Myocardial necrosis in ICU patients with acute non-cardiac disease: A prospective study

S. Arlati, G. P. Casella, M. Lanzani, S. Brenna, L. Prencipe, A. Marocchi, C. Gandini

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Objective: To ascertain if, after an episode of hypotension, unnoticed myocardial necrosis could occur in critical care patients with acute non-cardiac illness and to search for signs of cardiac necrosis. Design: A prospective observational study. Setting: General intensive care unit (ICU) at a tertiary level hospital. Patients: Thirty-one patients in two groups. Group 1 included 19 patients with severe sepsis/septic shock (ACCP/SCCM Consensus Conference). Group 2 included 12 patients with hypovolemic shock. Interventions: Biochemical markers of myocardial necrosis (cardiac troponin I (cTnI), creatine kinase (CK), creatine kinase MB mass (CKMB) and myoglobin) were measured at 12 h (T1), 24 h (T2) and 48 h (T3) after enrollment. A standard 12-lead ECG was recorded upon enrollment (T0) and at T2. Anomalous Q-waves or ST segment depression or elevation was considered diagnostic for acute myocardial infarction (AMI). A hypotensive episode (arterial systolic pressure <90 mmHg at heart rate > 100 bpm) was considered moderate if it lasted 30-60 min or severe if longer than 60 min. Measurements and results: At T0 none of the patients had AMI on ECG. At T2 a non-Q AMI developed in five patients. Increased levels of troponin I, myoglobin, CK and CKMB were found in 74.2%, 96.8%, 74.2% and 67.7% of the patients, respectively. Cardiac troponin I increased in 11 out of 19 septic patients and in all hypovolemic patients. There was a significant difference between the groups (p <0.05). All biochemical markers increased in relationship to the degree of hypotension with cTnI again showing a significant difference. The longer the hypotensive episode was, the greater was the increase (moderate hypotension: median 1.16; quartiles 0.55-3.44 ng/ml, severe hypotension: median 8.53; quartiles 1.1-20.7 ng/ml; p <0.05). Abnormal levels of cTnI were more frequent in non-survivors than in survivors (p <0.05). Conclusions: Hypotension may cause cardiac damage in critically ill patients with acute non-cardiac diseases as shown by abnormal levels of cTnI. It is likely that a high number of these myocardial necroses may go unnoticed on the ECG.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalIntensive Care Medicine
Volume26
Issue number1
Publication statusPublished - 2000

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Intensive Care Units
Necrosis
Prospective Studies
Troponin I
Hypotension
MB Form Creatine Kinase
Electrocardiography
Myoglobin
Myocardial Infarction
Creatine Kinase
Biomarkers
Hypovolemia
Critical Care
Septic Shock
Tertiary Care Centers
Critical Illness
Observational Studies
Survivors
Shock
Sepsis

Keywords

  • Cardiac troponin I
  • Hypovolemia
  • Myocardial necrosis
  • Sepsis
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Arlati, S., Casella, G. P., Lanzani, M., Brenna, S., Prencipe, L., Marocchi, A., & Gandini, C. (2000). Myocardial necrosis in ICU patients with acute non-cardiac disease: A prospective study. Intensive Care Medicine, 26(1), 31-37.

Myocardial necrosis in ICU patients with acute non-cardiac disease : A prospective study. / Arlati, S.; Casella, G. P.; Lanzani, M.; Brenna, S.; Prencipe, L.; Marocchi, A.; Gandini, C.

In: Intensive Care Medicine, Vol. 26, No. 1, 2000, p. 31-37.

Research output: Contribution to journalArticle

Arlati, S, Casella, GP, Lanzani, M, Brenna, S, Prencipe, L, Marocchi, A & Gandini, C 2000, 'Myocardial necrosis in ICU patients with acute non-cardiac disease: A prospective study', Intensive Care Medicine, vol. 26, no. 1, pp. 31-37.
Arlati S, Casella GP, Lanzani M, Brenna S, Prencipe L, Marocchi A et al. Myocardial necrosis in ICU patients with acute non-cardiac disease: A prospective study. Intensive Care Medicine. 2000;26(1):31-37.
Arlati, S. ; Casella, G. P. ; Lanzani, M. ; Brenna, S. ; Prencipe, L. ; Marocchi, A. ; Gandini, C. / Myocardial necrosis in ICU patients with acute non-cardiac disease : A prospective study. In: Intensive Care Medicine. 2000 ; Vol. 26, No. 1. pp. 31-37.
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AU - Marocchi, A.

AU - Gandini, C.

PY - 2000

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N2 - Objective: To ascertain if, after an episode of hypotension, unnoticed myocardial necrosis could occur in critical care patients with acute non-cardiac illness and to search for signs of cardiac necrosis. Design: A prospective observational study. Setting: General intensive care unit (ICU) at a tertiary level hospital. Patients: Thirty-one patients in two groups. Group 1 included 19 patients with severe sepsis/septic shock (ACCP/SCCM Consensus Conference). Group 2 included 12 patients with hypovolemic shock. Interventions: Biochemical markers of myocardial necrosis (cardiac troponin I (cTnI), creatine kinase (CK), creatine kinase MB mass (CKMB) and myoglobin) were measured at 12 h (T1), 24 h (T2) and 48 h (T3) after enrollment. A standard 12-lead ECG was recorded upon enrollment (T0) and at T2. Anomalous Q-waves or ST segment depression or elevation was considered diagnostic for acute myocardial infarction (AMI). A hypotensive episode (arterial systolic pressure <90 mmHg at heart rate > 100 bpm) was considered moderate if it lasted 30-60 min or severe if longer than 60 min. Measurements and results: At T0 none of the patients had AMI on ECG. At T2 a non-Q AMI developed in five patients. Increased levels of troponin I, myoglobin, CK and CKMB were found in 74.2%, 96.8%, 74.2% and 67.7% of the patients, respectively. Cardiac troponin I increased in 11 out of 19 septic patients and in all hypovolemic patients. There was a significant difference between the groups (p <0.05). All biochemical markers increased in relationship to the degree of hypotension with cTnI again showing a significant difference. The longer the hypotensive episode was, the greater was the increase (moderate hypotension: median 1.16; quartiles 0.55-3.44 ng/ml, severe hypotension: median 8.53; quartiles 1.1-20.7 ng/ml; p <0.05). Abnormal levels of cTnI were more frequent in non-survivors than in survivors (p <0.05). Conclusions: Hypotension may cause cardiac damage in critically ill patients with acute non-cardiac diseases as shown by abnormal levels of cTnI. It is likely that a high number of these myocardial necroses may go unnoticed on the ECG.

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KW - Cardiac troponin I

KW - Hypovolemia

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KW - Sepsis

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