Cargando…
Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
(1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study ai...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406324/ https://www.ncbi.nlm.nih.gov/pubmed/30759844 http://dx.doi.org/10.3390/jcm8020239 |
_version_ | 1783401275018182656 |
---|---|
author | Kim, June-Sung Kim, Muyeol Kim, Youn-Jung Ryoo, Seung Mok Sohn, Chang Hwan Ahn, Shin Kim, Won Young |
author_facet | Kim, June-Sung Kim, Muyeol Kim, Youn-Jung Ryoo, Seung Mok Sohn, Chang Hwan Ahn, Shin Kim, Won Young |
author_sort | Kim, June-Sung |
collection | PubMed |
description | (1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study aimed to evaluate the role of admission and peak troponin-I testing for the identification of sepsis-induced myocardial dysfunction (SIMD) by transthoracic echocardiography (TTE). (2) Methods: This was a retrospective cohort study using a prospective registry of septic shock at an Emergency Department from January 2011 and April 2017. All 1,776 consecutive adult septic shock patients treated with protocol-driven resuscitation bundle therapy and tested troponin-I were enrolled. SIMD was defined as left ventricular (LV) systolic/diastolic dysfunction, right ventricular (RV) diastolic dysfunction, or global/regional wall motion abnormalities (WMA). (3) Results: Of 660 (38.4%) septic shock patients with an elevated hs-TnI (≥0.04 ng/mL) at admission, 397 patients underwent TTE and 258 cases (65%) showed SIMD (LV systolic dysfunction (n = 163, 63.2%), LV diastolic dysfunction (n = 104, 40.3%), RV dysfunction (n = 97, 37.6%), and WMA (n = 186, 72.1%)). In multivariate analysis, peak hs-TnI (odds ratio 1.03, 95% confidence interval 1.01–1.06, p = 0.008) and ST-T wave changes in the electrocardiogram (odds ratio 1.82, 95% confidence interval 1.04–2.39, p = 0.013) were associated with SIMD, in contrast to hs-TnI level at admission. The area under the curve of peak hs-TnI was 0.668. When the peak hs-TnI cutoff value was 0.634 ng/mL, the sensitivity and specificity for SIMD were 58.6% and 59.1%, respectively. 4) Conclusions: About two-thirds of patients with an elevated hs-TnI level have various cardiac dysfunctions in terms of TTE. Rather than the initial level, the peak hs-TnI and ST-T change may be considered as a risk factor of SIMD. |
format | Online Article Text |
id | pubmed-6406324 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-64063242019-03-22 Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock Kim, June-Sung Kim, Muyeol Kim, Youn-Jung Ryoo, Seung Mok Sohn, Chang Hwan Ahn, Shin Kim, Won Young J Clin Med Article (1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study aimed to evaluate the role of admission and peak troponin-I testing for the identification of sepsis-induced myocardial dysfunction (SIMD) by transthoracic echocardiography (TTE). (2) Methods: This was a retrospective cohort study using a prospective registry of septic shock at an Emergency Department from January 2011 and April 2017. All 1,776 consecutive adult septic shock patients treated with protocol-driven resuscitation bundle therapy and tested troponin-I were enrolled. SIMD was defined as left ventricular (LV) systolic/diastolic dysfunction, right ventricular (RV) diastolic dysfunction, or global/regional wall motion abnormalities (WMA). (3) Results: Of 660 (38.4%) septic shock patients with an elevated hs-TnI (≥0.04 ng/mL) at admission, 397 patients underwent TTE and 258 cases (65%) showed SIMD (LV systolic dysfunction (n = 163, 63.2%), LV diastolic dysfunction (n = 104, 40.3%), RV dysfunction (n = 97, 37.6%), and WMA (n = 186, 72.1%)). In multivariate analysis, peak hs-TnI (odds ratio 1.03, 95% confidence interval 1.01–1.06, p = 0.008) and ST-T wave changes in the electrocardiogram (odds ratio 1.82, 95% confidence interval 1.04–2.39, p = 0.013) were associated with SIMD, in contrast to hs-TnI level at admission. The area under the curve of peak hs-TnI was 0.668. When the peak hs-TnI cutoff value was 0.634 ng/mL, the sensitivity and specificity for SIMD were 58.6% and 59.1%, respectively. 4) Conclusions: About two-thirds of patients with an elevated hs-TnI level have various cardiac dysfunctions in terms of TTE. Rather than the initial level, the peak hs-TnI and ST-T change may be considered as a risk factor of SIMD. MDPI 2019-02-12 /pmc/articles/PMC6406324/ /pubmed/30759844 http://dx.doi.org/10.3390/jcm8020239 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kim, June-Sung Kim, Muyeol Kim, Youn-Jung Ryoo, Seung Mok Sohn, Chang Hwan Ahn, Shin Kim, Won Young Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock |
title | Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock |
title_full | Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock |
title_fullStr | Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock |
title_full_unstemmed | Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock |
title_short | Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock |
title_sort | troponin testing for assessing sepsis-induced myocardial dysfunction in patients with septic shock |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406324/ https://www.ncbi.nlm.nih.gov/pubmed/30759844 http://dx.doi.org/10.3390/jcm8020239 |
work_keys_str_mv | AT kimjunesung troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock AT kimmuyeol troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock AT kimyounjung troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock AT ryooseungmok troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock AT sohnchanghwan troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock AT ahnshin troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock AT kimwonyoung troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock |