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dc.contributor.authorAbbott, TEFen_US
dc.contributor.authorPearse, RMen_US
dc.contributor.authorCuthbertson, BHen_US
dc.contributor.authorWijeysundera, DNen_US
dc.contributor.authorAckland, GLen_US
dc.contributor.authorMETS study investigatorsen_US
dc.date.accessioned2018-11-26T13:59:23Z
dc.date.available2018-10-22en_US
dc.date.issued2019-02en_US
dc.date.submitted2018-10-22T11:43:32.853Z
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/53303
dc.description.abstractBACKGROUND: The aetiology of perioperative myocardial injury is poorly understood and not clearly linked to pre-existing cardiovascular disease. We hypothesised that loss of cardioprotective vagal tone [defined by impaired heart rate recovery ≤12 beats min-1 (HRR ≤12) 1 min after cessation of preoperative cardiopulmonary exercise testing] was associated with perioperative myocardial injury. METHODS: We conducted a pre-defined, secondary analysis of a multi-centre prospective cohort study of preoperative cardiopulmonary exercise testing. Participants were aged ≥40 yr undergoing non-cardiac surgery. The exposure was impaired HRR (HRR≤12). The primary outcome was postoperative myocardial injury, defined by serum troponin concentration within 72 h after surgery. The analysis accounted for established markers of cardiac risk [Revised Cardiac Risk Index (RCRI), N-terminal pro-brain natriuretic peptide (NT pro-BNP)]. RESULTS: A total of 1326 participants were included [mean age (standard deviation), 64 (10) yr], of whom 816 (61.5%) were male. HRR≤12 occurred in 548 patients (41.3%). Myocardial injury was more frequent amongst patients with HRR≤12 [85/548 (15.5%) vs HRR>12: 83/778 (10.7%); odds ratio (OR), 1.50 (1.08-2.08); P=0.016, adjusted for RCRI). HRR declined progressively in patients with increasing numbers of RCRI factors. Patients with ≥3 RCRI factors were more likely to have HRR≤12 [26/36 (72.2%) vs 0 factors: 167/419 (39.9%); OR, 3.92 (1.84-8.34); P<0.001]. NT pro-BNP greater than a standard prognostic threshold (>300 pg ml-1) was more frequent in patients with HRR≤12 [96/529 (18.1%) vs HRR>12 59/745 (7.9%); OR, 2.58 (1.82-3.64); P<0.001]. CONCLUSIONS: Impaired HRR is associated with an increased risk of perioperative cardiac injury. These data suggest a mechanistic role for cardiac vagal dysfunction in promoting perioperative myocardial injury.en_US
dc.description.sponsorshipThe METS Study was funded by peer-reviewed grants from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, National Institute of Academic Anaesthesia, UK Clinical Research Network, Australian and New Zealand College of Anaesthetists, and Monash University. TEFA was supported by a Medical Research Council and British Journal of Anaesthesia clinical research training fellowship (grant reference MR/M017974/1); RP is supported by a UK National Institute for Health Research Professorship; GLA is supported by British Journal of Anaesthesia/Royal College of Anaesthetists basic science Career Development award, British Oxygen Company research chair grant in anaesthesia from the Royal College of Anaesthetists and British Heart Foundation Programme Grant (RG/14/4/30736). BHC and DNW are supported in part by Merit Awards from the Department of Anesthesia at the University of Toronto. DNW is supported by a New Investigator Award from the Canadian Institutes of Health Researchen_US
dc.format.extent188 - 197en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofBr J Anaesthen_US
dc.rightsThis is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
dc.subjectB-type natriuretic peptideen_US
dc.subjectcardiopulmonary exercise testingen_US
dc.subjectheart rateen_US
dc.subjectmyocardial injury after non-cardiac surgeryen_US
dc.subjectsurgeryen_US
dc.subjecttroponinen_US
dc.subjectvagal functionen_US
dc.titleCardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study.en_US
dc.typeArticle
dc.rights.holder© 2018 The Author(s).
dc.identifier.doi10.1016/j.bja.2018.10.060en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/30686304en_US
pubs.issue2en_US
pubs.notesNot knownen_US
pubs.publication-statusPublisheden_US
pubs.volume122en_US
dcterms.date2018-12-17
dcterms.dateAccepted2018-10-20en_US
qmul.funderParasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesiaen_US
qmul.funderParasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesiaen_US


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