HIGH-SENSITIVITY TROPONIN-T LEVEL AFTER PEDIATRIC CONGENITAL HEART DISEASE SURGERY

  • SINAN YOUSIF NAJEEB Abiko, M., Inai, K., Shimada, E., Asagai, S., Nakanishi, T. (2018). The prognostic value of high sensitivity cardiac troponin T in patients with congenital heart disease. Journal of Cardiology, 71(4):389-393. doi: 10.1016/j.jjcc.2017.09.012. Epub 2017 Nov 3. Almandel, A., Younis, H., Gilbert, C., Marr, S., Bowtell, K., Forsberg, B., Shauchenka, P., Suslin, E., Molloy, F., Novick, W. (2013). Pediatric cardiac services in Iraq: current status and future plans. Journal of Cardiothoracic Surgery, 8(Suppl 1), O303. Baggish, A. L., MacGillivray, T. E., Hoffman, W., Newell, J. B., Lewandrowski, K. B., Lee-Lewandrowski, E., Anwaruddin, S., Siebert, U., Januzzi, J. L. (2004, Sep). Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery. Critical Care Medicine, 32(9):1866-1871. doi: 10.1097/01.ccm.0000139692.19371.7c. PMID: 15343014. Bohn, M. K., Higgins, V., Kavsak, P., Hoffman, B., Adeli, K. (2019, April). High-Sensitivity Generation 5 Cardiac Troponin T Sex- and Age-Specific 99th Percentiles in the CALIPER Cohort of Healthy Children and Adolescents. Clinical Chemistry, 65(4), 589–591. Boroński, B., Piotrowski, A., Pągowska-Klimek, I. (2022). Value of troponin T measurements for prediction of postoperative course and length of ICU stay of children after surgical correction of congenital heart disease. Anaesthesiology Intensive Therapy, 54(2), 114-119. https://doi.org/10.5114/ait.2022.114488. Bottio, T., Vida, V., Padalino, M., Gerosa, G., Stellin, G. (2006, August). Early and long-term prognostic value of Troponin-I after cardiac surgery in newborns and children. European Journal of Cardio-Thoracic Surgery, 30(2), 250-255. doi: 10.1016/j.ejcts.2006.05.001. Epub 2006 Jul 10. Carmona, F., Manso, P. H., Vicente, W. V., Castro, M., Carlotti, A. P. (2008, June). Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: a multimarker approach combining inflammatory mediators, N-terminal pro-B-type natriuretic peptide and troponin I. Cytokine, 42(3), 317-324. doi: 10.1016/j.cyto.2008.03.005. Cosgrave, J., Foley, B., Ho, E., Bennett, K., McGovern, E., Tolan, M., Young, V., Crean, P. (2006, September). Troponin T elevation after coronary bypass surgery: clinical relevance and correlation with perioperative variables. Journal of Cardiovascular Medicine, 7(9), 669-674. Gallacher, P. J., Miller-Hodges, E., Shah, A. S., Anand, A., Dhaun, N., Mills, N. L, High-STEACS Investigators. (2021, Sep 1). Use of High-Sensitivity Cardiac Troponin in Patients With Kidney Impairment A Randomized Clinical Trial. JAMA Internal Medicine, 181(9), 1237-1239. Gupta, M., Lent, R. W., Kern, J. H., Flynn, P. A., Klein, A. A., Schiller, M. S., Friedman, D. M. (1999, April 1). Troponin I as a Marker for Myocardial Injury and Ischemia during Pediatric Cardiopulmonary Bypass Surgery. Pediatric Research, 45(23). Immer, F. F., Stocker, F., Seiler, A. M., Pfammatter, J. P., Bachmann, D., Printzen, G., Carrel, T. (1999, May). Troponin-I for Prediction of Early Postoperative Course After Pediatric Cardiac Surgery. Journal of the American College of Cardiology, 33(6), 1719-1723. Imura, H., Caputo, M., Parry, A., Pawade, A., Angelini, G. D., Suleiman, M. S. (2001, March 20). Age-dependent and hypoxia-related differences in myocardial protection during pediatric open-heart surgery. Circulation, 103(11), 1551-1556. doi: 10.1161/01.cir.103.11.1551. Javed, F., Aleysae, N. A., Al-Mahbosh, A. Y., Zubani, A. A., Atash, A. M., Bin Salem, H. B., Abdallah, M., Alkhatib, O., Abu-Adas, A., Hrays, M. A., Alqarni, N. A., Felemban, A., Alsaedi, S. A., Jamjoom, A. A. (2021, October 15). Complications After Surgical Repair of Congenital Heart Disease in Infants. An Experience from Tertiary Care Center. Journal of the Saudi Heart Association, 33(4), 271-278. Jenkins, K. J., Botto, L. D., Correa, A., Foster, E., Kupiec, J. K., Marino, B.S., Oster, M. E., Stout, K. K., Honein, M. A. (2019). Public health approach to improve outcomes for congenital heart disease across the life span. Journal of the American Heart Association, 8,1-8. Kavsak, P. A., Rezanpour, A., Chen, Y., Adeli, K. (2014, December 1). Assessment of the 99th or 97.5th percentile for cardiac troponin I in a healthy pediatric cohort. Clinical Chemistry, 60(12), 1574–1576. Liu, Y., Chen, S., Zuhlke, L., Black, G. C., Choy, M. K., Li, N., Keavney, B. D. (2019). Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. International Journal of Epidemiology,48,455-463. Malhotra, M. G., Kern, J. H., Flynn, P. A., Schiller, M. S., Quaegebeur, J. M., Friedman, D. M. (2013 June). Cardiac troponin I after cardiopulmonary bypass in infants in comparison with older children. Cardiology in the Young, 23(3), 431-435. Mangla, A., Gupta, S., Staros, E. B. (2019). Troponins [Internet]. New York: Medscape; 2019. Reference Range. Available from: https://emedicine.medscape.com/article/2073935-overview. Martin, J. A., Hamilton, B. E., Osterman, M. J., Driscoll, A. K., Mathews, T. J. (2017). Births: final data for 2015. National Vital Statistics Reports, 66,1–55. Mildh, L. H., Pettila, V., Sairanen, H. I., Rautiainen, P. H. (2006, November). Cardiac troponin T levels for risk stratification in pediatric open heart surgery. Annals of Pediatric Cardiology, 82(5), 1643-1648. doi: 10.1016/j.athoracsur.2006.05.014. Militaru, M., Martinovici, D. (2005). Our experience in pediatric sepsis. Jurnalul Pediatrului, 8(6), 29-30. Mirzaei, M., Mirzaei, S., Sepahvand, E., Koshkaki, A. F., Jahromi, M. K. (2015). Evaluation of complications of heart surgery in children with congenital heart disease at dena hospital of shiraz. Global Journal of Health Science, 8(5), 33–38.Available from: doi: 10.5539/gjhs.v8n5p33. Momeni, M., Poncelet, A., Rubay, J., Matta, A., Veevaete, L., Detaille, T., Houtekie, L., Clement de Clety, S., Derycke, E., Moniotte, S., Sluysmans, T., Veyckemans, F. (2017, Feb). Does Postoperative Cardiac Troponin-I Have Any Prognostic Value in Predicting Midterm Mortality After Congenital Cardiac Surgery?. Journal of Cardiothoracic and Vascular Anesthesia, 31(1), 122-127. Murni, I. K., Djer, M. M., Yanuarso, P.B., Putra, S.T., Advani, N., Rachmat, J., Perdana, A., Sukardi, R. (2019). Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Annals of Pediatric Cardiology, 12(1), 38-44. doi: 10.4103/apc.APC_146_17. Philips, D. A. (2012). Sickness, Violence and Reconciliation: Congenital Heart Disease in Iraq. Thesis,Georgia State University. Poncelet, A. J., Van, S. M., Moniotte, S., Detaille, T., Beauloye, C., Bertrand, L., Nassogne, M. C., Rubay, J. E. (2011, December). Cardiac and neurological assessment of normothermia/warm blood cardioplegia vs hypothermia/cold crystalloid cardioplegia in pediatric cardiac surgery: insight from a prospective randomized trial. European Journal of Cardio-Thoracic Surgery, 40(6), 1384-1390. Su, J. A., Kumar, R., Mahmoud, H., Bowdish, M. E., Toubat, O., Wood, J. C., Kung, G. C. (2019). Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery. Seminars in Thoracic and Cardiovascular Surgery, 31(2), 244–251. Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., White, H. D. (2018, November 25). Fourth Universal Definition of Myocardial Infarction. European Heart Journal, 40(3), 237–269. https://doi.org/10.1093/eurheartj/ehy462. Wada, T., Yokozawa, M., Takamuro, M., Araki, D., Ebuoka, N., Ohba, J., Tachibana, T., Mori, M., Tsutsumi, H. (2018). Cardiac troponin I and perioperative factors in pediatric open heart surgery. Sapporo Medical Journal, 87(1-6), 25-33. Welsh, P., Preiss, D., Hayward, C., Shah, A. S. V., McAllister, D., Briggs, A., Boachie, C., McConnachie, A., Padmanabhan, S., Welsh, C., Woodward, M., Campbell, A., Porteous, D., Mills, N. L., Sattar, N. (2019, Jun). Cardiac Troponin T and Troponin I in the General Population. Circulation, 139(24), 2754-2764. doi: 10.1161/CIRCULATIONAHA.118.038529. Epub 2019 Apr 24. PMID: 31014085; PMCID: PMC6571179. Wu, A. H., Christenson, R. H., Greene, D.N., Jaffe, A. S., Kavsak, P. A., Ordonez-Llanos, J., Apple, F. S. (2018, April). Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clinical Chemistry, 64(4):645-655. doi: 10.1373/clinchem.2017.277186. Yasuda, S., Shimokawa, H. (2009, November). Acute myocardial infarction: the enduring challenge for cardiac protection and survival. Circulation Journal, 73(11), 2000-2008. doi: 10.1253/circj.cj-09-0655. Epub 2009 Oct 7. Zavriyev, A. I., Kaya, K., Farzam, P., Farzam, P. Y., Sunwoo, J., Jassar, A. S., Sundt, T. M., Carp, S. A., Franceschini, M. A., Qu, J. Z. (2021). The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests. JTCVS Tech, 7, 178-179.
  • NADINE A. MAHMOOD College of Medicine, Hawler Medical University, Kurdistan Region-Iraq
Keywords: Troponin T, Congenital Heart Disease Surgery, Open-Heart surgery in children

Abstract

Cardiac tissue ischemia can be assessed by a troponin biomarker in adults. However, its effectiveness after pediatric open-heart surgery is still being debated despite the increased demand for congenital heart surgeries. This study assesses the relationship of troponin T levels with many surgical, biochemical, and prognostic variables.

This prospective, longitudinal study included 70 patients collected over one year. These patients underwent open-heart surgery and required a cardiopulmonary bypass machine at the Cardiac Center in Erbil, Iraq. Troponin T measurements were taken 4 times for each patient: the day before the operation, 4 and 24 hours post-surgery, and on the discharge day from the hospital. These measurements were correlated with many variables.

The study revealed significantly higher troponin levels in children younger than three years old and in those with Fallot surgeries. Most patients with high 4-hour troponin levels developed short-term complications. Furthermore, significant correlations were observed between troponin levels with the duration of the whole operation and the durations of these specific procedures: cardiopulmonary bypass, aortic cross-clamp, and inotropic support. We also found that high troponin levels, particularly 4 hours post-surgery, can predict a longer-than-usual stay in the intensive care unit and hospital, as well as short-term complications

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References

Abiko, M., Inai, K., Shimada, E., Asagai, S., Nakanishi, T. (2018). The prognostic value of high sensitivity cardiac troponin T in patients with congenital heart disease. Journal of Cardiology, 71(4):389-393. doi: 10.1016/j.jjcc.2017.09.012. Epub 2017 Nov 3.
Almandel, A., Younis, H., Gilbert, C., Marr, S., Bowtell, K., Forsberg, B., Shauchenka, P., Suslin, E., Molloy, F., Novick, W. (2013). Pediatric cardiac services in Iraq: current status and future plans. Journal of Cardiothoracic Surgery, 8(Suppl 1), O303.
Baggish, A. L., MacGillivray, T. E., Hoffman, W., Newell, J. B., Lewandrowski, K. B., Lee-Lewandrowski, E., Anwaruddin, S., Siebert, U., Januzzi, J. L. (2004, Sep). Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery. Critical Care Medicine, 32(9):1866-1871. doi: 10.1097/01.ccm.0000139692.19371.7c. PMID: 15343014.
Bohn, M. K., Higgins, V., Kavsak, P., Hoffman, B., Adeli, K. (2019, April). High-Sensitivity Generation 5 Cardiac Troponin T Sex- and Age-Specific 99th Percentiles in the CALIPER Cohort of Healthy Children and Adolescents. Clinical Chemistry, 65(4), 589–591.
Boroński, B., Piotrowski, A., Pągowska-Klimek, I. (2022). Value of troponin T measurements for prediction of postoperative course and length of ICU stay of children after surgical correction of congenital heart disease. Anaesthesiology Intensive Therapy, 54(2), 114-119. https://doi.org/10.5114/ait.2022.114488.
Bottio, T., Vida, V., Padalino, M., Gerosa, G., Stellin, G. (2006, August). Early and long-term prognostic value of Troponin-I after cardiac surgery in newborns and children. European Journal of Cardio-Thoracic Surgery, 30(2), 250-255. doi: 10.1016/j.ejcts.2006.05.001. Epub 2006 Jul 10.
Carmona, F., Manso, P. H., Vicente, W. V., Castro, M., Carlotti, A. P. (2008, June). Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: a multimarker approach combining inflammatory mediators, N-terminal pro-B-type natriuretic peptide and troponin I. Cytokine, 42(3), 317-324. doi: 10.1016/j.cyto.2008.03.005.
Cosgrave, J., Foley, B., Ho, E., Bennett, K., McGovern, E., Tolan, M., Young, V., Crean, P. (2006, September). Troponin T elevation after coronary bypass surgery: clinical relevance and correlation with perioperative variables. Journal of Cardiovascular Medicine, 7(9), 669-674.
Gallacher, P. J., Miller-Hodges, E., Shah, A. S., Anand, A., Dhaun, N., Mills, N. L, High-STEACS Investigators. (2021, Sep 1). Use of High-Sensitivity Cardiac Troponin in Patients With Kidney Impairment A Randomized Clinical Trial. JAMA Internal Medicine, 181(9), 1237-1239.
Gupta, M., Lent, R. W., Kern, J. H., Flynn, P. A., Klein, A. A., Schiller, M. S., Friedman, D. M. (1999, April 1). Troponin I as a Marker for Myocardial Injury and Ischemia during Pediatric Cardiopulmonary Bypass Surgery. Pediatric Research, 45(23).
Immer, F. F., Stocker, F., Seiler, A. M., Pfammatter, J. P., Bachmann, D., Printzen, G., Carrel, T. (1999, May). Troponin-I for Prediction of Early Postoperative Course After Pediatric Cardiac Surgery. Journal of the American College of Cardiology, 33(6), 1719-1723.
Imura, H., Caputo, M., Parry, A., Pawade, A., Angelini, G. D., Suleiman, M. S. (2001, March 20). Age-dependent and hypoxia-related differences in myocardial protection during pediatric open-heart surgery. Circulation, 103(11), 1551-1556. doi: 10.1161/01.cir.103.11.1551.
Javed, F., Aleysae, N. A., Al-Mahbosh, A. Y., Zubani, A. A., Atash, A. M., Bin Salem, H. B., Abdallah, M., Alkhatib, O., Abu-Adas, A., Hrays, M. A., Alqarni, N. A., Felemban, A., Alsaedi, S. A., Jamjoom, A. A. (2021, October 15). Complications After Surgical Repair of Congenital Heart Disease in Infants. An Experience from Tertiary Care Center. Journal of the Saudi Heart Association, 33(4), 271-278.
Jenkins, K. J., Botto, L. D., Correa, A., Foster, E., Kupiec, J. K., Marino, B.S., Oster, M. E., Stout, K. K., Honein, M. A. (2019). Public health approach to improve outcomes for congenital heart disease across the life span. Journal of the American Heart Association, 8,1-8.
Kavsak, P. A., Rezanpour, A., Chen, Y., Adeli, K. (2014, December 1). Assessment of the 99th or 97.5th percentile for cardiac troponin I in a healthy pediatric cohort. Clinical Chemistry, 60(12), 1574–1576.
Liu, Y., Chen, S., Zuhlke, L., Black, G. C., Choy, M. K., Li, N., Keavney, B. D. (2019). Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. International Journal of Epidemiology,48,455-463.
Malhotra, M. G., Kern, J. H., Flynn, P. A., Schiller, M. S., Quaegebeur, J. M., Friedman, D. M. (2013 June). Cardiac troponin I after cardiopulmonary bypass in infants in comparison with older children. Cardiology in the Young, 23(3), 431-435.
Mangla, A., Gupta, S., Staros, E. B. (2019). Troponins [Internet]. New York: Medscape; 2019. Reference Range. Available from: https://emedicine.medscape.com/article/2073935-overview.
Martin, J. A., Hamilton, B. E., Osterman, M. J., Driscoll, A. K., Mathews, T. J. (2017). Births: final data for 2015. National Vital Statistics Reports, 66,1–55.
Mildh, L. H., Pettila, V., Sairanen, H. I., Rautiainen, P. H. (2006, November). Cardiac troponin T levels for risk stratification in pediatric open heart surgery. Annals of Pediatric Cardiology, 82(5), 1643-1648. doi: 10.1016/j.athoracsur.2006.05.014.
Militaru, M., Martinovici, D. (2005). Our experience in pediatric sepsis. Jurnalul Pediatrului, 8(6), 29-30.
Mirzaei, M., Mirzaei, S., Sepahvand, E., Koshkaki, A. F., Jahromi, M. K. (2015). Evaluation of complications of heart surgery in children with congenital heart disease at dena hospital of shiraz. Global Journal of Health Science, 8(5), 33–38.Available from: doi: 10.5539/gjhs.v8n5p33.
Momeni, M., Poncelet, A., Rubay, J., Matta, A., Veevaete, L., Detaille, T., Houtekie, L., Clement de Clety, S., Derycke, E., Moniotte, S., Sluysmans, T., Veyckemans, F. (2017, Feb). Does Postoperative Cardiac Troponin-I Have Any Prognostic Value in Predicting Midterm Mortality After Congenital Cardiac Surgery?. Journal of Cardiothoracic and Vascular Anesthesia, 31(1), 122-127.
Murni, I. K., Djer, M. M., Yanuarso, P.B., Putra, S.T., Advani, N., Rachmat, J., Perdana, A., Sukardi, R. (2019). Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Annals of Pediatric Cardiology, 12(1), 38-44. doi: 10.4103/apc.APC_146_17.
Philips, D. A. (2012). Sickness, Violence and Reconciliation: Congenital Heart Disease in Iraq. Thesis,Georgia State University.
Poncelet, A. J., Van, S. M., Moniotte, S., Detaille, T., Beauloye, C., Bertrand, L., Nassogne, M. C., Rubay, J. E. (2011, December). Cardiac and neurological assessment of normothermia/warm blood cardioplegia vs hypothermia/cold crystalloid cardioplegia in pediatric cardiac surgery: insight from a prospective randomized trial. European Journal of Cardio-Thoracic Surgery, 40(6), 1384-1390.
Su, J. A., Kumar, R., Mahmoud, H., Bowdish, M. E., Toubat, O., Wood, J. C., Kung, G. C. (2019). Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery. Seminars in Thoracic and Cardiovascular Surgery, 31(2), 244–251.
Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., White, H. D. (2018, November 25). Fourth Universal Definition of Myocardial Infarction. European Heart Journal, 40(3), 237–269. https://doi.org/10.1093/eurheartj/ehy462.
Wada, T., Yokozawa, M., Takamuro, M., Araki, D., Ebuoka, N., Ohba, J., Tachibana, T., Mori, M., Tsutsumi, H. (2018). Cardiac troponin I and perioperative factors in pediatric open heart surgery. Sapporo Medical Journal, 87(1-6), 25-33.
Welsh, P., Preiss, D., Hayward, C., Shah, A. S. V., McAllister, D., Briggs, A., Boachie, C., McConnachie, A., Padmanabhan, S., Welsh, C., Woodward, M., Campbell, A., Porteous, D., Mills, N. L., Sattar, N. (2019, Jun). Cardiac Troponin T and Troponin I in the General Population. Circulation, 139(24), 2754-2764. doi: 10.1161/CIRCULATIONAHA.118.038529. Epub 2019 Apr 24. PMID: 31014085; PMCID: PMC6571179.
Wu, A. H., Christenson, R. H., Greene, D.N., Jaffe, A. S., Kavsak, P. A., Ordonez-Llanos, J., Apple, F. S. (2018, April). Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clinical Chemistry, 64(4):645-655. doi: 10.1373/clinchem.2017.277186.
Yasuda, S., Shimokawa, H. (2009, November). Acute myocardial infarction: the enduring challenge for cardiac protection and survival. Circulation Journal, 73(11), 2000-2008. doi: 10.1253/circj.cj-09-0655. Epub 2009 Oct 7.
Zavriyev, A. I., Kaya, K., Farzam, P., Farzam, P. Y., Sunwoo, J., Jassar, A. S., Sundt, T. M., Carp, S. A., Franceschini, M. A., Qu, J. Z. (2021). The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests. JTCVS Tech, 7, 178-179.
Published
2022-11-10
How to Cite
NAJEEB, S. Y., & MAHMOOD, N. A. (2022). HIGH-SENSITIVITY TROPONIN-T LEVEL AFTER PEDIATRIC CONGENITAL HEART DISEASE SURGERY. Journal of Duhok University, 25(2), 129-141. https://doi.org/10.26682/sjuod.2022.25.2.12
Section
Pure and Engineering Sciences