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Despite a comprehensive preoperative cardiovascular evaluation, patients undergoing orthotopic liver transplantation tend to have a higher peri- and post-operative cardiovascular event rate. Troponin T (TnT) may help risk stratify patients for development of cardiovascular events.
Consecutive patients undergoing orthotopic liver transplantation at Mayo Clinic in Florida between 1998 and 2010 and who had TnT obtained within 10 days following surgery were included. Three groups were compared based on TnT level: normal (TnT ≤0.01 ng/mL), intermediate (TnT 0.02–0.11 ng/mL) and elevated (TnT >0.11 ng/mL). Clinical, echocardiographic, and stress testing data were compared between groups. Overall and cardiovascular mortality was assessed.
The cohort included 78 patients. There was no difference in age, gender, severity of liver disease, and echocardiographic and stress test findings between the three groups. The overall mortality rate of our cohort was 12.8 percent with a follow-up period of at least two years post-transplant. All patients had normal preoperative stress testing. Patients in the normal and intermediate TnT groups had a lower overall mortality rate (14.3 percent and 0 percent, respectively) when compared to those with elevated TnT (50 percent; p=0.001). Patients in the elevated TnT group had a cardiovascular mortality rate of 37.5 percent compared to that of 1.4 percent in the other groups combined (p<0.01). Additionally, patients in the elevated TnT group had a much higher mortality rate when compared to those in the intermediate group (p<0.0001).
Patients undergoing orthotopic liver transplantation have high morbidity and mortality, which may be reflective of underlying cardiovascular disease which went undetected with conventional preoperative cardiovascular assessment. TnT may help risk stratify patients in the postoperative setting to allow for early detection and treatment of coronary artery disease and myocardial ischemia.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Biomarkers and Cardiovascular Risk
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1303-206
- 2013 American College of Cardiology Foundation