Background

Peri-operative mortality remains a global problem and an improved pre-operative risk assessment identifying those at highest risk for peri-operative myocardial injury might improve postsurgical outcomes.

Aims

To determine whether pre-operative measures of advanced electrocardiography (A-ECG) could predict elevated serum troponin T (TnT) in patients undergoing elective, major non-cardiac surgery.

Material and methods

This observational cohort study included 257 surgical patients who underwent elective major non-cardiac surgery between the years 2012–2013 and 2015–2016 at Karolinska University Hospital. All selected patients were ≥ 18 years of age [median age 70 (63–75) years], had a pre-operative digital 12‑lead ECG < 6 months prior to the procedure and a postoperative high-sensitivity cardiac TnT (hs-cTnT) sample. A-ECG confounders including atrial fibrillation or flutter, abundant premature atrial or ventricular contractions, bundle branch blocks, QRS duration >110 ms, heart rate > 100 beats/min and paced rhythms were excluded. Previously validated A-ECG diagnostic scores that detect cardiovascular pathologies were calculated and compared in patients with and without peri-operative myocardial injury, defined as hs-cTnT >14 ng l⁻¹.

Results

Pre-operative left ventricular systolic dysfunction by A-ECG was more probable in patients with than without peri-operative myocardial injury (p = 0.03).

Conclusions

While a pre-operative A-ECG score for LVSD was able to differentiate between patients with versus without elevated peri-operative TnT levels, it did not add any further utility to standard clinical parameters for predicting troponin-related events in the studied population.

中文翻译：

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高级心电图预测围手术期肌钙蛋白升高

背景

围手术期死亡率仍然是一个全球性问题，改进术前风险评估以确定围手术期心肌损伤风险最高的人群可能会改善术后结果。

宗旨

确定高级心电图 (A-ECG) 的术前测量是否可以预测接受择期非心脏大手术的患者血清肌钙蛋白 T (TnT) 升高。

材料与方法

这项观察性队列研究包括 257 名在 2012-2013 年和 2015-2016 年期间在卡罗林斯卡大学医院接受了非心脏大手术的外科患者。所有选定的患者均≥ 18 岁 [中位年龄 70 (63-75) 岁]，术前数字 12 导联心电图 < 6 个月，术后高敏心脏 TnT (hs-cTnT ） 样本。A-ECG 混杂因素包括房颤或扑动、大量房性或室性早搏、束支传导阻滞、QRS 持续时间 > 110 ms、心率 > 100 次/分钟和起搏节律。在有和没有围手术期心肌损伤（定义为 hs-cTnT >.

结果

与没有围手术期心肌损伤的患者相比，A-ECG 显示术前左心室收缩功能障碍的可能性更大 ( p = 0.03)。

结论

虽然 LVSD 的术前 A-ECG 评分能够区分围手术期 TnT 水平升高的患者与没有升高的患者，但它并没有为标准临床参数增加任何用于预测研究人群中肌钙蛋白相关事件的进一步效用。