Pericardial fluid cardiac troponin I predicts postoperative atrial fibrillation after coronary artery bypass grafting.
- 1School of Nursing, Capital Medical University, Beijing, P. R. China.
- 2Department of Cardiac Surgery Intensive Care Unit (ICU) 4, Beijing Anzhen Hospital, Capital Medical University, Beijing, P. R. China.
- 3Department of Cardiac Surgery Intensive Care Unit (ICU) 1, Beijing Anzhen Hospital, Capital Medical University, Beijing, P. R. China.
Abstract
Objective
Cardiac troponin I (cTnI) is a sensitive biomarker of myocardial injury. We hypothesized that cTnI measured in pericardial drainage fluid (PCF), which reflects the cardiac microenvironment, may enhance risk stratification for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting.Methods
In this prospective cohort study, 114 patients undergoing elective coronary artery bypass grafting were enrolled. The primary end point was new-onset POAF within 7 days postoperatively. Blood and PCF cTnI at 6 hours postoperatively were measured. Variables were screened using least absolute shrinkage and selection operator regression and were then incorporated into multivariable logistic regression to construct a predictive model. A simplified risk score (CALT score) was developed. Model performance was compared with existing POAF tools, including the POAF score, CHA₂DS₂-VASc, and the atrial fibrillation risk index.Results
POAF occurred in 30.7% of the cohort. Postoperative 6-hour PCF-cTnI was an independent predictor of POAF (odds ratio, 5.502; 95% CI, 1.887-16.045; P = .002) and significantly enhanced continuous net reclassification improvement (0.562; 95% CI, 0.189-0.921; P = .002). The CALT score comprised left circumflex artery lesions, left atrial diameter, left ventricular end-diastolic diameter, postoperative 0-hour serum calcium, and postoperative 6-hour PCF-cTnI. The PCF-cTnI-based model demonstrated good discrimination (area under the receiver operating characteristic curve = 0.821), with favorable calibration and clinical utility. Compared with commonly used risk scores, the CALT score exhibited superior discrimination and calibration.Conclusions
This study provides novel evidence that PCF-cTnI is a strong predictor of POAF. The CALT score, integrating PCF-cTnI with clinical factors, provided superior predictive performance by capturing both the vulnerable atrial substrate and localized myocardial injury.
Related
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- Reduced apelin expression and atrial fibrosis in postoperative atrial fibrillation following coronary artery bypass grafting
- Association between rhythm control strategy and clinical outcomes in postoperative atrial fibrillation after coronary artery bypass grafting: a retrospective cohort study
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BibTeX
@article{shu2026pericardial,
title = {{Pericardial fluid cardiac troponin I predicts postoperative atrial fibrillation after coronary artery bypass grafting.}},
author = {Yue Shu and Chaoyue Gao and Xiaoshuang Ren and Xun Deng and Lin Luo and Taiwei Wang and Zexinyao Ren and Jiahui Zhao and Yisi Liu},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101954},
url = {https://europepmc.org/article/MED/42948431},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pericardial fluid cardiac troponin I predicts postoperative atrial fibrillation after coronary artery bypass grafting.
AU - Yue Shu
AU - Chaoyue Gao
AU - Xiaoshuang Ren
AU - Xun Deng
AU - Lin Luo
AU - Taiwei Wang
AU - Zexinyao Ren
AU - Jiahui Zhao
AU - Yisi Liu
PY - 2026
DA - 2026/07/06
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101954
UR - https://europepmc.org/article/MED/42948431
AB - Objective Cardiac troponin I (cTnI) is a sensitive biomarker of myocardial injury. We hypothesized that cTnI measured in pericardial drainage fluid (PCF), which reflects the cardiac microenvironment, may enhance risk stratification for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting.Methods In this prospective cohort study, 114 patients undergoing elective coronary artery bypass grafting were enrolled. The primary end point was new-onset POAF within 7 days postoperatively. Blood and PCF cTnI at 6 hours postoperatively were measured. Variables were screened using least absolute shrinkage and selection operator regression and were then incorporated into multivariable logistic regression to construct a predictive model. A simplified risk score (CALT score) was developed. Model performance was compared with existing POAF tools, including the POAF score, CHA₂DS₂-VASc, and the atrial fibrillation risk index.Results POAF occurred in 30.7% of the cohort. Postoperative 6-hour PCF-cTnI was an independent predictor of POAF (odds ratio, 5.502; 95% CI, 1.887-16.045; P = .002) and significantly enhanced continuous net reclassification improvement (0.562; 95% CI, 0.189-0.921; P = .002). The CALT score comprised left circumflex artery lesions, left atrial diameter, left ventricular end-diastolic diameter, postoperative 0-hour serum calcium, and postoperative 6-hour PCF-cTnI. The PCF-cTnI-based model demonstrated good discrimination (area under the receiver operating characteristic curve = 0.821), with favorable calibration and clinical utility. Compared with commonly used risk scores, the CALT score exhibited superior discrimination and calibration.Conclusions This study provides novel evidence that PCF-cTnI is a strong predictor of POAF. The CALT score, integrating PCF-cTnI with clinical factors, provided superior predictive performance by capturing both the vulnerable atrial substrate and localized myocardial injury.
SN - 2666-2736
ER -