Cardiac Troponin T level is not a predictor of mortality in patients with post-cardiotomy shock supported with venoarterial extracorporeal membrane oxygenation

Abstract

Abstract Background The prognostic significance of a dominant biomarker of cardiac injury, troponin, is unexplored in patients with post-cardiotomy cardiogenic shock supported with venoarterial extracorporeal membrane oxygenation (PCCS–VA-ECMO). Aims We sought to investigate the association of early postoperative troponin T with short- and long-term mortality in patients supported with VA-ECMO in the postoperative period. Methods We analyzed 1457 troponin measurements of 102 patients with PCCS–VA-ECMO treated between 2013–2018 in a cardiosurgical and transplantation centre. We focused on the relation of troponin concentration 24–48 hours after surgery and 24–48 hours after VA-ECMO implantation and peak troponin value with VA-ECMO weaning, 90-day and one-year mortality. Results The median troponin T 24–48 hours following VA-ECMO implantation was 1338 ng/L [Q1–Q3: 526–2727, 90-day survivors 1529 ng/L (Q1–Q3: 836–5791) vs. non-survivors 1294 ng/L (Q1–Q3: 316–2657); P = 0.146]. The median peak troponin was 3583 ng/L [Q1–Q3: 1710–9238, 90-day survivors 3337 ng/L (Q1–Q3: 1863–12305) vs. non-survivors 3666 ng/L (Q1-Q3: 1462–9238); P = 0.709]. Multivariate models of troponin analysis: for VA-ECMO explanation, in-hospital, 90-day and 1-year mortality showed no relation between troponin and mortality. Age, urgency, type and number of procedures, left ventricle ejection fraction before surgery, Euroscore II result, cardiac arrest prior to VA-ECMO implantation or duration of VA-ECMO did not correlate with the extent of troponin release. The strongest risk factor for short- and long-term mortality was the need for hemodiafiltration [HR 2.4]. Conclusions Isolated early Troponin T release and peak troponin T were not associated, while organ complications were linked with VA-ECMO weaning or short- and long-term prognosis. The results underscore the multiorgan implications of PCCS in determining survival.