Clinical Study of Deceleration Capacity in Early Precaution of Patients with Sepsis-induced Myocardial Dysfunction

ZHAO Jian-gao; LU Le; YANG Run-hua

doi:10.3969/j.issn.1002-3429.2017.07.024

Abstract：Objective To investigate change and clinical significance of deceleration capacity of rate (DC) in patients with sepsis-induced myocardial dysfunction (SIMD).Methods A total of 66 sepsis patients admitted during January 2015 and June 2016 were divided into SIMD group (n=38) and non-SIMD group (n=28) according to whether or not having SIMD.Values of N-terminal-pro-B-type natriuretic peptide (NT-proBNP), troponin I (cTnI), left ventricular end-diastolic dimension (LVEDD), left atrial end systolic diameter (LASD), left ventricular ejection fraction (LVEF) and E/A blood flow rate of mitral orifice diastolic period were analyzed and compared at the time of entering groups and at the time of confirming SIMD in two groups.Receiver operating curve (ROC) was drawn to analyze diagnostic effect of DC for SIMD, and the correlation between DC and SIMD was also analyzed.Results The time from onset to having syndrome of cardiac dysfunction was 3-7 (4.4±1.2)d in SIMD group.There were no significant differences in values of NT-proBNP, cTnI, LVEDD, LASD, LVEF and E/A in two groups at the time of entering groups (P>0.05).DC level in SIMD group [(2.1±0.2)s] was significantly lower than(5.3±0.5)s in non-SIMD group (P<0.01).In SIMD group, at the time of confirming SIMD, NT-proBNP value was significantly increased, while LASD, LVEF and E/A values were significantly decreased compared with those at the time of entering groups (P<0.05 or P<0.01).ROC analysis showed that area under curve of DC in early precaution of SIMD was 0.835;95% CI was 0.756,0.877;cut-off value was 1.8 ms;sensitivity was 85.3%, and specificity was 82.9%.Correlation analysis of Pearson and Spearman showed that DC was negatively associated with SIMD onset and 28-day mortality (r=-0.698, P=0.001;r=-0.634, P=0.002).Conclusion DC may be a reliable index in early precaution of SIMD, and it has a certain correlation with clinical prognosis in SIMD patients.