| Objective: To explore the diagnostic value of transthoracic echocardiogram (TTE) and/orplasma B-type natriuretic peptide (BNP) for left ventricular (LV) systolic dysfunction and/orLV diastolic dysfunction in patients with sepsis. To explore the protective effect of differenttarget blood glucose control on cardiac dysfunction in patients with sepsis.Methods: This is a prospective, randomised, double-blinded, interventional study.90patientswith sepsis were randomised as follows: group A, blood glucose levels of4.4to6.1mmol/L;group B, blood glucose levels of6.1to8.3mmol/L; and group C, blood glucose levels of8.3to10.0mmol/L, with30patients in each group. There were30participants with non-sepsis inthe control group. Each individual underwent serial transthoracic echocardiogram (TTEs) tomeasure left ventricle ejection fraction (LVEF) and the ratio of the blood flow velocity ofmitral annulus during early diastole (E) and atrial contraction (A) before and1,3,7days afterblood glucose control with insulin therapy. The plasma levels of BNP were detected asELISA simultaneously. Patients’ medical records were took to obtain information aboutdemographics, APACHE II scores, incidence of hypoglycemia and28-days survival rates.Results: LVEF and E/A were downgraded significantly more in sepsis group (P=0.00) andBNP elevated in sepsis group (P=0.00). LVEF and E/A showed a drop first then followed by arise. On the contrary, BNP increased by degrees and subsequently decreased. There waspositively correlated between LVEF and E/A (r=0.670，P=0.00), and BNP levels negativecorrelation with LVEF and E/A (r1=-0.733，P1=0.00；r2=-0.929，P2=0.00). ROC curveanalysis calculated that BNP cutoff point at536.3pg/ml for diagnosis of sepsis-induced LVsystolic dysfunction having sensitivity as84.4%, specificity as68.7%. It also showed adescription that BNP cutoff point at505.0pg/m for diagnosis of sepsis-induced LV diastolicdysfunction having sensitivity as56.0%, specificity as97.4%. There was no significantimprovement in their mean values in comparing LVEFs from A, B and C (P=0.184),respectively, and the E/As differed among the groups, including a statistical differencebetween A and C (p=0.005). There was a increasing trend of the levels of BNP of A, B, and C,and comparison of A with B and comparison of A and C were statistically variability(PAB=0.028，PAC=0.000). It was found that LVEFs was no variation (P1=0.310、P3=0.174),while E/A and BNP in group A were significantly higher or lower than those in others on day1and3(p=0.005). The comparison of the LVEFs among glucoses were similar on day7, butsubsequent E/As and BNPs derived from A, B, and C resulted statistical differences. Thevariation of E/As with time were only changing between A, B, and C.Conclusions: Our findings suggest that TTE may exhibit septic patients whose LV diastolicdysfunction comes earlier and reverses later than systolic type. And it may also participate insystolic dysfunction. The levels of BNP, which maybe has adjustment to LV function, aremore closely aligned with the severity of septic LV diastolic dysfunction. The combinedapplication of TTE and plasma BNP appears to be efficacious and needed for dynamicallyassessing the cardiac function in patients with sepsis in clinical works. Maintaining targetblood glucose at4.4to6.1mmol/L can improve cardiac dysfunction. Furthermore, it has more significant improvement at diastolic dysfunction than at systolic. Combined utilizationof LVEF, E/A and BNP evaluates critical ill patients with sepsis-induced cardiomyopathy attarget blood glucose control, suggesting that glucose of4.4to6.1mmol/L has positivesignificance of cardiac consistent dysfunction in patients with sepsis during7days aftertreatment. |
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