8^th Global Cardiologists and Echocardiography Annual Meeting

Biography

Biography: Govindan Vijayaraghavan

Abstract

Background: Sepsis patients with myocardial injury has very high mortality(30-60%).Only a few studies incorporating electrocardiography, high sensitive troponin T(hsTnT), N-terminal pro-BNP(pro-BNP) and echocardiography has been conducted in these patients . Methods and Results: Out of 204 patients with sepsis enrolled, 111 patients satisfied the inclusion criteria and 103 completed the study. Myocardial injury was defined by elevation of hsTnT > 25 pg/ml. Initial hsTnT, pro-BNP and 2D echocardiography were repeated if sepsis progresses. Primary and secondary end point were in hospital mortality and left ventricular dysfunction(LVD).Simple sepsis was diagnosed in 45%; 19% had septic shock and 36% developed severe sepsis. male predominance(63%) with majority being diabetic (66%) and above 50 years of age (54%).Sinus tachycardia was present in 65% and T inversion in inferior leads in 32%.Systolic dysfunction(SD) was present in 42%, diastolic dysfunction (DD) in 21% and 21% had both SD and DD. HsTnT was elevated in 84% of the patients. Both HsTnT and pro-BNP were significantly correlated with LVD (p<0.001).Though pro BNP and HsTnT vary in different levels of LVD (table1), variation was more marked with pro-BNP. Both levels were lesser in DD than SD. Grade III DD was always associated with severe SD .Pro-BNP had significant correlation with pro-calcitonin level (p<0.001) and APACHE II score (p<0.001); HsTnT had significant correlation only with APACHE II score (p<0.001). CRP level did not have correlation with cardiac markers. In hospital mortality was 8%.In survivors hsTnT was 158pg/ml and pro-BNP was 6400 pg/ml.In non-survivors hsTnT was 256 pg/ml (p<0.047) and pro-BNP was 21805pg/ml(p<0.001).Pro BNP has better correlation with the survival. ROC curve showed that a pro-BNP level >8530 pg/ml signified with mortality (sensitivity-100% and specificity-80%) and HsTnT level >178pg/ml correlated with mortality with 88% sensitivity and 71% specificity. Base line creatinine was normal in all patients; 55% had elevated creatinine during the sepsis and had linear correlation with hsTnT level (p<0.01). Conclusion: Pro-BNP is a powerful tool for prognostication in sepsis with myocardial dysfunction and a value>8530 pg/ml signified decreased survival with 100% sensitivity. The significant elevation of pro-BNP with minimal elevation of hsTnT indicated that the pathophysiology is mainly myocardial stretch and not myocardial necrosis in sepsis; with full recovery in survivors. Table 1: distribution of pro-BNP and HsTnT in LVD (*21% had combined LVD) ECHOCARDIOGRAPHY % Mean pro-BNP(pg/ml) Mean HsTnT(pg/ml) Normal 16 2433 (700-4100) 76 (<25-160) Mild LV SD 11 5481 (3200-9200) 210 (80-360) Moderate LV SD 13 9608 (5400-16100) 254 (150-480) Severe LV SD 18 16844 (7200-25000) 268 (148-450) Grade I DD 8 3132 (1024-5250) 117 (60-220) Grade II DD 13 6596 (3500-9000) 125 (26-240)