title: Prognostic Value of High-Sensitivity Troponin-T to Identify Patients at Risk of Left Ventricular Graft Dysfunction After Heart Transplantation.
abstract: Primary graft dysfunction after heart transplantation (HTx) has a very high mortality rate, especially if the left ventricle (PGD-LV) is involved. Early diagnosis is important to select the appropriate therapy to improve prognosis. The value of high-sensitivity troponin T (HS-TNT) measurement obtained at patient arrival at the intensive care unit was analyzed in 71 HTx patients. Mild or moderate PGD-LV was defined by hemodynamic compromise with one of the following criteria: left ventricular ejection fraction <40%, hemodynamic compromise with right atrial pressure >15 mm Hg, pulmonary capillary wedge pressure >20 mm Hg, cardiac index <2.0 L/min/m2, hypotension (mean arterial pressure <70 mm Hg), and need for high-dose inotropes (inotrope score >10) or newly placed intra-aortic balloon pump. The mean recipient age was 54 ± 12 years (73% men), and donor age was 47 ± 11 years. Ischemic time was 200 ± 51 minutes, and coronary bypass time was 122 ± 31 minutes. Nine (13%) HTx patients were diagnosed with PGD-LV post-HTx, 8 with biventricular dysfunction. Four patients died, 2 with PGD-LV (22%) and 2 without PGD (4%). Mean HS-TNT before HTx was 158 ± 565 ng/L, and post-HT was 1621 ± 1269 ng/L. The area under the curve (receiver-operator characteristic) of HS-TNT to detect patients at risk of PGD-LV was 0.860 (P < .003). A cutoff value of HS-TNT >2000 ng/L had a sensitivity of 75% and specificity of 87% to identify patients at risk of PGD-LV. Multivariate analysis identified HS-TNT >2000 ng/L (P < .02) and coronary bypass-time (P < .01) as independent predictors of PGD-LV. HS-TNT >2000 ng/L at intensive care admission after HT and prolonged coronary bypass time were the most powerful predictors of PGD-LV. HS-TNT may be helpful for early detection of HTx patients at risk of PGD-LV.
authors.affiliation: Department of Cardiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: A B
authors.initials: AB
authors.lastname: Méndez
authors.affiliation: Department of Biochemistry, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ordonez-Llanos
authors.affiliation: Department of Cardiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Mirabet
authors.affiliation: Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Galan
authors.affiliation: Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Maestre
authors.affiliation: Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Brossa
authors.affiliation: Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Rivilla
authors.affiliation: Department of Cardiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: López
authors.affiliation: Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Koller
authors.affiliation: Department of Cardiology, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sionis
authors.affiliation: Department of Cardiology, Hospital de Sant Pau, Barcelona, Spain. Electronic address: eroigm@santpau.cat.
authors.forename: E
authors.initials: E
authors.lastname: Roig
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects; D042241:Early Diagnosis; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D055031:Primary Graft Dysfunction / Q000175:diagnosis*; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D020107:Troponin T / Q000378:metabolism*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers; D020107:Troponin T