肾功能受损对心脏手术后高敏心肌肌钙蛋白动力学的影响。

Impact of impaired renal function on kinetics of high-sensitive cardiac troponin following cardiac surgery.

作者信息

Rudolph Felix, Deutsch Marcus-André, Friedrichs Kai Peter, Renner André, Scholtz Werner, Gerçek Muhammed, Kirchner Johannes, Ayoub Mohamed, Rudolph Tanja Katharina, Schramm René, Gummert Jan, Rudolph Volker, Omran Hazem

机构信息

Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.

Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Medical School and University Medical Center OWL, Universität Bielefeld, Georgstr. 11, 32545, Bad Oeynhausen, Germany.

出版信息

Clin Res Cardiol. 2025 Jan 29. doi: 10.1007/s00392-025-02595-7.

DOI:10.1007/s00392-025-02595-7

PMID:39878853

Abstract

BACKGROUND

Impaired renal function can increase cardiac troponin levels due to reduced elimination, potentially affecting its diagnostic utility. Limited data exist on high-sensitivity cardiac troponin I (hs-cTnI) kinetics after cardiac surgery relative to renal function. This study evaluates how impaired renal function influences hs-cTnI kinetics following cardiac surgery, distinguishing between patients with and without postoperative myocardial infarction (PMI).

METHODS

We conducted a retrospective analysis of adult patients who underwent elective cardiac surgery at our hospital from January 2013 to May 2019. Serial hs-cTnI measurements were taken from baseline up to 48 h post-surgery. Renal function was assessed using the MDRD formula, defining impaired renal function as a GFR < 60 ml/min. Acute kidney injury (AKI) was based on postoperative creatinine levels, and PMI was defined by ARC-2 criteria. Predictors of long-term all-cause mortality were analyzed using Cox regression.

RESULTS

Out of 14,355 patients (51.4% CABG, 39.4% valvular procedures, 9.2% thoracic aortic procedures), 139 (1.0%) had PMI. Hs-cTnI levels were higher in patients with impaired renal function across the cohort and in those without PMI. However, in patients with PMI, hs-cTnI levels did not vary significantly with renal function. Elevated hs-cTnI ≥ 213 times the upper limit of normal was a significant predictor of long-term mortality regardless of renal function (hazard ratio: 1.28, 95% CI: 1.17-1.40, p < 0.001), but early postoperative hs-cTnI measures held poor discriminatory yield to predict PMI with an AUC of 0.55 (95% confidence intervals: 0.54-0.56).

CONCLUSION

Renal function and acute kidney injury affect hs-cTnI kinetics post-surgery only in patients without PMI. Elevated hs-cTnI remains a strong predictor of long-term mortality, independent of renal function, but early postoperative detection of PMI requires additional metrics, including ECG, transthoracic echocardiography (TTE), and signs of hemodynamic instability.

摘要

背景

肾功能受损可因清除减少而导致心肌肌钙蛋白水平升高，这可能会影响其诊断效用。关于心脏手术后高敏心肌肌钙蛋白I（hs-cTnI）动力学相对于肾功能的数据有限。本研究评估肾功能受损如何影响心脏手术后hs-cTnI动力学，区分有无术后心肌梗死（PMI）的患者。

方法

我们对2013年1月至2019年5月在我院接受择期心脏手术的成年患者进行了回顾性分析。从基线到术后48小时进行连续hs-cTnI测量。使用MDRD公式评估肾功能，将肾功能受损定义为肾小球滤过率（GFR）<60ml/分钟。急性肾损伤（AKI）基于术后肌酐水平，PMI根据ARC-2标准定义。使用Cox回归分析长期全因死亡率的预测因素。

结果

在14355例患者中（51.4%为冠状动脉旁路移植术，39.4%为瓣膜手术，9.2%为胸主动脉手术），139例（1.0%）发生PMI。整个队列中肾功能受损的患者以及无PMI的患者hs-cTnI水平较高。然而，在有PMI的患者中，hs-cTnI水平并未随肾功能显著变化。无论肾功能如何，hs-cTnI升高≥正常上限的213倍是长期死亡率的重要预测因素（风险比：1.28，95%置信区间：1.17-1.40，p<0.001），但术后早期hs-cTnI测量对预测PMI的鉴别能力较差，曲线下面积（AUC）为0.55（95%置信区间：0.54-0.56）。