ISSN 2996-8215
International Journal of Cardiology | Vol. 10, No. 12, December 2019 | pp. 89–96
DOI: 10.46882/2019/IJC/000129
Original Research Article
Independent Predictive Value of High-Sensitivity Postoperative Cardiac Troponin T Release for New-Onset Postoperative Atrial Fibrillation
Chloe Jenkins¹, Oliver Vance¹, Sarah E. Lawson²
¹Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
²School of Medicine, University of Queensland, Brisbane, Queensland, Australia
Abstract:
Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery, associated with a higher risk of systemic stroke and prolonged hospitalization. While inflammation is a recognized trigger, the role of subclinical periprocedural myocardial injury as an arrhythmogenic substrate requires verification. This prospective observational study evaluated the independent association between early postoperative high-sensitivity cardiac troponin T (hs-cTnT) elevations and the development of new-onset POAF. We enrolled 210 patients in baseline sinus rhythm who underwent elective coronary artery bypass grafting or valvular replacement surgery. Plasma hs-cTnT levels were collected preoperatively and at 12 hours post-surgery. Continuous telemetry tracked cardiac rhythms throughout the hospital stay. New-onset POAF lasting longer than 30 seconds developed in 64 patients (30.5%). Preoperative troponin levels did not differ between the cohorts. However, at 12 hours postoperatively, hs-cTnT concentrations were significantly higher in patients who subsequently developed POAF than in those who remained in sinus rhythm (425.4 ± 84.6 ng/L vs. 284.2 ± 62.1 ng/L, p < 0.001). Multivariable logistic regression revealed that a 12-hour postoperative hs-cTnT level above 350 ng/L was a potent independent predictor of POAF development (odds ratio: 2.34, 95% CI: 1.41–3.88, p = 0.002), after adjusting for surgical parameters and advanced age. Elevated early postoperative high-sensitivity cardiac troponin T release independently predicts new-onset postoperative atrial fibrillation, indicating that subclinical periprocedural myocardial injury serves as a primary driver of postoperative arrhythmogenesis.
Keywords: Atrial fibrillation, Cardiac surgery, High-sensitivity cardiac troponin T, Myocardial injury, Postoperative complications, Arrhythmogenesis
Received: September 15, 2019; Revised: October 28, 2019; Accepted: November 12, 2019; Published: December 19, 2019
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