Perioperative myocardial injury after adult heart transplant: determinants and prognostic value.
OBJECTIVE
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.
Chair of Cardiac Surgery, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy-Casa di Cura Montevergine (AV).
Luca Salvatore
LS
De Santo
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Michele
M
Torella
Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy.
Gianpaolo
G
Romano
Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy.
Ciro
C
Maiello
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Marianna
M
Buonocore
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Ciro
C
Bancone
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Alessandro
A
Della Corte
Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy.
Nicola
N
Galdieri
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Gianantonio
G
Nappi
Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy.
Cristiano
C
Amarelli
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D004452:Echocardiography; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D014336:Troponin / Q000378:metabolism*
D014336:Troponin