COronary Microcirculation and Troponin Elevation in Septic Shock
Plasma cardiac troponin (cTn) elevation is an indicator of increased mortality in patients with sepsis yet the underlying cause of troponin elevation in sepsis is not known. The COMTESS study investigates whether elevated high-sensitive cardiac Troponin T (hs-cTnT) levels in hemodynamically unstable patients with sepsis can be explained by an underlying coronary artery disease or a process within the coronary microcirculation. Fifty patients with sepsis and with hs-cTnT elevation (>15 ng/L) will undergo coronary angiography, including an assessment of coronary flow using a method called thermo-dilution to record the index of microcirculatory resistance (IMR) in the left anterior descending artery (LAD). The relationship between IMR and hs-cTnT will subsequently be analysed. It is important to identify the underlying causes of elevated cTn during sepsis to target further research with an aim to improve the survival in patients suffering from this condition.
- EligibilityCriteria: Inclusion Criteria:  Patients fulfilling the Sepsis-3 definition of and diagnostic criteria for sepsis or septic shock Age 40 - 85 years Life expectancy > 1 year hs-cTnT values >15 ng/L  Exclusion Criteria:  pregnancy previous medical history of coronary artery by-pass grafting heart transplant previously verified ejection fraction (EF) ≤39% prior to hospital admission Hypertrophic cardiomyopathy (Septum > 15 mm) severe aortic stenosis amyloidosis or sarcoidosis with myocardial engagement estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 prior to hospital admission asthma infectious endocarditis a medical history of abdominal, thoracic, or orthopaedic surgery within the last three months prior to hospital admission. - HealthyVolunteers: No - Gender: All - MinimumAge: 40 Years - MaximumAge: 85 Years - StdAgeList: Adult, Older Adult - StudyPopulation: Sepsis- or septic shock-patients with a life expectancy of >1year and non-normal high-sensitive cardiac troponin T values (>15 ng/L) - SamplingMethod: Non-Probability Sample