title: Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome.
abstract: To assess the clinical significance of serial troponin I levels (measured in the first 72 hours from admission) in 42 consecutive patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Echocardiography and electrocardiogram testings were serially performed in the time window.
  
  
  
  Troponin I was measured every 12 hours in the first 72 hours from intensive care unit (ICU) admission. Echocardiography and electrocardiogram testings were serially performed in the same time window to clinically interpret Tn I levels.
  
  
  
  Patients with admission positive Tn I (38.1%) showed higher values of systolic pulmonary hypertension (P = .013) associated with significantly lower values of tricuspid annular plane excursion (P = .011). Twenty-five patients (25/42, 59.5%) exhibited positive peak Tn I and at second echocardiographic assessment exhibited significant lower tricuspid annular plane excursion values (P = .005). At stepwise regression analysis the following variables were an independent predictor for in-ICU mortality: Pco2 (OR 1.08, 95% CI 1.011-1.161, P = .023), systolic pulmonary arterial hypertension (OR 0.83, 95% CI 0.701-0.977, P = .002), log peak Tn I (OR 3.56, 95% CI 1.045-12.132, P = .042).
  
  
  
  In moderate-to-severe ARDS, serial troponin I assessment together with echocardiography evaluation helped to identify a subgroup at higher risk for in-ICU death. Moreover, troponin release can be related to right ventricular dysfunction, thus highlighting the clinical role of echocardiography in ARDS patients.
authors: Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: lazzeric@libero.it.
authors: Chiara
authors: C
authors: Lazzeri
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Manuela
authors: M
authors: Bonizzoli
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Morena
authors: M
authors: Cozzolino
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Camilla
authors: C
authors: Verdi
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Giovanni
authors: G
authors: Cianchi
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Stefano
authors: S
authors: Batacchi
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Andrea
authors: A
authors: Franci
authors: Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Florence, Italy.
authors: Gian Franco
authors: GF
authors: Gensini
authors: Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Adriano
authors: A
authors: Peris
mesh_terms: D018806:APACHE; D015415:Biomarkers / Q000097:blood*; D003422:Critical Care; D019560:Echocardiography, Three-Dimensional; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D012189:Retrospective Studies; D014336:Troponin / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000150:complications*
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: ARDS; Echocardiography (transthoracic, transesophageal); Prognosis; Right ventricle dysfunction