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(Circulation. 1995;92:409-414.)
© 1995 American Heart Association, Inc.

Articles

Circulating Cardiac Troponin T in Potential Heart Transplant Donors

Presented in part at the seventh Meeting of the International Trauma Anesthesia and Critical Society, Paris, May 23-25, 1994.

Bruno Riou, MD, PhD; Sophie Dreux, PhD; Sabine Roche, MD; Martine Arthaud, PhD; Jean-Pierre Goarin, MD; Philippe Léger, MD; Michel Saada, MD; Pierre Viars, MD

From the Département d'Anesthésie-Réanimation (B.R., S.R., J.-P.G., P.L., M.S., P.V.) and Laboratoire de Biologie des Urgences (S.D., M.A.), Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, Paris, France.

Correspondence to Dr Bruno Riou, Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'hôpital, 75651 Paris Cedex 13, Paris, France.

Background Brain death may induce myocardial dysfunction, the mechanisms of which are not yet fully understood. Circulating cardiac troponin T is considered a highly sensitive and specific marker of myocardial cell injury.

Methods and Results We prospectively measured circulating cardiac troponin T in 100 brain-dead patients and measured the left ventricular ejection fraction area (LVEFa), using transesophageal echocardiography. Sixty-one patients had normal LVEFa, 25 had moderate decrease in LVEFa (30% to 50%), and 14 had severe decrease in LVEFa (30%). Circulating cardiac troponin T concentrations were significantly higher (1.68±1.03 µg/L^-1, P<.01) in patients with a severe decrease in LVEFa than in the two other groups (0.42±0.43 and 0.12±0.16 µg/L^-1, respectively), and there was a significant correlation between LVEFa and cardiac troponin T concentration (=-0.59, P<.0001). An elevated circulating cardiac troponin T concentration (0.5 µg/L^-1) was more accurate (sensitivity, 1.00; specificity, 0.84) in predicting a severe decrease in LVEFa than an elevated CKMB value or an increased CKMB/CK ratio.

Conclusions An elevated circulating cardiac troponin T was associated with a severe decrease in LVEFa in brain-dead patients, suggesting that severe and potentially irreversible myocardial cell damage occurred. In contrast, CKMB determination was not useful. Since the quality of the donor's heart is considered an important prognosis factor in heart transplantation, the determination of circulating cardiac troponin T concentration could be useful to the heart transplantation team.

Key Words: troponin T • brain death • transplantation

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