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Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study.
Álvarez-Garcia, Jesús; Popova, Ekaterine; Vives-Borrás, Miquel; de Nadal, Miriam; Ordonez-Llanos, Jordi; Rivas-Lasarte, Mercedes; Moustafa, Abdel-Hakim; Solé-González, Eduard; Paniagua-Iglesias, Pilar; Garcia-Moll, Xavier; Viladés-Medel, David; Leta-Petracca, Rubén; Oristrell, Gerard; Zamora, Javier; Ferreira-González, Ignacio; Alonso-Coello, Pablo; Carreras-Costa, Francesc.
  • Álvarez-Garcia J; Department of Cardiology, Hospital Universitario Ramon y Cajal, M-607, 9,100, 28034, Madrid, Spain.
  • Popova E; Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
  • Vives-Borrás M; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.
  • de Nadal M; IIB SANT PAU, Institut d'Investigació Biomèdica Sant Pau, Sant Quintí 77, 08041, Barcelona, Spain. epopova@santpau.cat.
  • Ordonez-Llanos J; Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. epopova@santpau.cat.
  • Rivas-Lasarte M; Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
  • Moustafa AH; Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Department of Cardiology, Carretera de Valldemossa, 79, 07120, Palma, Balearic Islands, Spain.
  • Solé-González E; Department of Cardiology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, Palma, Illes Balears, Spain.
  • Paniagua-Iglesias P; Department of Anaesthesiology and Intensive Care, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain. miriam.denadal@vallhebron.cat.
  • Garcia-Moll X; Department of Biochemistry, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
  • Viladés-Medel D; Foundation for Clinical Biochemistry & Molecular Pathology, Barcelona, Spain.
  • Leta-Petracca R; Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
  • Oristrell G; Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.
  • Zamora J; Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
  • Ferreira-González I; Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
  • Alonso-Coello P; Department of Cardiology, Hospital Clinic i Provincial, C. de Villarroel, 170, 08036, Barcelona, Spain.
  • Carreras-Costa F; Department of Anaesthesia and Pain Management, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08026, Barcelona, Spain.
BMC Cardiovasc Disord ; 23(1): 78, 2023 02 10.
Article in English | MEDLINE | ID: covidwho-2238645
ABSTRACT

BACKGROUND:

Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention.

METHODS:

Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48-72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality.

RESULTS:

We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%).

CONCLUSION:

This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes. Trial registration Clinicaltrials.gov identifier NCT03438448 (19/02/2018).
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Coronary Artery Disease / Myocardial Ischemia / COVID-19 / Heart Injuries Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: BMC Cardiovasc Disord Journal subject: Vascular Diseases / Cardiology Year: 2023 Document Type: Article Affiliation country: S12872-023-03065-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Coronary Artery Disease / Myocardial Ischemia / COVID-19 / Heart Injuries Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: BMC Cardiovasc Disord Journal subject: Vascular Diseases / Cardiology Year: 2023 Document Type: Article Affiliation country: S12872-023-03065-6