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J Korean Soc Emerg Med > Volume 30(5); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(5): 428-436.
패혈성 쇼크 환자의 좌심실 이완기 기능장애와 트로포닌 테스트의 관계
김무열 , 김준성 , 김윤정 , 안신 , 김원영
울산대학교 의과대학 서울아산병원 응급의학과
Association between high-sensitivity troponin test and tissue Doppler assessment of left ventricular diastolic dysfunction in critically ill septic patients
Muyeol Kim , June-Sung Kim , Youn-Jung Kim , Shin Ahn , Won Young Kim
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence  Won Young Kim ,Tel: 02-3010-3350, Fax: 02-3010-3360, Email: wonpia73@naver.com,
Received: January 25, 2019; Revised: March 15, 2019   Accepted: April 9, 2019.  Published online: October 31, 2019.
ABSTRACT
Objective:
Although a left ventricular (LV) diastolic dysfunction is an important prognostic factor in myocardial dysfunction in septic shock, emergency departments (EDs) have limited capability of performing echocardiography. Cardiac troponin is a specific marker of a myocardial injury. On the other hand, little is known about the LV diastolic dysfunction in septic shock patients. This study examined the associations between troponin-I (TnI) level and LV diastolic dysfunction.
Method:
A 5-year retrospective cohort study was conducted between January 2011 and December 2015, including adult septic shock patients who were treated with protocol-driven resuscitation bundle therapy and had the TnI tested at the ED. The LV diastolic dysfunction was defined as E/e′ratios above 15 in echocardiography.
Results:
Of the 442 septic shock patients with an abnormal TnI (≥0.04 ng/mL) at admission, echocardiography was performed on 255 patients and 81 patients (31.8%) showed a LV diastolic dysfunction. The TnI level at ED admission was higher in the LV diastolic dysfunction group compared to the non-dysfunction group (0.08 [0.03-0.25] ng/mL vs. 0.14 [0.05-0.43] ng/mL, P=0.035). On the other hand, according to multivariate logistic regression and chronic kidney disease (odds ratio, 1.74; 95% confidence interval, 1.02-2.99) was the only factor associated with a LV diastolic dysfunction. Receiver operating characteristic analysis revealed the area under the curve of the initial TnI to be only 0.589 (P=0.038) and no correlation was observed between the initial TnI and E/e′(r=0.079, P=0.199).
Conclusion:
A LV diastolic dysfunction occurred in approximately quarter of septic shock patients with TnI elevation, but the TnI test showed a weak association with diastolic dysfunction. Further studies will be needed to identify the predictors for a diastolic dysfunction in septic shock patients.
Key words: Troponin; Septic shock; Cardiomyopathies; Biomarkers; Organ failure
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