Abstract
BackgroundLeft ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock.MethodsA prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), high-sensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (é, á, E/é) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated.ResultshsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/é (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and non-survivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5).ConclusionshsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.
Highlights
Left ventricular (LV) dysfunction is well documented in the critically ill
Echocardiography is regarded useful for assessing cardiac function [23] but there are conflicting data regarding the prognostic value of LV systolic and diastolic function in patients in the intensive care unit (ICU) [3,4,24,25]
The aim of this study was to investigate whether high-sensitive troponin T (hsTNT), B-natriuretic peptide (BNP) and echocardiographic parameters of LV function measured within 12 h are associated with 1year mortality in patients with shock
Summary
We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock. CTn is highly useful for both diagnosis and prognostication in patients with cardiac disease [5,9]. In the critically ill raised levels of BNP and NTproBNP can be found in many patients for a variety of reasons [20] and can be used as prognostic indicators [21,22]. Echocardiography is regarded useful for assessing cardiac function [23] but there are conflicting data regarding the prognostic value of LV systolic and diastolic function in patients in the intensive care unit (ICU) [3,4,24,25]. We investigated well established parameters of LV systolic [26,27,28,29] and diastolic function [30], where the latter have gained interest in ICU populations during the recent years [3,25]
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