Diagnostic Value of High-Sensitivity Troponin T for Subclinical Left Ventricular Systolic Dysfunction in Patients with Sepsis

Abstract

Background. Left ventricular systolic dysfunction (LVSD) is common in sepsis. Speckle-tracking echocardiography (STE) is a useful emerging tool for evaluating the intrinsic left ventricular systolic function. High-sensitivity cardiac troponin T (hs-cTnT) is the most sensitive biomarker of myocardial injury. However, there are limited data regarding the association between hs-cTnT level and left ventricular systolic dysfunction based on STE in septic patients. We performed this prospective study to evaluate the diagnostic value of hs-cTnT level for subclinical left ventricular systolic dysfunction measured by STE in septic patients according to the sepsis-3 definition. Methods. Patients with sepsis based on sepsis-3 definition admitted to the intensive care unit were prospectively performed STE and hs-cTnT level within 24 hours after the onset of sepsis. Baseline clinical and echocardiographic variables were collected. Left ventricular systolic dysfunction was defined as a global longitudinal strain of ≥−15%. Results. During a 19-month period, 116 patients were enrolled in the study. The elevated hs-cTnT level was seen in 86.2% of septic patients, and 43.1% of patients had LVSD on STE. The median hs-cTnT level and the proportion of elevated hs-cTnT level (>14 ng/L) were significantly higher in patients with LVSD than in patients without LVSD. The area under the ROC curves of hs-cTnT to detect LVSD was 0.73 ( P < 0.001). In the multivariate analysis, hs-cTnT (HR, 1.002; 95% CI, 1.000 to 1.004; P = 0.025) and septic shock (HR, 7.6; 95% CI, 2.25 to 25.76; P = 0.001) were independent predictors of LVSD. Conclusion. Our study indicated that the serum hs-cTnT level might be a useful biomarker for detecting LVSD in septic patients.

Evaluation Value and Clinical Significance of Cardiac Troponin Level and Pediatric Sequential Organ Failure Score in the Definition of Sepsis 3.0 in Critically Ill Children

“…The fatality rate of children with tumor complicated with sepsis is even as high as 68%. In recent years, SOFA score has been widely adopted as the mean to identify patients with sepsis, and the relationship between SOFA and death risk has been fully verified Computational and Mathematical Methods in Medicine [27]. SOFA score indicators (such as creatinine or bilirubin levels) need to be tested in the laboratory; so, they cannot quickly capture the dysfunction of individual organ systems.…”

Cardiac Troponin I Reveals Diagnostic and Prognostic Superiority to Aminoterminal Pro-B-Type Natriuretic Peptide in Sepsis and Septic Shock

“…In line with this, Mehta et al found lower LVEF, higher incidence of regional wall motion abnormalities and higher mortality in patients with elevated cTNI levels in 37 patients presenting with septic shock [ 37 ]. Moreover, a study by Hai et al from 2021 found an association between high levels of hs-cTNT and left ventricular systolic dysfunction (LVSD), as measured by speckle-tracking echocardiography, in 116 patients with sepsis or septic shock [ 38 ]. Those results are also in line with a monocentric prospective study from 2022, finding high-sensitivity cTNI (hs-cTNI) and NT-pro BNP to be related to a risk for LVSD in 124 septic patients [ 39 ].…”

Acute Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin I Levels in Adult Patients with Early Sepsis at a Tertiary Referral Center in Mexico: An Exploratory Study

“…Studies have shown that plasma concentrations of hs-cTn, as a biomarker of myocardial injury, even correlate well with the functional abnormalities observed in echocardiography of patients with sepsis and septic shock in the first days of diagnosis, especially with diastolic dysfunction of the left ventricular and right ventricular dilation [11] and left ventricular systolic dysfunction [12]. In patients with septic shock, up to 65% of those with an elevated hs-cTnI level have various cardiac dysfunctions on transthoracic echocardiography and, more than the baseline level, a maximum change in hs-cTnI and ST waves-T on the electrocardiogram can be considered a risk factor for the development of SIMD [13].…”