Association between high-sensitivity troponin test and tissue Doppler assessment of left ventricular diastolic dysfunction in critically ill septic patients

Kim, Muyeol; Kim, June-Sung; Kim, Youn-Jung; Ahn, Shin; Kim, Won Young

J Korean Soc Emerg Med > Volume 30(5); 2019 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2019;30(5): 428-436.

패혈성 쇼크 환자의 좌심실 이완기 기능장애와 트로포닌 테스트의 관계

김무열

울산대학교 의과대학 서울아산병원 응급의학과

Association between high-sensitivity troponin test and tissue Doppler assessment of left ventricular diastolic dysfunction in critically ill septic patients

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