Innocenti Francesca, Palmieri Vittorio, Stefanone Valerio Teodoro, D'Argenzio Federico, Cigana Marco, Montuori Michele, Capretti Elisa, De Paris Anna, Calcagno Stefano, Tassinari Irene, Pini Riccardo
High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Firenze, Italy.
Transplant Cardiosurgery Unit, Department of Cardiac Surgery and Transplant, Ospedale Dei Colli Monaldi-Cotugno-CTO, Naples, Italy.
Intern Emerg Med. 2022 Jan;17(1):223-231. doi: 10.1007/s11739-021-02701-3. Epub 2021 Mar 17.
In the context of sepsis, we tested the relationship between echocardiographic findings and Troponin, and their impact on prognosis. In this prospective study, we enrolled 325 septic patients (41% with shock), not mechanically ventilated, between October, 2012 and June, 2019 among those admitted to our High-Dependency Unit. By echocardiography within 24 h from the admission, sepsis-induced myocardial dysfunction (SIMD) was defined as left ventricular (LV) systolic dysfunction (speckle-tracking-based global longitudinal peak systolic strain, GLS, > - 14%) and/or right ventricular (RV) systolic dysfunction (Tricuspid Annular Plane Systolic Excursion, TAPSE < 16 mm). Troponin I levels were measured upon admission (T0) and after 24 h (T1); it was considered normal if > 0.1 ng/mL. Mortality was assessed at day-7 and day-28 end-points. One-hundred and forty-two patients had normal Troponin level at T0 and T1 (G1), 69 had abnormal levels at T0 or T1 (G2) and 114 showed abnormal Troponin levels at both T0 and T1 (G3). Compared to G1, patients in G3 had worse LV and RV systolic function (GLS - 11.6 ± 3.4% vs - 14.0 ± 3.5%, p < 0.001; TAPSE 18 ± 0.5 vs 19 ± 0.5 mm, p = 0.047) and greater day-28 (34% vs 20%, p = 0.015) mortality. In a Cox survival analysis including age, Troponin and SOFA score, mortality was predicted by the presence of SIMD (RR 3.24, 95% CI 1.72-6.11, p < 0.001) with no contribution of abnormal Troponin level. While abnormal Troponin levels were associated with SIMD diagnosed by echocardiography, only the presence of SIMD predicted the short- and medium-term mortality rate, without an independent contribution of increased Troponin levels.
在脓毒症背景下，我们测试了超声心动图检查结果与肌钙蛋白之间的关系及其对预后的影响。在这项前瞻性研究中，我们纳入了2012年10月至2019年6月期间入住我们高依赖病房的325例脓毒症患者（41%伴有休克），这些患者未接受机械通气。在入院后24小时内通过超声心动图检查，脓毒症诱导的心肌功能障碍（SIMD）被定义为左心室（LV）收缩功能障碍（基于斑点追踪的整体纵向峰值收缩应变，GLS，> -14%）和/或右心室（RV）收缩功能障碍（三尖瓣环平面收缩期位移，TAPSE < 16 mm）。入院时（T0）和24小时后（T1）测量肌钙蛋白I水平；如果> 0.1 ng/mL则认为正常。在第7天和第28天的终点评估死亡率。142例患者在T0和T1时肌钙蛋白水平正常（G1组），69例在T0或T1时水平异常（G2组），114例在T0和T1时均显示肌钙蛋白水平异常（G3组）。与G1组相比，G3组患者的左心室和右心室收缩功能更差（GLS -11.6±3.4%对 -14.0±3.5%，p < 0.001；TAPSE 18±0.5对19±0.5 mm，p = 0.047），第28天死亡率更高（34%对20%，p = 0.015）。在一项包括年龄、肌钙蛋白和序贯器官衰竭评估（SOFA）评分的Cox生存分析中，SIMD的存在可预测死亡率（风险比3.24，95%置信区间1.72 - 6.11，p < 0.001），而肌钙蛋白水平异常无影响。虽然肌钙蛋白水平异常与超声心动图诊断的SIMD相关，但只有SIMD的存在可预测短期和中期死亡率，肌钙蛋白水平升高无独立影响。
