Prognostic significance of test of cardiac troponin T and renal function in acute type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Ming ,  WANG Dongjin

Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;

Corresponding author：

WANG Dongjin, Email: jorismq@gmail.com

Keywords：

Acute type A aortic dissection; cardiac troponin T; renal function; clinical significance

DOI：

10.7507/1007-4848.201606008

Video：

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Objective To measure the rate of changes of the cardiac troponin T (cTnT) and serum urea nitrogen (N), serum creatinine (Cr), estimated glomerular filtration rate (eGFR) of acute type A aortic dissection (AAAD) patients before and after surgery, and to explore the prognostic significance of the rate of changes. Methods We retrospectively analyzed 77 AAAD patients' clinical data between August 2015 and March 2016 from the department of the cardiothoracic surgery in Nanjing Drum Tower Hospital. There were 57 males and 20 females with an average age of 51.1±13.1 years. The test results of cTnT, N, Cr, eGFR were recorded. Patients were divided into three groups based on the duration of ventilation: less than 48 hours, 48 hours to 7 days, longer than 7 days, and divided into two groups based on whether postoperative dialysis was performed: dialysis group and non-dialysis group. Results In the groups with different duration of ventilation, the rate of cTnT change differed significantly. The rate of Cr and eGFR change in the group with the duration of ventilation longer than 7 days showed significantly different compared to other two groups. We found that the rate of Cr and eGFR change were statistically significant between the dialysis group and the non-dialysis group. In the receiver operating characteristic curve (ROC), the optimal cut-off value of the Cr growth rate for predicting postoperative dialysis therapy was 58.1%, and the optimal cut-off value of the eGFR decline rate was 45.5%. Conclusion The rate of changes in cTnT, N, Cr and eGFR can be used as a reliable mean to evaluate respiratory and renal function for AAAD patients in the early stage, which will facilitate an early assessment of the prognosis of AAAD patients.

Citation： MA Ming, WANG Dongjin. Prognostic significance of test of cardiac troponin T and renal function in acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 222-227. doi: 10.7507/1007-4848.201606008 Copy

1.	Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: A review of 505 cases. Medicine (Baltimore), 1958, 37(3): 217-279.
2.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
3.	Pompilio G, Spirito R, Alamanni F, et al. Determinants of early and late outcome after surgery for type a aortic dissection. World J Surg, 2001, 25(12): 1500-1506.
4.	Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron, 1976, 16(1): 31-41.
5.	Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med, 1999, 131(1): 47-59.
6.	Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
7.	Sun L, Qi R, Zhu J, et al. Repair of acute type a dissection: Our experiences and results. Ann Thorac Surg, 2011, 91(4): 1147-1152.
8.	Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type a aortic dissection: The international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
9.	Augoustides JG, Geirsson A, Szeto WY, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type a aortic dissection: The penn classification. Nat Clin Pract Cardiovasc Med, 2009, 6(2): 140-146.
10.	Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type a aortic dissection: Validation of the penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382.
11.	Kimura N, Ohnuma T, Itoh S, et al. Utility of the penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol, 2014, 113(4): 724-730.
12.	Li F, Liu N, Dong P, et al. Analysis of factors related to acute renal failure post deep hypothermia circulatory arrest surgery of type a aorta dissection surgery. Zhonghua Wai Ke Za Zhi, 2013, 51(12): 1094-1098.
13.	Xiong J, Zhang M, Guo W, et al. Early malperfusion, ischemia reperfusion injury, and respiratory failure in acute complicated type b aortic dissection after thoracic endovascular repair. J Cardiothora Surg, 2013, 8: 17.
14.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type a aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
15.	Tanaka K, Chikazawa G, Sakaguchi T, et al. Hybrid treatment for type a acute aortic dissection with multiorgan malperfusion. The Ann Thorac Surg, 2014, 98(3): 1118-1120.
16.	Hirata K, Wake M, Takahashi T, et al. Clinical predictors for delayed or inappropriate initial diagnosis of type a acute aortic dissection in the emergency room. PloS one, 2015, 10(11): e0141929.
17.	Imasaka K, Tayama E, Tomita Y. Preoperative renal function and surgical outcomes in patients with acute type a aortic dissection. Interac Cardiovasc Thorac Surg, 2015, 20(4): 470-476.
18.	Duncan L, Heathcote J, Djurdjev O, et al. Screening for renal disease using serum creatinine: Who are we missing? Nephrol Dial Transplant, 2001,16(5): 1042-1046.
19.	Swedko PJ, Clark HD, Paramsothy K, et al. Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med, 2003, 163(3): 356-360.
20.	Bellorin-Font E, Ambrosoni P, Carlini RG, et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia, 2013, 33 (Suppl 1): 1-28.

1. Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: A review of 505 cases. Medicine (Baltimore), 1958, 37(3): 217-279.
2. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
3. Pompilio G, Spirito R, Alamanni F, et al. Determinants of early and late outcome after surgery for type a aortic dissection. World J Surg, 2001, 25(12): 1500-1506.
4. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron, 1976, 16(1): 31-41.
5. Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med, 1999, 131(1): 47-59.
6. Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
7. Sun L, Qi R, Zhu J, et al. Repair of acute type a dissection: Our experiences and results. Ann Thorac Surg, 2011, 91(4): 1147-1152.
8. Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type a aortic dissection: The international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
9. Augoustides JG, Geirsson A, Szeto WY, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type a aortic dissection: The penn classification. Nat Clin Pract Cardiovasc Med, 2009, 6(2): 140-146.
10. Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type a aortic dissection: Validation of the penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382.
11. Kimura N, Ohnuma T, Itoh S, et al. Utility of the penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol, 2014, 113(4): 724-730.
12. Li F, Liu N, Dong P, et al. Analysis of factors related to acute renal failure post deep hypothermia circulatory arrest surgery of type a aorta dissection surgery. Zhonghua Wai Ke Za Zhi, 2013, 51(12): 1094-1098.
13. Xiong J, Zhang M, Guo W, et al. Early malperfusion, ischemia reperfusion injury, and respiratory failure in acute complicated type b aortic dissection after thoracic endovascular repair. J Cardiothora Surg, 2013, 8: 17.
14. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type a aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
15. Tanaka K, Chikazawa G, Sakaguchi T, et al. Hybrid treatment for type a acute aortic dissection with multiorgan malperfusion. The Ann Thorac Surg, 2014, 98(3): 1118-1120.
16. Hirata K, Wake M, Takahashi T, et al. Clinical predictors for delayed or inappropriate initial diagnosis of type a acute aortic dissection in the emergency room. PloS one, 2015, 10(11): e0141929.
17. Imasaka K, Tayama E, Tomita Y. Preoperative renal function and surgical outcomes in patients with acute type a aortic dissection. Interac Cardiovasc Thorac Surg, 2015, 20(4): 470-476.
18. Duncan L, Heathcote J, Djurdjev O, et al. Screening for renal disease using serum creatinine: Who are we missing? Nephrol Dial Transplant, 2001,16(5): 1042-1046.
19. Swedko PJ, Clark HD, Paramsothy K, et al. Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med, 2003, 163(3): 356-360.
20. Bellorin-Font E, Ambrosoni P, Carlini RG, et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia, 2013, 33 (Suppl 1): 1-28.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic significance of test of cardiac troponin T and renal function in acute type A aortic dissection

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