ISSN 2996-8215
International Journal of Cardiology | Vol. 14, No. 6, June 2023 | pp. 41–48
DOI: 10.46882/2023/IJC/000170
Original Research Article
Early Postoperative High-Sensitivity Cardiac Troponin T Release as an Independent Predictor of New-Onset POAF
Chloe Jenkins¹, Oliver Vance¹, Sarah E. Lawson²
¹Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
²School of Medicine, University of Queensland, Brisbane, Queensland, Australia
Abstract:
Postoperative atrial fibrillation (POAF) complicates up to 30% of cardiac surgical interventions, increasing the risks of stroke and long-term healthcare expenditure. Subtle periprocedural myocardial injury may serve as an arrhythmogenic substrate, but its correlation with POAF development requires clarification. This prospective observational study evaluated the association between early postoperative high-sensitivity cardiac troponin T (hs-cTnT) elevations and the subsequent development of new-onset POAF. We enrolled 210 consecutive patients in baseline sinus rhythm who underwent elective coronary artery bypass grafting (CABG) or valvular replacement surgery. Serial plasma hs-cTnT levels were collected preoperatively and at 6, 12, and 24 hours postoperatively. Continuous cardiac telemetry monitored heart rhythms throughout the index hospitalization. POAF lasting longer than 30 seconds occurred in 64 patients (30.5%). Preoperative baseline hs-cTnT levels did not differ between cohorts. However, at 12 hours post-surgery, hs-cTnT levels peaked significantly higher in the POAF group than in the non-POAF group (425.4 ± 84.6 ng/L vs. 284.2 ± 62.1 ng/L, p < 0.001). Multivariable logistic regression revealed that a 12-hour postoperative hs-cTnT elevation above 350 ng/L was an independent predictor of POAF development (odds ratio: 2.34, 95% CI: 1.41–3.88, p = 0.002), alongside advanced age (odds ratio: 1.06 per year, p = 0.01). Elevated early postoperative hs-cTnT concentrations are strongly and independently linked to POAF development, indicating that subclinical periprocedural myocardial injury represents a primary contributor to postoperative atrial arrhythmogenesis.
Keywords: Atrial fibrillation, Cardiac surgery, High-sensitivity cardiac troponin T, Myocardial injury, Postoperative complications, Arrhythmogenesis
Received: March 12, 2023; Revised: April 25, 2023; Accepted: May 10, 2023; Published: June 19, 2023