Abstract
(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.
Highlights
Septic shock is still a leading cause of death worldwide as it can induce multi-organ failure [1,2]
We excluded any patients without a high-sensitivity troponin-I level or transthoracic echocardiography (TTE) check during their hospital stay and who showed abnormalities in past echocardiographic parameters such as left ventricle (LV) dysfunction, right ventricle (RV) dysfunction, or wall motion abnormalities (WMA) induced by previous assumed ischemic insults
Mehta et al reported that troponin I was an independent predictor of death and was correlated with lower LVEF (p < 0.001) [25], but, they included a relatively small number of patients (n = 16) and measured only LVEF via TTE
Summary
Septic shock is still a leading cause of death worldwide as it can induce multi-organ failure [1,2]. Cardiac dysfunction, referred to as sepsis-induced myocardial dysfunction (SIMD), is a loosely defined syndrome and presents in various ways, such as myocardial injury with cardiac biomarker elevation, myocardial dysfunction on echocardiography, and hemodynamic instability [3]. SIMD is a common complication (40–60%), which could possibly be the result of increased circulating catecholamine and cytokine levels in severe sepsis and septic shock and its presence significantly worsens the outcome [4,5]. SIMD may involve either the left ventricle (LV), the right ventricle (RV) or both. This may manifest as systolic dysfunction, LV diastolic dysfunction, RV dysfunction, global hypokinesia or regional wall motion abnormalities [6]. Echocardiography has been as a golden tool for SIMD, the echocardiographic findings of SIMD are still poorly defined, and it is not practical for performing echocardiography for every sepsis patient during early resuscitation due to its cost and limited round-the-clock availability
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