title: Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  Controlled-trials.com ISRCTN94845869.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: John
authors.initials: J
authors.lastname: Granton
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Gordon
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Stephen
authors.initials: S
authors.lastname: Lapinsky
authors.forename: Gary
authors.initials: G
authors.lastname: Newton
authors.forename: Kris
authors.initials: K
authors.lastname: Bandayrel
authors.forename: Anjuli
authors.initials: A
authors.lastname: Little
authors.forename: Chuin
authors.initials: C
authors.lastname: Siau
authors.forename: Dieter
authors.initials: D
authors.lastname: Ayers
authors.forename: Joel
authors.initials: J
authors.lastname: Singer
authors.forename: Terry C K
authors.initials: TC
authors.lastname: Lee
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
authors.forename: Michelle
authors.initials: M
authors.lastname: Storms
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holmes
authors.forename: Paul
authors.initials: P
authors.lastname: Hebert
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Presneill
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D004562:Electrocardiography / Q000379:methods; D017202:Myocardial Ischemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D009638:Norepinephrine / Q000627:therapeutic use; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D020107:Troponin T / Q000097:blood; D014667:Vasopressins / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D009638:Norepinephrine; D020107:Troponin T; D014667:Vasopressins