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Titolo:
Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study
Autore:
Arlati, S; Brenna, S; Prencipe, L; Marocchi, A; Casella, GP; Lanzani, M; Gandini, C;
Indirizzi:
Niguarda Ca Granda Hosp, Intens Care Unit G Bozza, I-20123 Milan, Italy Niguarda Ca Granda Hosp Milan Italy I-20123 Bozza, I-20123 Milan, Italy Niguarda Ca Granda Hosp, Biochem Lab, I-20123 Milan, Italy Niguarda Ca Granda Hosp Milan Italy I-20123 em Lab, I-20123 Milan, Italy Maugeri Fdn, IRCCS, Toxicol Serv, I-27100 Pavia, Italy Maugeri Fdn PaviaItaly I-27100 RCCS, Toxicol Serv, I-27100 Pavia, Italy
Titolo Testata:
INTENSIVE CARE MEDICINE
fascicolo: 1, volume: 26, anno: 2000,
pagine: 31 - 37
SICI:
0342-4642(200001)26:1<31:MNIIPW>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; CREATINE KINASE-MB; TROPONIN-I; OXYGEN DELIVERY; SEPTIC SHOCK; INFARCTION; DYSFUNCTION; MORTALITY; INJURY; TRAUMA;
Keywords:
shock; sepsis; hypovolemia; cardiac troponin I; myocardial necrosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
36
Recensione:
Indirizzi per estratti:
Indirizzo: Arlati, S Niguarda Ca Granda Hosp, Intens Care Unit G Bozza, Pza Osped Maggiore, I-20123 Milan, Italy Niguarda Ca Granda Hosp Pza Osped Maggiore Milan Italy I-20123
Citazione:
S. Arlati et al., "Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study", INTEN CAR M, 26(1), 2000, pp. 31-37

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. Astandard 12-lead ECC was recorded upon enrollment (TO) 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 EGG. At T2a 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 thepatients, respectively. Cardiac troponin I increased in 11 out of 19 septic patients acid 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). Abnormallevels 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 EGG.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/09/20 alle ore 00:45:49