Peri-operative troponin monitoring using a prototype high-sensitivity cardiac troponin I (hs-cTnI) assay: comparisons with hs-cTnT and contemporary cTnI assays

Abstract

Background: Non-cardiac surgery is associated with major vascular complications and higher incidences of elevated plasma troponin (cTn) concentration. Goal-directed therapy (GDT) is a stroke volume (SV)-guided approach to intravenous (IV) fluid therapy that improves tissue perfusion, oxygenation and reduces post-operative complications. In patients undergoing major gastro-intestinal surgery, we compared high sensitive and contemporary troponin assays and correlated results with patient outcome. Methods: Patients (n ¼ 135) were randomized to receive IV fluid, guided by either the central venous pressure (CVP group, n ¼ 45) or SV (AE dopexamine inotrope, n ¼ 45 per group). Serum was obtained pre-and post-operatively (0, 8 and 24 h) for troponin analysis by a prototype hs-cTnI assay (Abbott Laboratories), hs-cTnT (Roche Diagnostics) and contemporary cTnI (Beckman Coulter) assays. Results: All troponin measurements were increased (P 4 0.05) post-operatively but there was no difference (P > 0.05) amongst treatments. Post-operative increases were reported more frequently (P 4 0.05) and earlier with hs-cTnI. Temporal increases (P 4 0.05) were reported in patients with and without complications for hs-cTnI/T assays but only in the complications group for cTnI measurements. Elevations 599th centile occurred most often (P 4 0.05) for hs-cTnT measurements but with similar frequency for both outcome groups (all assays). Only the hs-cTnI assay showed an increased relative risk of mortality (P 4 0.05) for elevations 599th centile Conclusions: Our study may suggest a possible preference for the hs-cTnI assay in the peri-operative setting; however, our findings should be verified for larger cohort studies where emerging reference range data is incorporated for improving risk prediction with hs-cTn assays.

Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial

“…35 Several troponin assays are commercially available, and differences in performance in the perioperative setting have been described. 12 The clinical and biochemical findings of our study concur with findings of two smaller single-centre trials investigating postoperative troponin concentration after haemodynamic therapy 11 12 and of a recently published systematic review, which examined the association between haemodynamic therapy and cardiac complications. 4 Studies have found that peak postoperative troponin is correlated with outcome.…”

High-sensitivity cardiac troponin in acute conditions

“…Perioperative troponin increases occurred most frequently for hsTnT, but the only troponin assay significantly related to mortality was hs-cTnI [28]. Perioperative troponin increases occurred most frequently for hsTnT, but the only troponin assay significantly related to mortality was hs-cTnI [28].…”

“…On the other hand, an isolated postoperative hs-cTn above the 99th percentile has to be interpreted carefully considering the global clinical picture, including preoperative levels. There are also sex-related differences to consider: men have higher hs-cTn values compared with women [28,31,32]. There are also sex-related differences to consider: men have higher hs-cTn values compared with women [28,31,32].…”

Two Different Troponin Isoforms for Detecting Early Myocardial Injury after Curative Resection of Oesophageal Cancer

“…The minimum concentration of the fth-generation hs-ctnt STAT assay is 3 pg/ml, and its positive predictive value is approximately 95%. cTnI is a unique contractility protein, its normal values range from 0 to 0.03 g/L, cTnI ≥0.04 g/L can be diagnosed as myocardial infarction [6] , and the positive predictive value of the third-generation enhanced AccuTnI assay is approximately 60 . Although hs-cTnT and cTnI are both sensitive indicators for the detection of myocardial injury, hs-cTnT and cTnI have the risk of missing early myocardial injury.…”