Postoperative Myocardial Injury Does Not Predict Early and 1-Year Mortality After Living Donor Liver Transplantation

Canbolat, İsmail Polat; Adali, Güpse; Akdeni̇z, Celal; Bozkurt, Birkan; Ferah, Oya; Bulutcu, F.; Yüzer, Yıldıray; Tokat, Yaman

doi:10.1016/j.transproceed.2019.02.046

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…S1 ). Similarly, studies reporting all types of non-cardiac surgery 2 , 22 , 30 , 33 , 35 , 38 , 43 , 44 , 47 , 49 , 51 , 60–62 had a death rate of 0.23 (95 per cent c.i. 0.07–0.71) per day.…”

Section: Resultsmentioning

confidence: 94%

“…A summary of study characteristics is included in Table 1 . The majority of studies included all types of non-cardiac surgery in their eligibility criteria 2 , 15 , 22 , 30 , 33–35 , 37 , 38 , 40 , 43 , 44 , 46–49 , 51 , 56 , 58 , 60–62 , 65 . Seventeen studies focused on specific surgical subspecialties including vascular 28 , 39 , 41 , 42 , 45 , 52–54 , orthopaedic 29 , 31 , 32 , 50 , 55 , 59 , 64 , urology 36 , 63 and thoracic surgery 36 , 63 .…”

Section: Resultsmentioning

confidence: 99%

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Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

et al. 2023

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Background Myocardial injury after non-cardiac surgery is diagnosed following asymptomatic troponin elevation in the perioperative interval. Myocardial injury after non-cardiac surgery is associated with high mortality rates and significant rates of major adverse cardiac events within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aimed to establish the rates of long-term morbidity and mortality associated with myocardial injury after non-cardiac surgery. Methods MEDLINE, Embase and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials, reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with myocardial injury after non-cardiac surgery, were included. Risk of bias was assessed using the Quality in Prognostic Studies tool. A random-effects model was used for the meta-analysis of outcome subgroups. Results Searches identified 40 studies. The meta-analysis of 37 cohort studies found a rate of major adverse cardiac events-associated myocardial injury after non-cardiac surgery of 21 per cent and mortality following myocardial injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A non-linear increase in mortality rate was observed up to 1 year after surgery. Major adverse cardiac event rates were also lower in elective surgery compared with a subgroup including emergency cases. The analysis demonstrated a wide variety of accepted myocardial injury after non-cardiac surgery and major adverse cardiac events diagnostic criteria within the included studies. Conclusion A diagnosis of myocardial injury after non-cardiac surgery is associated with high rates of poor cardiovascular outcomes up to 1 year after surgery. Work is needed to standardize diagnostic criteria and reporting of myocardial injury after non-cardiac surgery-related outcomes. Registration This review was prospectively registered with PROSPERO in October 2021 (CRD42021283995).

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

et al. 2023

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“…However, Canbolat and colleagues [66] did not find a significant correlation between high cTnI and 30-day inhospital and 1-year mortality. They defined myocardial injury as a cTnI level >0.04 ng/mL.…”

Section: Biomarkers 821 Troponinmentioning

confidence: 87%

“…They defined myocardial injury as a cTnI level >0.04 ng/mL. They found that although myocardial injury identified by serum cTnI elevation was common (57.4%) after living donor liver transplant, this elevation was not linked to 30-day in-hospital and 1-year mortality [66]. The role of cardiac troponin in the prediction of cardiac events in liver recipients needs further investigation.…”

Section: Biomarkers 821 Troponinmentioning

confidence: 99%

Cardiovascular events after liver transplantation: MACE hurts

Altieri¹,

Liu²,

Lee³

2022

Rev. Cardiovasc. Med.

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The curative therapy for patients with end-stage liver disease is liver transplantation. However, liver transplantation challenges the cardiovascular system, and is associated with major adverse cardiovascular events (MACE). Immediately after implantation of the liver graft, changes in cardiac preload and afterload increase the cardiac workload. Longer-term postoperatively, a more sedentary lifestyle and enhanced appetite increase obesity and body mass index. Immunosuppressants may also affect the cardiovascular system. All these factors that liver recipients encounter impact the function of the cardiovascular system. Cardiac events are the third-leading cause of death in liver recipients. This review describes the pertinent factors that predispose to development of MACE after liver transplantation, and how to predict these cardiovascular events in the post-transplant period. We review the roles of metabolic syndrome, renal dysfunction, non-alcoholic fatty liver disease, diagnostic tests such as imaging and biomarkers, and parameters such as systolic and diastolic dysfunction, and QT interval prolongation in cardiovascular events. We summarize the current literature on scoring systems to predict cardiovascular events.

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“…Postoperative troponin levels should only be measured in patients at risk for MI, because elevated troponin levels in patients without coronary disease have not been shown to be predictive of a poor outcome. In patients undergoing living donor liver transplantation, for example, a rise in troponin was not predictive of early and 1-year mortality [79].…”

Section: Atherosclerotic Plaque Stabilizationmentioning

confidence: 92%

Current Concepts in the Prevention of Perioperative Myocardial Injury

Bohringer¹,

Liu²

2020

Transl Perioper & Pain Med

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Perioperative myocardial injury is frequently caused by tachycardia from excessive sympathetic nervous system activity resulting from the surgical stimulation (type 2) rather than by rupture of atherosclerotic plaques with superimposed thrombosis (type 1). The elevated sympathetic nervous system activity results in tachycardia that induces demand ischemia within the myocardium and damages the heart muscle. A rise in troponin has been shown to be a reliable predictor of adverse cardiovascular events when measured in a population at risk. This holds true even when the troponin rise is isolated and other markers for myocardial damage like prolonged ischemic type chest pain, new electrocardiogram changes or evidence of new myocardial damage on echocardiography and other cardiac imaging studies are absent. Treatments that prevent tachycardia by successfully controlling elevated sympathetic tone, like dexmedetomidine and thoracic epidural blockade with local anesthetic reduce troponin release and have been shown to prevent myocardial damage. Intravenous lidocaine and magnesium can also prevent tachycardia. Beta blockers reduce myocardial injury, but are associated with an increase in hypotension and ischemic stroke. Any method of attenuating sympathetic nervous system activity, may however, require treatment with intravenous fluids and vasopressors to prevent hypotension. Rupture of atherosclerotic plaques with superimposed coronary thrombosis is a far less common cause of myocardial infarction in the perioperative period than elevated sympathetic tone. This explains why prophylactic statins in previously statin-naïve patients do not reduce major adverse cardiovascular event rates. Antiplatelet agents are also ineffective in reducing adverse cardiovascular events in the perioperative period. Clinicians, therefore, need to focus their attention on heart rate control and the attenuation of the stress response to surgery, rather than on atherosclerotic plaque stability and antiplatelet drugs in order to successfully prevent perioperative myocardial injury.

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Postoperative Myocardial Injury Does Not Predict Early and 1-Year Mortality After Living Donor Liver Transplantation

Cited by 5 publications

References 14 publications

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

Cardiovascular events after liver transplantation: MACE hurts

Current Concepts in the Prevention of Perioperative Myocardial Injury

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