title: Myocardial injury in critically ill patients. A frequently unrecognized complication.
abstract: OBJECTIVE
  To determine the incidence and effect of unrecognized cardiac injury in critically ill patients.
  
  
  METHODS
  Prospective, blinded, single-center study.
  
  
  METHODS
  The medical and respiratory intensive care unit of an academic health center.
  
  
  METHODS
  Two hundred nine patients (224 admissions).
  
  
  METHODS
  Daily measurement of levels of cardiac troponin I, a sensitive, highly specific, and long-lived marker of myocardial injury. Concurrently, signs and symptoms potentially related to myocardial ischemia were tabulated by blinded investigators. All clinical evaluation and management decisions were made by the physicians responsible for the care of the patient.
  
  
  RESULTS
  Thirty-two (15%) of the 209 patients had evidence of myocardial damage based on elevated levels of cardiac troponin I. Only 12 (37%) of these 32 patients were diagnosed as having acute myocardial infarction by the intensive care unit staff. Cardiac damage was unrecognized in the other 20 (63%). Unrecognized cardiac injury was more common in young patients and in blacks. Mortality in patients with myocardial injury that was recognized (42%) or unrecognized (40%) was higher than in those without myocardial injury (15%) (P < .001). Patients with cardiac injury were more frequently hypotensive (75% vs 50%; P = .007) and in need of mechanical ventilation (66% vs 27%; P < .001) and had longer intensive care unit stays (5.3 vs 3.1 days; P < .007) than patients without cardiac injury.
  
  
  CONCLUSIONS
  The incidence of myocardial injury defined by elevated levels of cardiac troponin I was unexpectedly high and associated with increased morbidity and mortality. Clinically, it was often unrecognized.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Guest
authors.forename: A V
authors.initials: AV
authors.lastname: Ramanathan
authors.forename: P G
authors.initials: PG
authors.lastname: Tuteur
authors.forename: K B
authors.initials: KB
authors.lastname: Schechtman
authors.forename: J H
authors.initials: JH
authors.lastname: Ladenson
authors.forename: A S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011446:Prospective Studies; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin