It was expected that patients with increased rates of cardiovascular mortality would have had some type of baseline deficit on echocardiography or noninvasive stress testing prior to transplantation, selleck chemicals llc but this was not the case. Our results suggest that the decision regarding cardiovascular work-up following transplant should not be solely based on the findings prior to transplant. Patients with elevated TnT were also noted to have higher Inhibitors,Modulators,Libraries overall MELD scores and INR values when compared with the other groups. There was a higher percentage of patients with renal dysfunction in the elevated TnT group compared with the others, yet this was not statistically different. This data suggest that perhaps those patients with elevated TnT levels are more acutely ill than the other groups and that the elevated in TnT is likely secondary to an alternative cause such as myopathy.
Multiorgan Inhibitors,Modulators,Libraries system failure can also potentially cause TnT elevation, yet no difference in proportion of patients with multiorgan system failure was noted between the groups. Electrocardiogram changes at the time of TnT elevation were not significantly different between the three groups. The negative and intermediate TnT groups did have a higher percentage of patients with normal electrocardiograms versus those in the elevated group which often had nonspecific ST-segment changes. While it is recommended that electrocardiogram changes not to be used solely to decide whether or not a patient following transplantation is at risk for cardiovascular complications, Inhibitors,Modulators,Libraries these findings do suggest that patients with an abnormal electrocardiogram in the setting of an elevated TnT may have worse outcomes.
Many limitations should be acknowledged, including the relatively small patient population. However, to our knowledge, this reflects the largest study to date evaluating the association between troponin and mortality following OLT. We acknowledge Inhibitors,Modulators,Libraries the many factors that may cause or contribute to an elevated troponin Inhibitors,Modulators,Libraries level and certainly there may be some caution to using this laboratory value to guide when to pursue invasive angiography, especially in the setting of recent transplantation. The lack of invasive testing adds merit to this assumption in that clinicians likely attributed the troponin elevation to surgery itself. The lack of invasive coronary assessment is a large boundary in this study as we cannot be certain as to the precise mechanism of troponin elevation.
While these findings do point to patients in the elevated troponin group having worse liver disease and renal dysfunction, some may have been predisposed GSK-3 to perioperative infarction given their underlying risk factors. Patients in this study have at least two years of followup following transplantation, yet an additional limitation is the lack of longer-term followup.