title: Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial.
abstract: BACKGROUND
  Evidence suggests that cardiac output-guided haemodynamic therapy algorithms improve outcomes after high-risk surgery, but there is some concern that this could promote acute myocardial injury. We evaluated the incidence of myocardial injury in a perioperative goal-directed therapy trial.
  
  
  METHODS
  Patients undergoing major gastrointestinal surgery (n=723) were randomly assigned to cardiac output-guided haemodynamic therapy (intervention group) or usual care as part of the OPTIMISE trial. At four participating sites, 288 patients were enrolled in a biomarker substudy. Serum high-sensitivity cardiac troponin I (TnI) concentration and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were measured before and at 24 and 72 h after surgery.
  
  
  RESULTS
  Median preoperative TnI and NT-ProBNP concentrations were 4.3 ng litre(-1) and 144 pg ml(-1), respectively. After surgery, 67 (46%) patients in the intervention group and 68 (48%) patients receiving usual care had TnI concentrations above the 99th centile upper reference limit (P=0.82). Peak serum TnI concentration was similar in the intervention and usual care groups (median [interquartile range]: 10.0 [5.3-21.5] vs 7.8 [5.0-21.8] ng litre(-1); P=0.85), and no differences were observed in serum TnI concentrations over 72 h (repeated-measures anova, P=0.51). Likewise, there were no differences in peak NT-proBNP concentration between intervention and usual care groups (645 [362-1169] vs 659 [381-1028] pg ml(-1); P=0.86) or in serial NT-proBNP concentrations over 72 h (P=0.20).
  
  
  CONCLUSIONS
  Myocardial injury is common among patients undergoing major gastrointestinal surgery. In this study, the frequency was not affected by cardiac output-guided fluid and low-dose inotropic therapy.
authors.affiliation: Department of Critical Care, University of Edinburgh, Edinburgh, UK michael.gillies@ed.ac.uk.
authors.forename: M A
authors.initials: MA
authors.lastname: Gillies
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: A S V
authors.initials: AS
authors.lastname: Shah
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mullenheim
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Tricklebank
authors.affiliation: Lancashire Teaching Hospitals NHS Trust, Preston, UK.
authors.forename: T
authors.initials: T
authors.lastname: Owen
authors.affiliation: Department of Critical Care, University of Edinburgh, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Antonelli
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: F
authors.initials: F
authors.lastname: Strachan
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: N L
authors.initials: NL
authors.lastname: Mills
authors.affiliation: Queen Mary University, London, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Pearse
mesh_terms: D000368:Aged; D002302:Cardiac Output; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011183:Postoperative Complications / Q000209:etiology*; D019210:Troponin I / Q000097:blood
chemical_list: D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: biochemistry; complications, myocardial infarction; fluids, i.v; heart, dopexamine; surgery