Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock

Pulido, Juan N.; Afessa, Bekele; Miyamoto, Masaki; Yuasa, Toshinori; Gillespie, Shane; Herasevich, Vitaly; Brown, Daniel R.; Oh, Jae K.

doi:10.1016/j.mayocp.2012.01.018

Cited by 260 publications

(245 citation statements)

References 31 publications

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“…Severe sepsis was defined as consequent organ dysfunction, hypoperfusion, or hypotension, and septic shock was defined as hypotension refractory to fluid resuscitation of 30 mL/kg body weight. Hypoperfusion was defined as blood lactate level ≥2.3 mmol/L, organ dysfunction as Sequential Organ Failure Assessment score ≥2, and hypotension as systolic blood pressure ≤90 mm Hg or a reduction of ≤40 mm Hg from baseline 15. Patients with denial of research authorization, readmissions for severe sepsis, known pregnancy, and lack of available TnT levels were excluded from this study.…”

Section: Methodsmentioning

confidence: 99%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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BackgroundTroponin‐T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin‐T testing in the prognostication of these patients.Methods and ResultsThis was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin‐T and significant delta troponin‐T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in‐hospital mortality. Secondary outcomes included 1‐year mortality and lengths of stay. During this 8‐year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin‐T ≥0.01 ng/mL. Serial troponin‐T values were available in 732 (78%) patients. Elevated admission troponin‐T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin‐T was associated with higher severity of illness. Admission log10 troponin‐T was associated with unadjusted in‐hospital (odds ratio 1.6; P=0.003) and 1‐year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin‐T and log10 delta troponin‐T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin‐T remained an independent predictor of in‐hospital mortality (odds ratio 1.4; P=0.04) and 1‐year survival (hazard ratio 1.3; P=0.008).ConclusionsIn patients with sepsis and septic shock, elevated admission troponin‐T was associated with higher short‐ and long‐term mortality. Routine serial troponin‐T testing did not add incremental prognostic value in these patients.

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Section: Methodsmentioning

confidence: 99%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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“…Since a reduced LVEF is the most commonly used definition of septic cardiac dysfunction, echocardiographic studies have mainly concerned the systolic function of the heart. Nonetheless, the diastolic function in sepsis is gaining interest (22,34). Most studies have assessed cardiac function at or close to ICU admission, and few have studied the echocardiographic characteristics of septic cardiac dysfunction over time (24,35).…”

Section: Cardiac Function Imaging In Sepsismentioning

confidence: 99%

“…Nonetheless, in spite of being extensively studied, the effect of systolic dysfunction evaluated using LVEF on the risk of death is increasingly questioned (65). In contrast, a substantial impact of LV diastolic dysfunction on mortality has been demonstrated (22,34,66). In cardiology, cardiac strain measured using speckle tracking has been shown to be superior to LVEF in predicting death in heart failure patients (67).…”

Section: Cardiac Biomarkers and Echocardiography In Outcome Predictionmentioning

confidence: 99%

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Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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“…A disfunção miocárdica ocorre em até 64% dos pacientes humanos com sepse e parece estar associada a um prognóstico desfavorável (Pulido et al, 2012). Quanto aos animais, as informações epidemiológicas ainda são limitadas (Osterbur et al, 2014).…”

Section: Introductionunclassified

Avaliação da depressão miocárdica por meio do feature tracking bidimensional em cadelas com sepse

Figueiredo

Muzzi

Pereira

et al. 2016

Arq. Bras. Med. Vet. Zootec.

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RESUMOO objetivo deste estudo prospectivo foi analisar a função do ventrículo esquerdo de cadelas que apresentavam sepse ou não e diagnosticar a depressão miocárdica de forma precoce, por meio do feature tracking imaging bidimensional (FTI-2D).Vinte e nove cadelas diagnosticadas com piometra, patologia usada como modelo experimental para sepse, foram avaliadas. Os animais foram submetidos ao exame ecocardiográfico convencional e ao FTI-2D e divididos em três grupos: grupo I (controle), grupo II (piometra sepse) e grupo III (piometra não sepse). Em relação aos parâmetros da ecocardiografia convencional, não houve diferença estatística entre os grupos avaliados. Quanto ao strain radial, os grupos II e III apresentaram função ventricular inferior no momento do diagnóstico (22,805,80 grupo I; 18,455,96 grupo II; 18,719,45 grupo III; P=0,032) e o grupo III manteve essa redução no retorno. Já no strain rate radial, apenas o grupo III obteve função ventricular inferior no momento do diagnóstico (1,900,57 grupo I; 1,910,70 grupo II, 1,570,53 grupo III; P=0,021). Para o strain longitudinal, observouse função ventricular mais baixa nos grupos II e III no momento do diagnóstico (11,043,38 grupo I; 8,593,97 grupo II; 8,211,99; P=0,048) e após 10 dias de pós-cirúrgico (11,043,38 grupo I; 9,002,16 grupo II; 8,122,27 grupo III; p=0,048). O FTI-2D foi capaz de detectar alterações precoces da função ventricular esquerda, que não foram observadas no exame ecocardiográfico convencional, sugerindo quadro de depressão miocárdica, até mesmo em cadelas com piometra sem quadro clínico evidente de sepse. Assim, essa modalidade pode ser útil no diagnóstico, pois pode detectar alterações cardíacas precoces, possibilitando uma intervenção terapêutica rápida.Palavras-chave: cão, disfunção miocárdica, ecocardiografia, strain, strain rate Strain, group II and III had lower ventricular function at diagnosis (22.805.80 Group I; 18.455.96 Group II; 18.719.45 Group III; P = 0.032) and group III maintained this reduction in return. Regarding the radial Strain rate, only the III group had lower ventricular function at diagnosis (1.900.57 Group I; 1.910.70 Group II, 1.570.53 Group III; P = 0.021). For the Longitudinal Strain we observed lower ventricular function in groups II and III at diagnosis (11.043.38 Group I, Group II 8.593.97, 8.211.99; P = 0.048) ABSTRACT The aim of this prospective study was to analyze the left ventricular function of dogs who had sepsis or not and diagnose myocardial depression early on through the two-dimensional feature tracking imaging (2D-FTI). Twenty-nine dogs diagnosed with pyometra, a pathology used as an experimental model for sepsis were evaluated. The animals were subjected to conventional echocardiography and 2D-FTI, and divided into three groups: Group I (control), group II (sepsis pyometra) and group III (no sepsis pyometra). Regarding the parameters of conventional echocardiography, there was no statistical difference between the groups. As for the radial

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Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock

Cited by 260 publications

References 31 publications

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Avaliação da depressão miocárdica por meio do feature tracking bidimensional em cadelas com sepse

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