Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study

Intensive Care Med. 2000 Jan;26(1):31-7. doi: 10.1007/s001340050008.


Objective: To ascertain if, after an episode of hypotension, unnoticed myocardial necrosis could occur in critical care patients with acute non-cardiac illness and to search for signs of cardiac necrosis.

Design: A prospective observational study.

Setting: General intensive care unit (ICU) at a tertiary level hospital.

Patients: Thirty-one patients in two groups. Group 1 included 19 patients with severe sepsis/septic shock (ACCP/SCCM Consensus Conference). Group 2 included 12 patients with hypovolemic shock.

Interventions: Biochemical markers of myocardial necrosis (cardiac troponin I (cTnI), creatine kinase (CK), creatine kinase MB mass (CKMB) and myoglobin) were measured at 12 h (T1), 24 h (T2) and 48 h (T3) after enrollment. A standard 12-lead ECG was recorded upon enrollment (T0) and at T2. Anomalous Q-waves or ST segment depression or elevation was considered diagnostic for acute myocardial infarction (AMI). A hypotensive episode (arterial systolic pressure < 90 mmHg at heart rate > 100 bpm) was considered moderate if it lasted 30-60 min or severe if longer than 60 min.

Measurements and results: At T0 none of the patients had AMI on ECG. At T2 a non-Q AMI developed in five patients. Increased levels of troponin I, myoglobin, CK and CKMB were found in 74.2 %, 96.8 %, 74.2 % and 67.7 % of the patients, respectively. Cardiac troponin I increased in 11 out of 19 septic patients and in all hypovolemic patients. There was a significant difference between the groups (p < 0.05). All biochemical markers increased in relationship to the degree of hypotension with cTnI again showing a significant difference. The longer the hypotensive episode was, the greater was the increase (moderate hypotension: median 1.16; quartiles 0.55-3.44 ng/ml, severe hypotension: median 8.53; quartiles 1.1-20.7 ng/ml; p < 0.05). Abnormal levels of cTnI were more frequent in non-survivors than in survivors (p < 0.05).

Conclusions: Hypotension may cause cardiac damage in critically ill patients with acute non-cardiac diseases as shown by abnormal levels of cTnI. It is likely that a high number of these myocardial necroses may go unnoticed on the ECG.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Creatine Kinase / metabolism*
  • Electrocardiography
  • Hospital Mortality
  • Humans
  • Hypotension / complications*
  • Intensive Care Units*
  • Isoenzymes
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardium / pathology*
  • Myoglobin / metabolism
  • Necrosis
  • Prospective Studies
  • Sepsis / complications*
  • Sepsis / physiopathology
  • Shock / complications*
  • Shock / physiopathology
  • Troponin I / metabolism*


  • Isoenzymes
  • Myoglobin
  • Troponin I
  • Creatine Kinase