Evidence map›Paper›PMID 31029407›Full record

Observational studyBritish journal of anaesthesia2019

Chronotropic incompetence and myocardial injury after noncardiac surgery: planned secondary analysis of a prospective observational international cohort study.

Tom E F Abbott, Rupert M Pearse, W Scott Beattie, Mandeep Phull, Christian Beilstein, Ashok Raj, Michael P W Grocott, Brian H Cuthbertson, Duminda Wijeysundera, Gareth L Ackland

Open access · hybridAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 3 countries.

Tom E F AbbottWilliam Harvey Research Institute, Queen Mary University of London, London, UK.
Rupert M PearseWilliam Harvey Research Institute, Queen Mary University of London, London, UK.
W Scott BeattieDepartment of Anesthesia, University of Toronto, Toronto, ON, Canada.
Mandeep PhullDepartment of Intensive Care Medicine, Queens Hospital, Romford, UK.
Christian BeilsteinDepartment of Anaesthesiology and Pain Therapy, Bern University Hospital, Bern, Switzerland.
Ashok RajDepartment of Intensive Care Medicine, Croydon University Hospital, Croydon, UK.
Michael P W GrocottCritical Care Research Group, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, University of Southampton, Southampton, UK.
Brian H CuthbertsonDepartment of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Duminda WijeysunderaDepartment of Anesthesia, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
Gareth L AcklandWilliam Harvey Research Institute, Queen Mary University of London, London, UK. Electronic address: g.ackland@qmul.ac.uk.
William Harvey Research Institute · GBCroydon University Hospital · GBHealth Sciences Centre · CAQueen's Hospital · GBSt. Michael's Hospital · CAUniversity Hospital of Bern · CHUniversity of Southampton · GBUniversity of Toronto · CA

Funding

British Heart Foundation RG/14/4/30736Medical Research Council MR/M017974/1
6 · The paper itself

Abstract

backgroundPhysiological measures of heart failure are common in surgical patients, despite the absence of a diagnosis. Heart rate (HR) increases during exercise are frequently blunted in heart failure (termed chronotropic incompetence), which primarily reflects beta-adrenoreceptor dysfunction. We examined whether chronotropic incompetence was associated with myocardial injury after noncardiac surgery.

methodsThis was a predefined analysis of an international cohort study where participants aged ≥40 yr underwent symptom-limited cardiopulmonary exercise testing before noncardiac surgery. Chronotropic incompetence was defined as the ratio of increase in HR during exercise to age-predicted maximal increase in HR <0.6. The primary outcome was myocardial injury within 3 days after surgery, defined by high-sensitivity troponin assays >99th centile. Explanatory variables were biomarkers for heart failure (ventilatory efficiency slope [minute ventilation/carbon dioxide production] ≥34; peak oxygen consumption ≤14 ml kg

resultsChronotropic incompetence occurred in 396/1325 (29.9%) participants; only 16/1325 (1.2%) had a heart failure diagnosis. Myocardial injury was sustained by 162/1325 (12.2%) patients. Raised preoperative NT pro-BNP was more common when chronotropic incompetence was <0.6 (OR: 1.57 [1.11-2.23]; P=0.011). Chronotropic incompetence was not significantly associated with myocardial injury (OR: 1.05 [0.74-1.50]; P=0.78), independent of rate-limiting therapy. HR recovery <12 beats min

conclusionsChronotropic incompetence is common in surgical patients. In contrast to parasympathetic dysfunction which was associated with myocardial injury, preoperative chronotropic incompetence (suggestive of sympathetic dysfunction) was not associated with postoperative myocardial injury.

Indexed as

Exercise TestSurgical Procedures, OperativeAgedAustraliaCanadaCohort StudiesFemaleHeart FailureHeart RateHumansMaleMiddle AgedNew ZealandPostoperative ComplicationsPreoperative CareProspective Studiesautonomic dysfunctiongeneral surgerymyocardiumsympatheticvagus

Identifiers

PMID31029407
PMCPMC6676775
OpenAlexW2940803790

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.