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AIMS: Transthoracic echocardiography is recommended in all patients with acute coronary syndrome but is time-consuming and lacks an evidence base. We aimed to assess the feasibility, diagnostic accuracy and time-efficiency of hand-held echocardiography in patients with acute coronary syndrome and describe the impact of echocardiography on clinical management in this setting. METHODS AND RESULTS: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiography with agreement between key imaging parameters assessed using kappa statistics. The immediate clinical impact of hand-held echocardiography in this population was systematically evaluated.Overall, 262 patients (65±12 years, 71% male) participated. Agreement between hand-held and transthoracic echocardiography was good-to-excellent (kappa 0.60-1.00) with hand-held echocardiography having an overall negative predictive value of 95%. Hand-held echocardiography was performed rapidly (7.7±1.6 min) and completed a median of 5 [interquartile range 3-20] hours earlier than transthoracic echocardiography. Systematic hand-held echocardiography in all patients with acute coronary syndrome identified an important cardiac abnormality in 50% and the clinical management plan was changed by echocardiography in 42%. In 85% of cases, hand-held echocardiography was sufficient for patient decision-making and transthoracic echocardiography was no longer deemed necessary. CONCLUSIONS: In patients with acute coronary syndrome, hand-held echocardiography provides comparable results to transthoracic echocardiography, can be more rapidly applied and gives sufficient imaging information for decision-making in the vast majority of patients. Systematic echocardiography has clinical impact in half of patients, supporting the clinical utility of echocardiography in this population, and providing an evidence-base for current guidelines.
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We have developed a statistical model-based approach to the quality analysis (QA) and quality control (QC) of a gas micro pre-concentrator chip (µPC) performance when manufactured at scale for chemical and biochemical analysis of volatile organic compounds (VOCs). To test the proposed model, a medium-sized university-led production batch of 30 wafers of chips were subjected to rigorous chemical performance testing. We quantitatively report the outcomes of each manufacturing process step leading to the final functional chemical sensor chip. We implemented a principal component analysis (PCA) model to score individual chip chemical performance, and we observed that the first two principal components represent 74.28% of chemical testing variance with 111 of 118 viable chips falling into the 95% confidence interval. Chemical performance scores and chip manufacturing data were analyzed using a multivariate regression model to determine the most influential manufacturing parameters and steps. In our analysis, we find the amount of sorbent mass present in the chip (variable importance score = 2.6) and heater and the RTD resistance values (variable importance score = 1.1) to be the manufacturing parameters with the greatest impact on chemical performance. Other non-obvious latent manufacturing parameters also had quantified influence. Statistical distributions for each manufacturing step will allow future large-scale production runs to be statistically sampled during production to perform QA/QC in a real-time environment. We report this study as the first data-driven, model-based production of a microfabricated chemical sensor.
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The adequate odorization of natural gas is critical to identify gas leaks and to reduce accidents. To ensure odorization, natural gas utility companies collect samples to be processed at core facilities or a trained human technician smells a diluted natural gas sample. In this work, we report a detection platform that addresses the lack of mobile solutions capable of providing quantitative analysis of mercaptans, a class of compounds used to odorize natural gas. Detailed description of the platform hardware and software components is provided. Designed to be portable, the platform hardware facilitates extraction of mercaptans from natural gas, separation of individual mercaptan species, and quantification of odorant concentration, with results reported at point-of-sampling. The software was developed to accommodate skilled users as well as minimally trained operators. Detection and quantification of six commonly used mercaptan compounds (ethyl mercaptan, dimethyl sulfide, n-propylmercaptan, isopropyl mercaptan, tertbutyl mercaptan, and tetrahydrothiophene) at typical odorizing concentrations of 0.1-5 ppm was performed using the device. We demonstrate the potential of this technology to ensure natural gas odorizing concentrations throughout distribution systems.
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Gas Natural , Odorantes , Humanos , Odorantes/análisis , Compuestos de Sulfhidrilo/análisis , Compuestos de Azufre/análisisAsunto(s)
Procedimiento de Fontan , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Complicaciones Posoperatorias , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/mortalidad , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Dobutamine stress echocardiography (DSE) is widely used during follow-up after cardiac transplant for the diagnosis of allograft vasculopathy. We investigated the effect of donor-recipient age difference on the ability to reach target heart rate (HR) during DSE. All cardiac transplant patients who were undergoing DSE over a 3-year period in a single institution were reviewed. Target HR was specified as 85%×(220 - patient age). Further patient and donor demographics were obtained from the local transplant database. 61 patients (45 male, 55±12 years) were stressed with a median dose of 40âmcg/kg per min dobutamine. Only 37 patients (61%) achieved target HR. Donor hearts were mostly younger (mean 41±14 years, P<0.001), with only 11 patients (18%) having donors who were older than they were. Patients with older donors required higher doses of dobutamine (median 50 vs 30âmcg/kg per min, P<0.001) but achieved a lower percentage target HR (mean 93% vs 101%, P=0.003) than those with younger donors did. Patients with older donors were less likely to achieve target HR (18% vs 67%, P=0.003). In conclusion, donor-recipient age difference affects the likelihood of achieving target HR and should be considered when a patient is consistently unable to achieve 'adequate' stress according to the patient's age.
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BACKGROUND: Left ventricular (LV) size is an important clinical variable, commonly assessed at echocardiography by measurement of the internal diameter in diastole (IDD). However, this has recognised limitations and volumetric measurement from apical views is considered superior, particularly with the use of echocardiographic contrast. We sought to determine the agreement in classification of LV size by different measures in a large population of patients undergoing echocardiography. METHODS AND RESULTS: Data were analysed retrospectively from consecutive patients (n=2008, 61% male, median 62â years) who received echocardiographic contrast for LV opacification over 3â years in a single institution. Repeat studies were not included. LVIDD was measured, and LV end-diastolic volume (LVEDV) calculated using Simpson's biplane method. Both measures were indexed (i) to body surface area and categorised according to the American Society of Echocardiography (ASE) guidelines as normal, mild, moderate or severely dilated. Of 320 patients with a severely dilated LVEDVi, only 95 (30%) were similarly classified by LVIDD, with 86 patients (27%) measuring in the normal range. LVIDDi agreement was poorer, with only 43 patients (13%) classified as being severely dilated, and 173 (54%) measuring in the normal range. CONCLUSIONS: Currently recommended echocardiographic measures of LV size show limited agreement when classified according to currently recommended cut-offs. LV diameter should have a limited role in the assessment of LV size, particularly where a finding of LV dilation has important diagnostic or therapeutic implications.
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BACKGROUND: There is a need for non-invasive and accurate techniques for assessment of severity of atherosclerotic disease in the carotid arteries. Recently an automated single sweep three-dimensional ultrasound (3D US) technique became available. The aims of this study were to evaluate the feasibility and reproducibility of the automated single sweep method in a cohort of patients undergoing clinically indicated carotid ultrasound. METHODS: Consecutive patients with a history of stroke or transient ischemic attack (TIA) and having a plaque in the internal carotid artery (ICA) were recruited for this study. Imaging was performed using a Philips iU 22 ultrasound system equipped with the single sweep volumetric transducer vL 13-5. Analysis was performed offline with software provided by the manufacturer. Two independent observers performed all measurements. RESULTS: Of 137 arteries studied (from 79 patients), plaque and artery volumes could be measured in 106 (77%). Reproducibility of plaque volume measurements was assessed in 82 arteries. Bland-Altman analysis demonstrated good inter-observer reproducibility with limits of agreement -0.06 to +0.07 ml. The mean percentage difference between two observers was 5.6% ± 6.0%. Reproducibility of artery volume measurement was assessed in 31 cases. Bland-Altman analysis demonstrated limits of agreement from -0.15 to +0.15 ml. The mean percentage difference was 6.4 ± 5.9%. CONCLUSION: The new automated single sweep 3D ultrasound is feasible in the majority of patients. Good reproducibility in plaque and artery volume measurements makes this technique suitable for serial assessment of carotid plaques.
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Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Anciano , Aterosclerosis , Automatización , Enfermedades de las Arterias Carótidas/diagnóstico , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , UltrasonografíaRESUMEN
We describe the case of a 52-year-old woman presenting with non-ST elevation myocardial infarction, atrial fibrillation, and a new diagnosis of hypertrophic cardiomyopathy. Transesophageal echocardiography following hemodynamic deterioration revealed completely restricted mitral leaflet motion with free mitral regurgitation, and severe left ventricular outflow tract (LVOT) obstruction. Surgical intervention was considered; however, repeat imaging following a period of clinical stability revealed resolution of the findings suggesting a transient ischemic etiology. The case is supported by clinical and echocardiographic images with movie clips, and a discussion of the likely pathology in the context of the underlying condition.
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Fibrilación Atrial/diagnóstico , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Toma de Decisiones , Ecocardiografía Transesofágica/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/cirugía , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Monitoreo Fisiológico , Pronóstico , Índice de Severidad de la Enfermedad , Ultrasonografía Doppler en Color/métodos , Obstrucción del Flujo Ventricular Externo/complicaciones , Obstrucción del Flujo Ventricular Externo/cirugíaRESUMEN
Several methods of analysis are available for quantification of left ventricular volumes and ejection fraction using three-dimensional (3D) echocardiography. This study compared the accuracy and reproducibility of five methods of analysis in a novel, irregularly shaped dynamic heart phantom with excellent image quality. Five 3D datasets were acquired on a Philips IE33 platform using an X5-1 3D transducer. Each dataset was analysed by five different methods using the Philips QLab v8.1 software: Methods A1, A2 and A3, semi-automated contour detection with varying degrees of user correction; Method B, Simpson's biplane method using optimally aligned four- and two-chamber views and Method C, method of discs, manually delineated in reconstructed short-axis views. Time-volume curves were generated for each method and compared with the true volumes measured throughout systole in the phantom heart. A second observer repeated measurements by each method in a single 3D dataset. Method A1 (uncorrected semi-automated contouring) produced the most consistent time-volume curves, although end-diastolic and end-systolic volumes varied between datasets. Any manual correction of contours (Methods A2, A3 and B) resulted in significant variation in the time-volume curves, with less consistent endocardial tracking. Method C was not only the most accurate and reproducible method, but also the most time-consuming one. Different methods of 3D volume quantification vary significantly in accuracy and reproducibility using an irregular phantom heart model. Although contouring may appear optimal in long-axis views, this may not be replicated circumferentially, and the resulting measures appeared to be less robust following the manual correction of semi-automated contours.
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BACKGROUND: Radiofrequency ablation (RFA) is undertaken as a potentially curative treatment for a variety of heart rhythm disturbances. Previous studies have demonstrated improved quality of life and reduced symptoms after ablation. In many health care environments waiting lists exist for scheduling of procedures. However, the psychological effects of waiting for radiofrequency ablation have not previously been assessed. We hypothesized that waiting for this intervention may be associated with increased psychological morbidity and health care costs. METHODS: Ninety-two patients scheduled for elective RFA completed repeated questionnaires comprising the Medical Outcomes Short Form 36, Hospital Anxiety and Depression Scale, and an in-house questionnaire designed to assess the burden of symptoms related to arrhythmia (arrhythmia-related burden score). Mean scores were generated and compared at time points while waiting, before and after the procedure. Regression analyses were carried out to identify predictors of increased psychological morbidity while waiting and immediately prior to the procedure. Health care costs during the waiting period as a consequence of arrhythmia were quantified. RESULTS: Mean scores for parameters of psychological morbidity worsened during the period of waiting and improved after the procedure. Predictors of adverse effects within the cohort varied according to the time point assessed for each of the measures of psychological morbidity. A conservative estimate of the health care cost incurred while waiting exceeds £ 181 per patient. CONCLUSIONS: Waiting for radiofrequency ablation appears to be associated with adverse psychological effects and health care costs. These results may support strategies to reduce waiting times and prioritize resource allocation.
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Arritmias Cardíacas/economía , Arritmias Cardíacas/psicología , Ablación por Catéter/economía , Ablación por Catéter/psicología , Trastornos Mentales/economía , Trastornos Mentales/psicología , Listas de Espera , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/cirugía , Comorbilidad , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Reino Unido/epidemiología , Adulto JovenRESUMEN
The neutrophil/lymphocyte (N/L) ratio integrates information on the inflammatory milieu and physiologic stress. It is an emerging marker of prognosis in patients with cardiovascular disease. We investigated the relation between the N/L ratio and postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting. In a prospective cohort study, 275 patients undergoing nonemergency coronary artery bypass grafting were recruited. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. The N/L ratio was determined preoperatively and on postoperative day 2. The study end point was AF lasting >30 seconds. Patients who developed AF (n = 107, 39%) had had a greater preoperative N/L ratio (median 3.0 vs 2.4, p = 0.001), but no differences were found in the other white blood cell parameters or C-reactive protein. The postoperative N/L ratio was greater in patients with AF (day 2, median 9.2 vs 7.2, p <0.001), and in multivariate models, a greater postoperative N/L ratio was independently associated with a greater incidence of AF (odds ratio 1.10 per unit increase, p = 0.003: odds ratio for N/L ratio >10.14 [optimal postoperative cutoff in our cohort], 2.83 per unit, p <0.001). Elevated pre- and postoperative N/L ratios were associated with an increased occurrence of AF after coronary artery bypass grafting. In conclusion, these results support an inflammatory etiology in postoperative AF but suggest that other factors are also important.
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Fibrilación Atrial/sangre , Fibrilación Atrial/epidemiología , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/sangre , Recuento de Linfocitos , Neutrófilos , Anciano , Fibrilación Atrial/diagnóstico , Proteína C-Reactiva/metabolismo , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
Considerable improvements have been made in care and provision for patients with congenital heart disease in the United Kingdom. However, delayed presentation of adult patients with sequelae of known childhood cardiac defects reflects the current situation that there is no national registry of patients with congenital heart disease, and this "lost cohort" of patients is difficult to trace. Maintaining regular follow-up for selected patients with congenital heart disease can be challenging for a variety of reasons, but remains particularly important as emerging therapies and treatment strategies continue to alter management. Despite recent calls from a variety of organisations to establish a national registry of patients with congenital heart disease, progress has been slow. Faced with competition for resources, the costs of such a venture may be cited as a likely hurdle, but the potential advantages for patients and healthcare providers alike justify calls to integrate a registry as part of the ongoing reorganisation of congenital heart services in the United Kingdom.
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Cardiopatías Congénitas/epidemiología , Sistema de Registros , Factores de Edad , Cardiopatías Congénitas/diagnóstico , Humanos , Sistema de Registros/normas , Factores de Tiempo , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG). We prospectively compared the ability of echocardiographic parameters and the cardiac neurohormones, brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict AF in this setting. METHODS: We recruited 275 patients undergoing nonemergency CABG. Patients undergoing valve surgery or with prior atrial dysrhythmia (based on clinical history and review of medical records) were excluded. Echocardiography was performed, and natriuretic peptide levels were measured, 24 hours before surgery. The primary end point was postoperative AF lasting >30 seconds. RESULTS: The only significant echocardiographic predictors of postoperative AF (n = 107, 39%) were the transmitral E to A-wave ratio and the early mitral annulus velocity. Levels of BNP and NT-proBNP were higher in patients who developed AF. Both natriuretic peptides, but none of the echocardiographic parameters, remained independently predictive in multivariable analysis. The optimum cut points for predicting AF were 31 pg/mL for BNP (odds ratio [OR] 2.74, P = .001) and 74 pg/mL for NT-proBNP (OR 2.74, P = .003). CONCLUSION: Levels of BNP and NT-proBNP are independent, though modestly effective, predictors of AF after isolated CABG. In contrast, none of the echocardiographic parameters assessed, including measures of LV systolic function and filling pressure, were independently predictive.
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Fibrilación Atrial/etiología , Puente de Arteria Coronaria/efectos adversos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Anciano , Fibrilación Atrial/sangre , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/epidemiología , Ecocardiografía Doppler , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Pronóstico , Estudios Prospectivos , Volumen Sistólico , Función Ventricular Izquierda/fisiologíaRESUMEN
OBJECTIVE: Elevated uric acid levels have been associated with an adverse cardiovascular outcome in several settings. Their utility in patients undergoing surgical revascularization has not, however, been assessed. We hypothesized that serum uric acid levels would predict the outcome of patients undergoing coronary artery bypass grafting. METHODS: The study cohort consisted of 1140 consecutive patients undergoing nonemergency coronary artery bypass grafting. Clinical details were obtained prospectively, and serum uric acid was measured a median of 1 day before surgery. The primary end point was all-cause mortality. RESULTS: During a median of 4.5 years, 126 patients (11%) died. Mean (+/- standard deviation) uric acid levels were 390 +/- 131 micromol/L in patients who died versus 353 +/- 86 micromol/L among survivors (hazard ratio 1.48 per 100 micromol/L; 95% confidence interval, 1.25-1.74; P < .001). The excess risk associated with an elevated uric acid was particularly evident among patients in the upper quartile (>or=410 micromol/L; hazard ratio vs all other quartiles combined 2.18; 95% confidence interval, 1.53-3.11; P < .001). After adjusting for other potential prognostic variables, including the European System for Cardiac Operative Risk Evaluation, uric acid remained predictive of outcome. CONCLUSION: Increasing levels of uric acid are associated with poorer survival after coronary artery bypass grafting. Their prognostic utility is independent of other recognized risk factors, including the European System for Cardiac Operative Risk Evaluation.
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Puente de Arteria Coronaria/mortalidad , Ácido Úrico/sangre , Anciano , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de RiesgoRESUMEN
BACKGROUND: The prognostic importance of renal function in patients undergoing surgery for valvular heart disease is poorly defined. The current study addresses this issue. METHODS: Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSCORE), were recorded prospectively from 514 consecutive patients undergoing heart valve surgery between April 2000 and March 2004. Patients with active infective endocarditis and/or requiring emergency surgery were excluded. The glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. RESULTS: During a median follow-up of 2 years, 87 patients died. In univariable analysis, both eGFR (hazard ratio [HR] 0.69 per 10 mL/min per 1.73 m2, P<.001) and creatinine (HR 1.04 per 10 micromol/L, P<.001) predicted mortality. Estimated GFR was a stronger predictor and was used in subsequent multivariable models. It remained a powerful independent predictor of death in a multivariable model including all study variables (HR 0.70 per 10 mL/min per 1.73 m2 increase, P<.001) and in a model including EuroSCORE (HR 0.64 per 10 mL/min per 1.73 m2 increase, P<.001). After correction for preoperative EuroSCORE, an eGFR of <60 mL/min per 1.73 m2 was associated with an excess hazard of death of 2.31 (P=.001). CONCLUSION: Renal function, particularly the eGFR, is a powerful predictor of outcome in patients undergoing heart valve surgery. This prognostic utility is independent of other recognized risk factors and the EuroSCORE.
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Tasa de Filtración Glomerular , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Riñón/fisiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , PronósticoRESUMEN
BACKGROUND: An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization. METHODS: Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality. RESULTS: The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1.13 per unit, P < .001). In a backward conditional model, including all study variables, it remained a strong predictor (HR 1.09 per unit, P = .004). In a further model, including the European system for cardiac operative risk evaluation, the N/L ratio remained an independent predictor (HR 1.08 per unit, P = .008). Likewise, it was an independent predictor of cardiovascular mortality and predicted death in the subgroup of patients with a normal white blood cell count. This excess hazard was concentrated in patients with an N/L ratio in the upper quartile (>3.36). CONCLUSION: An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.
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Puente de Arteria Coronaria/métodos , Linfocitos/patología , Isquemia Miocárdica/sangre , Neutrófilos/patología , Anciano , Femenino , Estudios de Seguimiento , Humanos , Recuento de Leucocitos , Masculino , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/cirugía , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Cardiac surgery may be associated with significant perioperative and postoperative morbidity and mortality. Underlying pathology, surgical technique, and postoperative complications may all influence outcome. These factors may be reflected as a rise in postoperative troponin levels. Interpretation of troponin levels in this setting may therefore be complex. This study assessed the prognostic significance of such measurements, taking into account potential confounding variables. METHODS AND RESULTS: One-thousand three hundred sixty-five patients undergoing cardiac surgery underwent measurement of cardiac troponin I (cTnI) at 2 and 24 hours after surgery. The relationship of these measurements to subsequent mortality was established. After taking into account all other variables, cTnI levels measured at 24 hours were independently predictive of mortality at 30 days (odds ratio [OR] 1.14 per 10 microg/L, 95% confidence interval [CI] 1.05 to 1.24, P=0.002), 1 year (OR 1.10 per 10 microg/L, 95% CI 1.03 to 1.18, P=0.006), and 3 years (OR 1.07 per 10 microg/L, 95% CI 1.00 to 1.15, P=0.04). Cardiac TnI levels in the highest quartile at 24 hours were associated with a particularly poor outcome. CONCLUSIONS: cTnI levels measured 24 hours after cardiac surgery predict short-, medium-, and long-term mortality and remain independently predictive when adjusted for all other potentially confounding variables, including operation complexity.