Pathophysiological mechanisms underlying increased circulating cardiac troponin in noncardiac surgery : a narrative review
Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved..
Assay-specific increases in circulating cardiac troponin are observed in 20-40% of patients after noncardiac surgery, depending on patient age, type of surgery, and comorbidities. Increased cardiac troponin is consistently associated with excess morbidity and mortality after noncardiac surgery. Despite these findings, the underlying mechanisms are unclear. The majority of interventional trials have been designed on the premise that ischaemic cardiac disease drives elevated perioperative cardiac troponin concentrations. We consider data showing that elevated circulating cardiac troponin after surgery could be a nonspecific marker of cardiomyocyte stress. Elevated concentrations of circulating cardiac troponin could reflect coordinated pathological processes underpinning organ injury that are not necessarily caused by ischaemia. Laboratory studies suggest that matching of coronary artery autoregulation and myocardial perfusion-contraction coupling limit the impact of systemic haemodynamic changes in the myocardium, and that type 2 ischaemia might not be the likeliest explanation for cardiac troponin elevation in noncardiac surgery. The perioperative period triggers multiple pathological mechanisms that might cause cardiac troponin to cross the sarcolemma. A two-hit model involving two or more triggers including systemic inflammation, haemodynamic strain, adrenergic stress, and autonomic dysfunction might exacerbate or initiate acute myocardial injury directly in the absence of cell death. Consideration of these diverse mechanisms is pivotal for the design and interpretation of interventional perioperative trials.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:132 |
|---|---|
| Enthalten in: |
British journal of anaesthesia - 132(2024), 4 vom: 11. März, Seite 653-666 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bollen Pinto, Bernardo [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Biomarkers |
|---|
| Anmerkungen: |
Date Completed 05.03.2024 Date Revised 05.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.bja.2023.12.017 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM367532786 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM367532786 | ||
| 003 | DE-627 | ||
| 005 | 20240305232234.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240124s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.bja.2023.12.017 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1317.xml |
| 035 | |a (DE-627)NLM367532786 | ||
| 035 | |a (NLM)38262855 | ||
| 035 | |a (PII)S0007-0912(23)00733-X | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bollen Pinto, Bernardo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pathophysiological mechanisms underlying increased circulating cardiac troponin in noncardiac surgery |b a narrative review |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 05.03.2024 | ||
| 500 | |a Date Revised 05.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a Assay-specific increases in circulating cardiac troponin are observed in 20-40% of patients after noncardiac surgery, depending on patient age, type of surgery, and comorbidities. Increased cardiac troponin is consistently associated with excess morbidity and mortality after noncardiac surgery. Despite these findings, the underlying mechanisms are unclear. The majority of interventional trials have been designed on the premise that ischaemic cardiac disease drives elevated perioperative cardiac troponin concentrations. We consider data showing that elevated circulating cardiac troponin after surgery could be a nonspecific marker of cardiomyocyte stress. Elevated concentrations of circulating cardiac troponin could reflect coordinated pathological processes underpinning organ injury that are not necessarily caused by ischaemia. Laboratory studies suggest that matching of coronary artery autoregulation and myocardial perfusion-contraction coupling limit the impact of systemic haemodynamic changes in the myocardium, and that type 2 ischaemia might not be the likeliest explanation for cardiac troponin elevation in noncardiac surgery. The perioperative period triggers multiple pathological mechanisms that might cause cardiac troponin to cross the sarcolemma. A two-hit model involving two or more triggers including systemic inflammation, haemodynamic strain, adrenergic stress, and autonomic dysfunction might exacerbate or initiate acute myocardial injury directly in the absence of cell death. Consideration of these diverse mechanisms is pivotal for the design and interpretation of interventional perioperative trials | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a cardiac troponin | |
| 650 | 4 | |a inflammation | |
| 650 | 4 | |a ischaemia | |
| 650 | 4 | |a myocardial injury | |
| 650 | 4 | |a perioperative stress | |
| 650 | 4 | |a postoperative complications | |
| 650 | 7 | |a Troponin |2 NLM | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 700 | 1 | |a Ackland, Gareth L |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t British journal of anaesthesia |d 1946 |g 132(2024), 4 vom: 11. März, Seite 653-666 |w (DE-627)NLM000000310 |x 1471-6771 |7 nnns |
| 773 | 1 | 8 | |g volume:132 |g year:2024 |g number:4 |g day:11 |g month:03 |g pages:653-666 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.bja.2023.12.017 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 132 |j 2024 |e 4 |b 11 |c 03 |h 653-666 | ||