Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine

Mehta S., Granton J., Gordon A.C., Cook D.J., Lapinsky S., Newton G., Bandayrel K., Little A., Siau C., Ayers D., Singer J., Lee T.C.K., Walley K.R., Storms M., Cooper D.J., Holmes C.L., Hebert P., Presneill J., Russell J.A., Cook D.J., Holmes C., Hebert P.C., Presneill J.J., Storms M.M., Hebert P.C., Mehta S., Storms M.M., Jones S., Gasparini A., Dorscheid D.R., Hameed M., Lazosky L., Helderweirt S., Foley K., Honeyman C., Terins T., Chittock D., Ronco J., Smith L., Logie S., Martinka G., Goulding S., Silverwood S., Leung L., Granton J.T., Steinberg M., Matte A., Cook D.J., McDonald E., Clarke F., Tkaczyk A., Zytaruk N., Mehta S., Stewart T., Suri A., Martinez-Motta C., MacDonald R., Sivanantham V., Ward M., Santos C.D., Friedrich J., Scales D., Smith O., DeCampos I., Richards A., Michalopoulos H., Bakshi U., Muscedere J. and Diemer C. (2013) Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Critical Care, 17 3: R117.1-R117.10. doi:10.1186/cc12789


Author Mehta S.
Granton J.
Gordon A.C.
Cook D.J.
Lapinsky S.
Newton G.
Bandayrel K.
Little A.
Siau C.
Ayers D.
Singer J.
Lee T.C.K.
Walley K.R.
Storms M.
Cooper D.J.
Holmes C.L.
Hebert P.
Presneill J.
Russell J.A.
Cook D.J.
Holmes C.
Hebert P.C.
Presneill J.J.
Storms M.M.
Hebert P.C.
Mehta S.
Storms M.M.
Jones S.
Gasparini A.
Dorscheid D.R.
Hameed M.
Lazosky L.
Helderweirt S.
Foley K.
Honeyman C.
Terins T.
Chittock D.
Ronco J.
Smith L.
Logie S.
Martinka G.
Goulding S.
Silverwood S.
Leung L.
Granton J.T.
Steinberg M.
Matte A.
Cook D.J.
McDonald E.
Clarke F.
Tkaczyk A.
Zytaruk N.
Mehta S.
Stewart T.
Suri A.
Martinez-Motta C.
MacDonald R.
Sivanantham V.
Ward M.
Santos C.D.
Friedrich J.
Scales D.
Smith O.
DeCampos I.
Richards A.
Michalopoulos H.
Bakshi U.
Muscedere J.
Diemer C.
Title Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2013-06
Year available 2013
Sub-type Article (original research)
DOI 10.1186/cc12789
Open Access Status DOI
Volume 17
Issue 3
Start page R117.1
End page R117.10
Total pages 10
Place of publication Philadelphia, United States
Publisher Current Science
Collection year 2014
Language eng
Formatted abstract
Introduction:
Cardiac troponins are sensitive and specific biomarkers of myocardial necrosis. We evaluated troponin, CK, and ECG abnormalities in patients with septic shock and compared the effect of vasopressin (VP) versus norepinephrine (NE) on troponin, CK, and ECGs.

Methods:
This was a prospective substudy of a randomized trial. Adults with septic shock randomly received, blinded, a low-dose infusion of VP (0.01 to 0.03 U/min) or NE (5 to 15 μg/min) in addition to open-label vasopressors, titrated to maintain a mean blood pressure of 65 to 75 mm Hg. Troponin I/T, CK, and CK-MB were measured, and 12-lead ECGs were recorded before study drug, and 6 hours, 2 days, and 4 days after study-drug initiation. Two physician readers, blinded to patient data and drug, independently interpreted ECGs.

Results:
We enrolled 121 patients (median age, 63.9 years (interquartile range (IQR), 51.1 to 75.3), mean APACHE II 28.6 (SD 7.7)): 65 in the VP group and 56 in the NE group. At the four time points, 26%, 36%, 32%, and 21% of patients had troponin elevations, respectively. Baseline characteristics and outcomes were similar between patients with positive versus negative troponin levels. Troponin and CK levels and rates of ischemic ECG changes were similar in the VP and the NE groups. In multivariable analysis, only APACHE II was associated with 28-day mortality (OR, 1.07; 95% CI, 1.01 to 1.14; P = 0.033).

Conclusions:
Troponin elevation is common in adults with septic shock. We observed no significant differences in troponin, CK, and ECGs in patients treated with vasopressin and norepinephrine. Troponin elevation was not an independent predictor of mortality.
Keyword Electrocardiogram
Myocardial ischemia
Norepinephrine
Septic shock
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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