Pneumonia, Pneumococcal, Myocardial Ischemia
Conditions
Keywords
Pneumococcal pneumonia, Acute cardiovascular events
Brief summary
Hypothesis: The novo cardiovascular events (CVE)in patients with severe community-acquired pneumonia (CAP) are frequent (17%) and could be associated with both direct pneumococcal myocardial invasion, toxin delivery (pneumolysin) or different biomarkers (histones, NETs(neutrophil extracellular traps), IL (Interleukin)-1b,h-Fabp (heart-Fatty acid bindding protein) ).The CVE frequency and its impact on outcome in patients without prior heart disease (CP) has not been studied. Objectives:1) To determine the incidence of myocardian injury (MI) and CVE in patients with CAP without CP evaluated by non-invasive techniques (Echocardiograph and MRI) and biomarkers levels (Tn-I (Troponin I), h-Fabp, NT-proBNP (N-terminal pro-brain natriuretic peptide) histones, NETs, IL 1b); 2) To assess if DMA and CVE are related to the etiology and their impact on outcome , 3) To investigate the presence of myocardial scarring by MRI and its relationship with etiology and MI, and 4) To identify prognostic factors of DMA and CVE to determine level of risk.
Detailed description
Area: Intensive care unit (ICU) of the participating hospitals. Patients: Forty patients with CAP without heart disease history will be included consecutively (20 patients with pneumococcal CAP and 20 patients with non-pneumococcal CAP).Ten healthy volunteers (controls) are included. Variables: Epidemiological, clinical and hemodynamic variables are recorded. Presence of MI and CVE measured by echocardiography and by biomarkers will be evaluated during the ICU stay. Presence of scarring miocardic by MRI technique will be determined at month 6 since ICU admission. Statistical analysis: Categorical (Fisher's exact test) and continuous variables( Wilconxon and Anova) will be used to determine differences between them. The Pearson correlation, ROC (discriminatory power) and logistic regression analysis(independent association) will be used to determine the association between variables and outcome. A p-value of 0.05 will be considered significant.
Interventions
DIAGNOSTIC_TESTEchocardiography
Standard protocols
DIAGNOSTIC_TESTCardiac Magnetic resonance
MRI with late gadolinium increase and T1 mapping
Sponsors
Alejandro Rodriguez Oviedo , MD
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
1. \- Patients admitted to the ICU due to community-acquired pneumonia according to IDSA/ATS criteria 2. \- No history of heart diasese 3. \- Informed consent signed
Exclusion criteria
1. \- Hospital or ventilator-associated pneumonia 2. \- Health care-associated pneumonia 3. \- Viral pneumonia 4. \- Bacterial/viral coinfection pneumonia 5. \- History of heart disease 6. \- Chronic administration of statins 7. \- Chronic administration of steorids (Prednisolone more 20 mg/day or equivalent) 8. \- No signed informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Myocardian injury (scarring) in patients with CAP without cardiac disease (CP)history at 6 months of ICU admission | at 6 months | MRI with late gadolinium increase and t1 mapping techniques for to detect myocardial scarring |
| Heart dysfunction in patients with CAP without cardiac disease (CP)history in the first week of ICU admission | at day 7 of ICU admission) | Echocardiography with standard and strain techniques for to detect the presence of decrease in ejection fraction of both vetricules |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Temporal profile of the Troponin I as a cardiac injury biomarker in patients with CAP without cardiac disease (CP)history in the first week of ICU admission | once per day ( days 1 to 7 of ICU admission) | Determination of serum troponin-I according to standard technique |
| Temporal profile of the N-terminal pro-brain natriuretic peptide(NT-proBNP) as a cardiac injury biomarker in patients with CAP without cardiac disease (CP)history in the first week of ICU admission | once per day (days 1 to 7 of ICU admission) | Determination of serum N-terminal pro-brain natriuretic peptide(NT-proBNP) according to standard technique |
| Temporal profile of the heart- fatty acid binding protein (h-Fabp) as a cardiac injury biomarker in patients with CAP without cardiac disease (CP)history in the first week of ICU admission | once per day (days 1 to 7 of ICU admission) | Determination of serum heart- fatty acid binding protein (h-Fabp)according to standard technique |
Countries
Spain
Outcome results
None listed