scholarly journals Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock

2019 ◽  
Vol 8 (2) ◽  
pp. 239 ◽  
Author(s):  
June-sung Kim ◽  
Muyeol Kim ◽  
Youn-Jung Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Septic Shock ◽  
Confidence Interval ◽  
Diastolic Dysfunction ◽  
Odds Ratio ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Area Under The Curve ◽  
Regional Wall Motion ◽  
Left Ventricular

(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.

Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and Its Clinical Significance

2016 ◽  
Vol 34 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Feifei Z. Williams ◽  
Ritu Sachdeva ◽  
Curtis D. Travers ◽  
Karen H. Walson ◽  
Kiran B. Hebbar
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Clinical Significance ◽  
Cold Shock ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Severity Of Illness ◽  
Left Ventricular ◽  
Hospital Length Of Stay ◽  
Z Score

Purpose: Myocardial dysfunction is a known complication in patients with pediatric septic shock (PSS); however, its clinical significance remains unclear. The purpose of this study was to characterize left ventricular (LV) and right ventricular (RV) dysfunction and their prevalence in patients with PSS using echocardiography (echo) and to investigate their associations with the severity of illness and clinical outcomes. Methods: Retrospective chart review between 2010 and 2015 from 2 tertiary care pediatric intensive care units. Study included 78 patients (mean age 9.3 ± 7 years) from birth up to 21 years who fulfilled criteria for fluid- and catecholamine-refractory septic shock. Echocardiographic parameters of systolic, diastolic, and global function were measured offline. They were correlated with admission Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction scores, vasoactive–inotrope score (VIS), β-type natriuretic peptide (BNP), lactate, type of shock, duration of mechanical ventilation (MV), intensive care unit and hospital length of stay, and mortality. Results: Overall, 28-day mortality was 26%, and 88% patients required MV. Prevalence of LV dysfunction was 72% and RV dysfunction was 63%. LV systolic dysfunction (fractional shortening z score <−2) was significantly associated with PRISM III, VIS, and BNP. RV systolic dysfunction (tricuspid annular plane systolic excursion z score <−2) was significantly associated with cold shock. LV and RV diastolic dysfunction did not have any significant clinical associations. No echocardiographic measures were associated with mortality. Conclusion: Myocardial dysfunction is highly prevalent in PSS but is not associated with mortality. LV systolic dysfunction is associated with a higher severity of illness, use of vasoactives, and BNP, whereas RV systolic dysfunction is associated with cold shock. Further studies are needed to determine the utility of echo in the bedside management of patients with PSS.

Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

2016 ◽  
Vol 33 (12) ◽  
pp. 680-686 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Shane M. Gillespie ◽  
David W. Barbara ◽  
Nandan S. Anavekar ◽  
Juan N. Pulido
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Diastolic Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Secondary Outcomes ◽  
Sepsis And Septic Shock

Background: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. Methods: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e′ >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. Results: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e′ ratio. Patients with LVDD had a higher E velocity and E/e′ ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. Conclusion: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

Abstract 19340: Advanced Peripheral Endothelial Dysfunction Correlates with Left Ventricular Diastolic Dysfunction and Heart Failure with Preserved Left Ventricular Ejection Fraction in Hypertensive Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eiichi Akiyama ◽  
Seigo Sugiyama ◽  
Yasushi Matsuzawa ◽  
Hiroyuki Suzuki ◽  
Masaaki Konishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Endothelial Dysfunction ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Endothelial Function ◽  
Diastolic Dysfunction ◽  
Odds Ratio ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hypertensive Patients

Background: Left ventricular (LV) diastolic dysfunction (DD) and vascular functions including peripheral endothelial function play an important role in the pathogenesis of heart failure (HF) with preserved LV ejection fraction (EF) (HFPEF). Hypertension is the most important risk factor in HFPEF and the increased workload caused by hypertension results in LV pathological hypertrophy and LVDD. However, the importance of endothelial function in hypertensive patients with LVDD or HFPEF remains yet undetermined. We investigated the association between peripheral endothelial function, LVDD, and HFPEF in hypertensive patients. Methods and Results: We evaluated cardiac function by echocardiography measuring the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’) and LVEF. We also noninvasively assessed peripheral endothelial function by reactive hyperemia-peripheral arterial tonometry (RH-PAT) as the RH-PAT index(RHI) in 405 hypertensive patients with preserved LVEF (LVEF>50%), comprising 180 HFPEF and 225 non-HF patients (LVDD; E/e’>15, non-HF with LVDD; n=98, non-HF without LVDD; n=127). RHI negatively correlated with E/e’ (r=-0.24, P<0.001) and B-type natriuretic peptide (r=-0.19, P<0.001). RHI was significantly lower in hypertensive patients with HFPEF than in non-HF hypertensive patients (0.49±0.17 vs. 0.62±0.20, P<0.001). Furthermore, RHI was significantly lower in non-HF hypertensive patients with LVDD than those without LVDD (0.58±0.19 vs. 0.65±0.21, P=0.01). Multivariate logistic regression analysis identified that lower RHI independently correlated with the presence of HFPEF in hypertensive patients with preserved LVEF (odds ratio: 0.65, 95% confidence interval: 0.55-0.77, P<0.001) and with the presence of LVDD in non-HF hypertensive patients (odds ratio: 0.65, 95% confidence interval: 0.71-0.95, P=0.01). Conclusions: RHI was independently associated with the presence of HFPEF and LVDD in hypertensive patients with preserved LVEF. Endothelial dysfunction in microcirculation could play a crucial role in the pathogenesis of LVDD and HFPEF in hypertensive patients.

Impact of Bi-ventricular systolic function on mortality in patients with sepsis and septic shock

2021 ◽  
Author(s):  
Elif Tükenmez Tigen ◽  
Alper Kepez ◽  
Murat Sünbül ◽  
Beste Özben ◽  
Buket Ertürk Şengel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Survivor Group ◽  
Significant Difference ◽  
Echocardiographic Examination ◽  
Sepsis And Septic Shock

Objectives: We aimed to evaluate left ventricular (LV) and right ventricular (RV) systolic performance in patients with sepsis or septic shock and possible functional alteration on in-hospital mortality. Patients and Methods: Thirty-seven consecutive patients with the diagnosis of sepsis or septic shock were included in the study. All patients underwent comprehensive transthoracic echocardiographic examination. Data of patients discharged from the intensive care unit was compared with data of patients who died in the hospital. Results: Fifteen patients (40.5%) survived, while 22 patients were died in the hospital (59.5%). A significant difference was detected between survivor and non-survivor groups regarding before discharge or death level of inflammatory markers such as CRP (p=0.05) and procalcitonin (p=0.03) besides BNP (p=0.01) and SOFA (p=0.009) score. There were two patients (5.4%) with EF value less than %50 in the study population. Eight patients (21.6%) displayed hypokinesia on the apical segment, and four patients (10.8%) had TAPSE values below 17 mm. One patient (6.6%) in the survivor group, but seven patients (31.8%) in the non-survivor group had apical hypokinesia with a trend towards significance (p=0.068). One patient in the survivor group (6.6%) and three patients (13.6%) in the non-survivor group had RV systolic dysfunction (p: 0.51). Conclusion: We found a much lower rate of LV and RV systolic dysfunction in patients with sepsis or septic shock compared with previous studies. None of the myocardial dysfunction types was associated with in-hospital mortality. Apical hypokinesia was also more prevalent in non-survivors despite borderline significance.

Association between right ventricle dysfunction and poor outcome in patients with septic shock

Heart ◽  
2020 ◽  
Vol 106 (21) ◽  
pp. 1665-1671 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Muyeol Kim ◽  
Seung Mok Ryoo ◽  
Won Young Kim
Keyword(s):  
Septic Shock ◽  
Right Ventricle ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Prolonged Mechanical Ventilation ◽  
Unit Length ◽  
Systolic Dysfunction ◽  
Serum Lactate ◽  
Right Ventricle Dysfunction ◽  
Lv Diastolic Dysfunction

ObjectiveSepsis-induced myocardial dysfunction (SIMD) can involve both the left and right ventricles. However, the characteristics and outcomes across various manifestations of SIMD remain unknown.MethodsThis was a retrospective cohort study using a prospective registry of septic shock from January 2011 and April 2017. Patients with clinically presumed cardiac dysfunction underwent echocardiography within 72 hours after admission and were enrolled (n=778). SIMD was classified as left ventricle (LV) systolic/diastolic and right ventricle (RV) dysfunction, which were defined based on the American Society of Echocardiography criteria. The primary outcome was 28-day mortality.ResultsOf the 778 septic shock patients who underwent echocardiography, 270 (34.7%) showed SIMD. The median age was 67.0 years old, and the male was predominant (57.3%). Among them, 67.3% had LV systolic dysfunction, 40.7% had RV dysfunction and 39.3% had LV diastolic dysfunction. Although serum lactate level and sequential organ failure assessment score were not significantly different between groups, SIMD group showed higher troponin I (0.1 vs 0.1 ng/mL; p=0.02) and poor clinical outcomes, including higher 28-day mortality (35.9 vs 26.8%; p<0.01), longer intensive care unit length of stay (5 vs 2 days; p<0.01) and prolonged mechanical ventilation (9 vs 4 days; p<0.01). Multivariate analysis showed that isolated RV dysfunction was an independent risk factor of 28-day mortality (OR 2.26, 95% CI 1.04 to 4.91).ConclusionsOne-third of patients with septic shock showed various myocardial dysfunctions. LV systolic dysfunction was common; however, only RV dysfunction was associated with short-term mortality.

Full Cardiac Cycle Strain Measurement Using Hyperelastic Warping, Application to Detecting Myocardial Dysfunction in Rat microPET Images

2011 ◽  
Author(s):  
G. E. Farrar ◽  
G. T. Gullberg ◽  
A. I. Veress
Keyword(s):  
Wall Motion ◽  
Cardiac Cycle ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Wall Function ◽  
Wall Deformation ◽  
Systolic And Diastolic Function ◽  
Heart Wall

Assessments of regional heart wall deformation (wall motion, thickening, strain) are commonly used to evaluate left ventricular wall function in the clinical setting. Nuclear based imaging modalities such as PET and SPECT are commonly used to localize ischemic myocardial disease, and can identify impairment of cardiac function due to hypertrophic or dilated cardiomyopathies. Regional wall motion analysis in conjunction with global left ventricular (LV) ejection fraction is commonly used to assess systolic and diastolic function. The quantification of ventricular strains throughout the entire cardiac cycle provides valuable information that could be used to more effectively differentiate between diastolic and systolic dysfunction, as well as a more complete picture of overall cardiac performance.

scholarly journals Study of NT-pro-BNP and Hs-Troponin I biomarkers for early detection of children’s heart function of protein-energy malnutrition

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Herlina Dimiati ◽  
Abdus Samik Wahab ◽  
Mohammad Juffrie ◽  
Madarina Julia ◽  
Basri A. Gani
Keyword(s):  
Troponin I ◽  
Heart Function ◽  
Protein Energy Malnutrition ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
The Body ◽  
Chromatography Method ◽  
Blood Electrolytes ◽  
Ventricular Mass ◽  
Protein Energy

The Protein Energy Malnutrition (PEM) is the condition of a lack of carbohydrate and protein stores in the body that trigger chronic failure nutrient intake and body maintenance function caused to impact the heart functions. The NT-pro-BNP and Hs- Troponin I proteins were found as the indicator of cardiac dysfunction. The sixty subjects of PEM, analyzed by standard of Indonesia Healt Ministry as well as nutritional status. The blood electrolytes examined by laboratory assay and the levels of Hs-Troponin 1 and NT-Pro-BNP were analyzed by Immune-Chromatography method. Assessing of the ventricular mass with the seeing the peak of the diastolic flow rate of left ventricular that estimated by the curve of the receiver operating characteristic and the area under the curve (P<0.05). The result has shown that the PEM decreased in the left ventricular mass for impaired heart function and systolic disorder. The Hs- Troponin I (90.9%) has better sensitivity than NT-pro-BNP (85.5%) if the merger of those markers possesses the lowest sensitivity (81.8%). These proteins have good biomarkers in heart function, mainly in cases where PEM is present.

Hypercoagulability in Septic Shock Patients With Thrombocytopenia

2021 ◽  
pp. 088506662110241
Author(s):  
Sang-Min Kim ◽  
Sang-Il Kim ◽  
Gina Yu ◽  
June-Sung Kim ◽  
Seok In Hong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Sofa Score ◽  
Odds Ratio ◽  
Fibrinogen Level ◽  
Limited Information

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.

Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

Kardiologiia ◽  
2021 ◽  
Vol 61 (8) ◽  
pp. 68-75
Author(s):  
E. K. Serezhina ◽  
A. G. Obrezan
Keyword(s):  
Heart Failure ◽  
Early Diagnosis ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Echocardiographic Evaluation

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters. 

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