The role of troponin and albumin to assess myocardial dysfunction after cardiac surgery and in the critically ill

In the first part of this thesis, the focus was on improving the use of Tn, which is a biomarker for damage to the heart to better identify the patients most at risk for cardiac dysfunction. First, in chapter 2, we found that Tn was not used in the recommended way. Subsequently, we found that in a heart attack after cardiac surgery, it takes longer before Tn reaches its maximum value compared to a spontaneously occurring heart attack (chapter 3). The next step was to evaluate how to best use Tn following cardiac surgery (chapter 4). We found that the maximum level of Tn had the highest association with dying within 30-days of surgery.
In the second part of this thesis we evaluated the prognostic value of the protein albumin. In chapter 5 we showed that low plasma levels of albumin immediately after cardiac surgery increased the total amount of cardiac damage. In chapter 6, we also demonstrated that albumin levels in patients admitted to an intensive care is predictive for the amount of cardiac support medication that is needed during the first 24 hours. In chapter 7, we demonstrated that albumin level is also related to new onset atrial fibrillation (a severe rhythm disturbance). Finally, we validated some of these results in chapter 8 in a separate cohort.