Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome

• Published in: Journal of critical care 2016-06, Vol.33, p.132-136
• Main Authors: Lazzeri, Chiara, MD, Bonizzoli, Manuela, MD, Cozzolino, Morena, Verdi, Camilla, Cianchi, Giovanni, MD, Batacchi, Stefano, MD, Franci, Andrea, MD, Gensini, Gian Franco, Peris, Adriano, MD
• Format: Article
• Language: English
• Subjects: APACHE; ARDS; Biomarkers; Biomarkers - blood; Critical Care; Echocardiography (transthoracic, transesophageal); Echocardiography, Three-Dimensional; Electrocardiography; Female; Humans; Hypertension; Intensive Care Units; Italy; Male; Medical imaging; Middle Aged; Monitoring, Physiologic; Mortality; Prognosis; Prospective Studies; Respiratory Distress Syndrome, Adult - blood; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - diagnostic imaging; Respiratory Distress Syndrome, Adult - mortality; Retrospective Studies; Right ventricle dysfunction; Troponin - blood; Ventricular Dysfunction, Right - complications
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.01.004

Abstract Purpose To assess the clinical significance of serial troponin I levels (measured in the first 72 hours from admission) in 42 consecutive patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Echocardiography and electrocardiogram testings were serially performed in the time window. Materials and methods Troponin I was measured every 12 hours in the first 72 hours from intensive care unit (ICU) admission. Echocardiography and electrocardiogram testings were serially performed in the same time window to clinically interpret Tn I levels. Results Patients with admission positive Tn I (38.1%) showed higher values of systolic pulmonary hypertension ( P = .013) associated with significantly lower values of tricuspid annular plane excursion ( P = .011). Twenty-five patients (25/42, 59.5%) exhibited positive peak Tn I and at second echocardiographic assessment exhibited significant lower tricuspid annular plane excursion values ( P = .005). At stepwise regression analysis the following variables were an independent predictor for in-ICU mortality: P co2 (OR 1.08, 95% CI 1.011-1.161, P = .023), systolic pulmonary arterial hypertension (OR 0.83, 95% CI 0.701-0.977, P = .002), log peak Tn I (OR 3.56, 95% CI 1.045-12.132, P = .042). Conclusions In moderate-to-severe ARDS, serial troponin I assessment together with echocardiography evaluation helped to identify a subgroup at higher risk for in-ICU death. Moreover, troponin release can be related to right ventricular dysfunction, thus highlighting the clinical role of echocardiography in ARDS patients.