmed/25942400 http://dx.doi.org/10.1371/journal.pone.0120813 Text en © 2015 De Santo et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article De Santo, Luca Salvatore Torella, Michele Romano, Gianpaolo Maiello, Ciro Buonocore, Marianna Bancone, Ciro Della Corte, Alessandro Galdieri, Nicola Nappi, Gianantonio Amarelli, Cristiano Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
title | Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
title_full | Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
title_fullStr | Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
title_full_unstemmed | Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
title_short | Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
title_sort | perioperative myocardial injury after adult heart transplant: determinants and prognostic value |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420471/ https://www.ncbi.nlm.nih.gov/pubmed/25942400 http://dx.doi.org/10.1371/journal.pone.0120813 |
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