BIOMARKERS OF MYOCARDIAL DAMAGE AND STRUCTURAL AND FUNCTIONAL CHANGES IN THE RIGHT VENTRICLE AFTER PNEUMONEECTOMY

The purpose of this study was to compare the dynamics of right ventricle (RV) size, pulmonary artery pressure, and biomarkers of myocardial injury after pneumonectomy in patients with non-small cell lung cancer (NSCLC).

Materials and methods. The study included 30 men with NSCLC aged 64.5 (61; 68) years old underwent pneumonectomy. The levels of cardiac troponin I (cTnI), creatine phosphokinase-MB (CPK-MB), and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) were determined 1 day before, 24 and 48 hours after surgery. Echocardiography was performed before surgery and 48 hours after it. The correlation between the dynamics of myocardial injury markers and RV structural and functional parameters was assessed.

Results. cTnI increased from 0.01 to 0.02 ng/ml 24 hours after and to 0.011 ng/ml 48 hours after surgery (p<0.001), NT-proBNP increased from 113 pg/ml to 748 and 712 pg/ml, respectively (p<0.001). In 7 patients (23.3%), postoperative cTnI met the criterion for myocardial injury after noncardiac surgery (>= 0.04 ng/ml). RV size, right ventricular: left ventricular (RV/LV) size ratio, and pulmonary artery systolic pressure increased after surgery. A direct correlation between the increase ratio in RV size and cTnI after 48 hours (r=+0.42), as well as the increase ratio in RV/LV and cTnI after 24 hours (r=+0.45) was found. According to univariate regression data, the increase in RV size was associated with the increase in cTnI concentration 24 hours (odds ratio (OR) 3.25; 95% confidence interval (CI) 1.06-9.97) and 48 hours (OR 1.54 ; 95% CI 1.34-16.24) after surgery, and with the increase in NT-proBNP 24 hours after surgery (OR 2.38; 95% CI 1.04-5.43). The increase in RV/LV was associated with the increase in cTnI 24 hours (OR 4.67; 95% CI 1.34-16.24) and 48 hours (OR 3.25; 95% CI 1.06-9.97) after surgery, and with the increase in NT-proBNP 48 hours after surgery (OR 2.43; 95% CI 1.01-5.86). The increase in pulmonary artery systolic pressure (PASP) was associated with the increase in cTnI 24 hours (OR 7.5; 95% CI 1.72- 32.8) and 48 hours (OR 3.25; 95 % CI 1.06-9.97) after surgery, and with the increase in NT-proBNP 24 hours (OR 3.5; 95% CI 1.41-8.67) and 48 hours (OR 5.0; 95% CI 1.71 -14.63) after surgery.

Conclusion. Pneumonectomy in patients with NSCLC was accompanied by the increase in RV size, RV/LV size ratio, and PASP during the first 2 days after surgery. Myocardial injury syndrome after noncardiac surgery was detected in 23.3% of patients. The increase in RV size, RV/LV size ratio, and PASP were associated with the increase in cTnI and NT-proBNP.

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