Association between cardiac troponin I and the prognosis of patients with severe cardiac disease receiving veno-arterial extracorporeal membrane oxygenation support

Background Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been effectively used as a circulatory support modality in patients with severe cardiac disease. Elevated cardiac troponin I (cTnI) indicates myocardial injury. The aim of this study was to evaluate the association between cTnI and the prognosis of patients with severe cardiac disease receiving V-A ECMO support. Methods The clinical data of patients receiving V-A ECMO support at our center between April 2018 and August 2024 were retrospectively analyzed. Demographic characteristics, treatment details, laboratory measurements, echocardiographic parameters, and prognostic outcomes were compared between the cTnI ≤50 ng/mL and cTnI >50 ng/mL groups, where cTnI was measured at 24 h after ECMO initiation. Results Forty-four patients receiving V-A ECMO support were enrolled, including 29 males and 15 females. The underlying etiologies consisted mainly of acute myocardial infarction (AMI), fulminant myocarditis, septic cardiomyopathy, and acute pulmonary embolism. There were no statistically significant differences between the two groups with respect to demographic characteristics, Sequential Organ Failure Assessment (SOFA) score, and the duration of cardiopulmonary resuscitation. The group with 24-h cTnI >50 ng/mL had higher proportions of AMI, arterial angiography, and intra-aortic balloon pump support, with higher admission creatinine and higher 24-h laboratory parameters, alongside a lower left ventricular ejection fraction. Length of hospital stay among survivors and length of ICU stay for all patients were comparable between the two groups ( p > 0.05). The overall in-hospital mortality was 61.36%, with a statistically significant difference between the two groups: 80.95% in the 24-h cTnI >50 ng/mL group versus 43.48% in the 24-h cTnI ≤50 ng/mL group ( p = 0.01). Conclusion V-A ECMO provides effective circulatory support for patients with severe cardiac disease. Univariate analysis in the present study revealed a preliminary statistical association between a 24-h cTnI level >50 ng/mL and higher in-hospital mortality. Without adjustment for confounders or etiological subgroup analyses, further validation in larger, multicenter cohorts is warranted.