dc.contributor.author | Abbott, TEF | en_US |
dc.contributor.author | Pearse, RM | en_US |
dc.contributor.author | Cuthbertson, BH | en_US |
dc.contributor.author | Wijeysundera, DN | en_US |
dc.contributor.author | Ackland, GL | en_US |
dc.contributor.author | METS study investigators | en_US |
dc.date.accessioned | 2018-11-26T13:59:23Z | |
dc.date.accessioned | 2019-05-14T17:30:19Z | |
dc.date.available | 2018-10-22 | en_US |
dc.date.available | 2019-05-14T17:30:19Z | |
dc.date.issued | 2019-02 | en_US |
dc.date.submitted | 2018-10-22T11:43:32.853Z | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/53303 | |
dc.identifier.uri | https://qmro.qmul.ac.uk/xmlui/handle/123456789/57537 | |
dc.description.abstract | BACKGROUND: 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.sponsorship | The 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 Research | en_US |
dc.format.extent | 188 - 197 | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | Br J Anaesth | en_US |
dc.relation.replaces | https://qmro.qmul.ac.uk/xmlui/handle/123456789/53303 | |
dc.relation.replaces | 123456789/53303 | |
dc.relation.replaces | 123456789/54495 | |
dc.relation.replaces | https://qmro.qmul.ac.uk/xmlui/handle/123456789/54495 | |
dc.rights | This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). | |
dc.subject | B-type natriuretic peptide | en_US |
dc.subject | cardiopulmonary exercise testing | en_US |
dc.subject | heart rate | en_US |
dc.subject | myocardial injury after non-cardiac surgery | en_US |
dc.subject | surgery | en_US |
dc.subject | troponin | en_US |
dc.subject | vagal function | en_US |
dc.title | Cardiac 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.type | Article | |
dc.rights.holder | © 2018 The Author(s). | |
dc.identifier.doi | 10.1016/j.bja.2018.10.060 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/30686304 | en_US |
pubs.issue | 2 | en_US |
pubs.merge-from | 123456789/54495 | |
pubs.merge-from | https://qmro.qmul.ac.uk/xmlui/handle/123456789/54495 | |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 122 | en_US |
dcterms.date | 2018-12-17 | |
dcterms.dateAccepted | 2018-10-20 | en_US |
qmul.funder | Parasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesia | en_US |
qmul.funder | Parasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesia | en_US |