Perioperative Medicine  |   April 2017
High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy: A Prospective, Observational Cohort Study
Author Notes
  • From the Division of Clinical and Translational Research, Department of Anesthesiology (A.D., S.P., J.J., M.A.H., A.B., B.G., C.Cartmill, F.B., F.S.-C., P.N.), Department of Psychiatry (J.R., M.J., N.B.F., C.F.Z., C.Conway), Division of Biostatistics (J.P.M.), Department of Pathology and Immunology (M.G.S.), and Taylor Family Institute for Innovative Psychiatric Research (N.B.F., C.F.Z., C.Conway, P.N.), Washington University School of Medicine in St. Louis, Missouri. Current position: Department of Anesthesiology and Critical Care, Medical University of Vienna, Vienna, Austria (A.D.).
  • A.D. and S.P. contributed equally to this article.
    A.D. and S.P. contributed equally to this article.×
  • Submitted for publication May 26, 2016. Accepted for publication January 4, 2017.
    Submitted for publication May 26, 2016. Accepted for publication January 4, 2017.×
  • Address correspondence to Dr. Nagele: Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8054, St. Louis, Missouri 63110. nagelep@wustl.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia
Perioperative Medicine   |   April 2017
High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy: A Prospective, Observational Cohort Study
Anesthesiology 4 2017, Vol.126, 643-652. doi:10.1097/ALN.0000000000001531
Anesthesiology 4 2017, Vol.126, 643-652. doi:10.1097/ALN.0000000000001531
Abstract

Background: While electroconvulsive therapy is widely regarded as a lifesaving and safe procedure, evidence regarding its effects on myocardial cell injury is sparse. The objective of this investigation was to determine the incidence and magnitude of new cardiac troponin elevation after electroconvulsive therapy using a novel high-sensitivity cardiac troponin I assay.

Methods: This was a prospective cohort study in adult patients undergoing electroconvulsive therapy in a single academic center (up to three electroconvulsive therapy treatments per patient). The primary outcome was new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy, defined as an increase of high-sensitivity cardiac troponin I greater than 100% after electroconvulsive therapy compared to baseline with at least one value above the limit of quantification (10 ng/l). Twelve-lead electrocardiogram and high-sensitivity cardiac troponin I values were obtained before and 15 to 30 min after electroconvulsive therapy; in a subset of patients, an additional 2-h high-sensitivity cardiac troponin I value was obtained.

Results: The final study population was 100 patients and a total of 245 electroconvulsive therapy treatment sessions. Eight patients (8 of 100; 8%) experienced new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy with a cumulative incidence of 3.7% (9 of 245 treatments; one patient had two high-sensitivity cardiac troponin I elevations), two of whom had a non–ST-elevation myocardial infarction (incidence 2 of 245; 0.8%). Median high-sensitivity cardiac troponin I concentrations did not increase significantly after electroconvulsive therapy. Tachycardia and/or elevated systolic blood pressure developed after approximately two thirds of electroconvulsive therapy treatments.

Conclusions: Electroconvulsive therapy appears safe from a cardiac standpoint in a large majority of patients. A small subset of patients with preexisting cardiovascular risk factors, however, may develop new cardiac troponin elevation after electroconvulsive therapy, the clinical relevance of which is unclear in the absence of signs of myocardial ischemia.