Changes in plasma free fatty acid levels in septic patients are associated with cardiac damage and reduction in heart rate variability.
Free fatty acids (FFAs) have been shown to produce alteration of heart rate variability (HRV) in healthy and diabetic individuals. Changes in HRV have been described in septic patients and in those with hyperglycemia and elevated plasma FFA levels. We studied if sepsis-induced heart damage and HRV alteration are associated with plasma FFA levels in patients. Thirty-one patients with sepsis were included. The patients were divided into two groups: survivors(n = 12) and nonsurvivors (n = 19). The following associations were investigated: (a) troponin I elevation and HRV reduction and (b) clinical evolution and HRV index, plasma troponin, and plasma FFA levels. Initial measurements of C-reactive protein and gravity Acute Physiology and Chronic Health Evaluation scores were similar in both groups. Overall, an increase in plasma troponin level was related to increased mortality risk. From the first day of study, the nonsurvivor group presented a reduced left ventricular stroke work systolic index and a reduced low frequency (LF) that is one of HRV indexes. The correlation coefficient for LF values and troponin was r(2) = 0.75 (P < 0.05). All patients presented elevated plasma FFA levels on the first day of the study (5.11 +/- 0.53 mg/mL), and this elevation was even greater in the nonsurvivor group compared with the survivors (6.88 +/- 0.13 vs. 3.85 +/- 0.48 mg/mL, respectively; P < 0.05). Cardiac damage was confirmed by measurement of plasma troponin I and histological analysis. Heart dysfunction was determined by left ventricular stroke work systolic index and HRV index in nonsurvivor patients. A relationship was found between plasma FFA levels, LFnu index, troponin levels, and histological changes. Plasma FFA levels emerged as possible cause of heart damage in sepsis.
Nogueira
Antonio Carlos
AC
São Paulo University Hospital, São Paulo, Brazil.
Kawabata
Victor
V
Biselli
Paolo
P
Lins
Marcelo Henrique
MH
Valeri
Carla
C
Seckler
Mauricio
M
Hoshino
Wagner
W
Júnior
Luiz Gonzaga
LG
Bernik
Marcia Martins Silveira
MM
de Andrade Machado
Juliana B
JB
Martinez
Marina Baquerizo
MB
Lotufo
Paulo Andrade
PA
Caldini
Elia Garcia
EG
Martins
Edgair
E
Curi
Rui
R
Soriano
Francisco Garcia
FG
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D001786:Blood Glucose / Q000378:metabolism; D005230:Fatty Acids, Nonesterified / Q000097:blood*; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D014280:Triglycerides / Q000097:blood; D019210:Troponin I / Q000097:blood
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D008074:Lipoproteins; D014280:Triglycerides; D019210:Troponin I