Newly Published
Perioperative Medicine  |   February 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.×
  • Acknowledgments: The authors thank the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine in St. Louis (St. Louis, Missouri) for their research funding support. The authors also thank the staff from the Washington University/Barnes-Jewish Hospital Electroconvulsive Therapy service for their clinical support during the study. The authors would like to thank Allan Jaffe, M.D., Professor of Medicine, Cardiovascular Division, Department of Internal Medicine, and Division of Core Clinical Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, for valuable comments related to the interpretation of high-sensitivity cardiac troponin elevations.
    Acknowledgments: The authors thank the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine in St. Louis (St. Louis, Missouri) for their research funding support. The authors also thank the staff from the Washington University/Barnes-Jewish Hospital Electroconvulsive Therapy service for their clinical support during the study. The authors would like to thank Allan Jaffe, M.D., Professor of Medicine, Cardiovascular Division, Department of Internal Medicine, and Division of Core Clinical Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, for valuable comments related to the interpretation of high-sensitivity cardiac troponin elevations.×
  • Research Support: Supported by the Departments of Anesthesiology and Psychiatry and the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine (St. Louis, Missouri). Abbott Laboratories (Chicago, Illinois) provided the high-sensitivity cardiac troponin I assay for free and covered the costs of running the tests. Dr. Gill received an Advanced Summer Program for Investigation and Research Education summer research stipend from the Washington University Institute of Clinical and Translational Sciences (grant No. UL1 RR024992). Dr. Bhat received a Medical Student Anesthesia Research Fellowship from the Foundation for Anesthesia Education and Research (Schaumburg, Illinois). Dr. Duma was supported by a Max Kade Research Fellowship from the Max Kade Foundation, New York, New York. Dr. Nagele received research funding and speaker fees from Roche Diagnostics (Indianapolis, Indiana) and research funding from Abbott Diagnostics (Abbott Park, Illinois); he is also currently supported by the Stanley Medical Research Institute (SMRI; Chevy Chase, Maryland), by grant no. 1R21MH108901 from the National Institute for Mental Health (NIMH; Bethesda, Maryland), a National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator Grant from the Brain and Behavior Research Foundation (New York, New York), a grant from the McDonnell Center for Systems Neuroscience at Washington University (St. Louis, Missouri). Dr. Scott is supported by Siemens Healthcare Diagnostic (Malvern, Pennsylvania), Abbott Diagnostics, Instrumentation Laboratories (Orangeburg, New York); and he serves as a consultant at Instrumentation Laboratories and Becton-Dickinson (Franklin Lakes, New Jersey). Dr. Conway received research funding from Bristol-Myers Squibb (New York, New York), Cyberonics (Houston, Texas), the Sidney Baer Foundation (Clayton, Missouri), and is currently supported by the SMRI, grant no. 1R21MH108901 from the NIMH, by an NARSAD Young Investigator grant from the Brain and Behavior Research Foundation, and by a grant from the McDonnell Center for Systems Neuroscience at Washington University. The sponsors had no role in the collection, management, and interpretation of the data; or preparation, review, or approval of the manuscript.
    Research Support: Supported by the Departments of Anesthesiology and Psychiatry and the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine (St. Louis, Missouri). Abbott Laboratories (Chicago, Illinois) provided the high-sensitivity cardiac troponin I assay for free and covered the costs of running the tests. Dr. Gill received an Advanced Summer Program for Investigation and Research Education summer research stipend from the Washington University Institute of Clinical and Translational Sciences (grant No. UL1 RR024992). Dr. Bhat received a Medical Student Anesthesia Research Fellowship from the Foundation for Anesthesia Education and Research (Schaumburg, Illinois). Dr. Duma was supported by a Max Kade Research Fellowship from the Max Kade Foundation, New York, New York. Dr. Nagele received research funding and speaker fees from Roche Diagnostics (Indianapolis, Indiana) and research funding from Abbott Diagnostics (Abbott Park, Illinois); he is also currently supported by the Stanley Medical Research Institute (SMRI; Chevy Chase, Maryland), by grant no. 1R21MH108901 from the National Institute for Mental Health (NIMH; Bethesda, Maryland), a National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator Grant from the Brain and Behavior Research Foundation (New York, New York), a grant from the McDonnell Center for Systems Neuroscience at Washington University (St. Louis, Missouri). Dr. Scott is supported by Siemens Healthcare Diagnostic (Malvern, Pennsylvania), Abbott Diagnostics, Instrumentation Laboratories (Orangeburg, New York); and he serves as a consultant at Instrumentation Laboratories and Becton-Dickinson (Franklin Lakes, New Jersey). Dr. Conway received research funding from Bristol-Myers Squibb (New York, New York), Cyberonics (Houston, Texas), the Sidney Baer Foundation (Clayton, Missouri), and is currently supported by the SMRI, grant no. 1R21MH108901 from the NIMH, by an NARSAD Young Investigator grant from the Brain and Behavior Research Foundation, and by a grant from the McDonnell Center for Systems Neuroscience at Washington University. The sponsors had no role in the collection, management, and interpretation of the data; or preparation, review, or approval of the manuscript.×
  • Competing Interests: Dr. Nagele has filed for intellectual property protection related to the use of nitrous oxide in major depression. Dr. Zorumski serves on the Scientific Advisory Board of Sage Therapeutics (Cambridge, Massachusetts). The other authors declare no competing interests.
    Competing Interests: Dr. Nagele has filed for intellectual property protection related to the use of nitrous oxide in major depression. Dr. Zorumski serves on the Scientific Advisory Board of Sage Therapeutics (Cambridge, Massachusetts). The other authors declare no competing interests.×
  • Correspondence: 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
Perioperative Medicine   |   February 2017
High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy: A Prospective, Observational Cohort Study
Anesthesiology Newly Published on February 9, 2017. doi:10.1097/ALN.0000000000001531
Anesthesiology Newly Published on February 9, 2017. 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.