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Mohamoud A, Abdallah N, Wardhere A, Teeri S, Ismayl M. Sepsis and septic shock outcomes and 90-day readmissions in heart failure with reduced ejection fraction: A national readmission database study. Curr Probl Cardiol 2024; 49:102696. [PMID: 38852912 DOI: 10.1016/j.cpcardiol.2024.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction (HFrEF) are at increased risk for sepsis/septic shock. METHOD A retrospective study was conducted using the Nationwide Readmission Database (2016-2020). Adult patients admitted with sepsis or septic shock were identified and stratified based on the presence of underlying HFrEF. Multivariable logistic regression assessed the association between HFrEF and in-hospital mortality, 90-day readmission, and other complications. RESULTS Among 7,326,930 sepsis/septic shock admissions, 6.2 % had HFrEF. HFrEF patients had higher in-hospital mortality (17 % vs. 9.6 %, p < 0.01) and 90-day readmission rates (30.2 % vs. 22.5 %, p < 0.01) compared to those without HFrEF. These differences persisted after adjustment with increased risk of in-hospital mortality (aOR 1.40, 95 %CI 1.38-1.42) and 90-day readmission (aOR 1.15, 95 %CI 1.13-1.16). CONCLUSION HFrEF patients admitted with sepsis/septic shock have significantly higher rates of in-hospital mortality, complications, and 90-day readmissions compared to those without HFrEF.
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Affiliation(s)
- Abdilahi Mohamoud
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.
| | - Nadhem Abdallah
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | | | - Samira Teeri
- Department of Internal Medicine, MedStar Washington Hospital Center, Georgetown University, Washington DC, USA
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Hasegawa D, Ishisaka Y, Maeda T, Prasitlumkum N, Nishida K, Dugar S, Sato R. Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis. J Intensive Care Med 2023; 38:797-808. [PMID: 37272081 DOI: 10.1177/08850666231180526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose: The prevalence and its impact on mortality of sepsis-induced cardiomyopathy (SICM) remain controversial. In this systematic review and meta-analysis, we investigated the prevalence and prognosis of SICM. Materials and Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Titles and abstracts were evaluated based on the following criteria: (1) published in English, (2) randomized controlled trials, cohort studies, or cross-sectional studies, (3) ≥ 18 years with sepsis, (4) reporting the prevalence and/or comparison of short-term mortality between those with and without SICM, defined as the new-onset reduction in left ventricular ejection fraction (LVEF) within 72 h on admission or from the diagnosis of sepsis. The random-effect model was used for all analyses. This meta-analysis was registered at PROSPERO (CDR42022332896). Results: Sixteen studies reported the prevalence of SICM and the pooled prevalence of SICM was 20% (95% confidence interval [CI], 16-25%; I2 = 89.9%, P < 0.01). Eleven studies reported short-term mortality and SICM was associated with significantly higher short-term mortality (The pooled odds ratio: 2.30, 95% CI, 1.43-3.69; I2 = 0%, P = 0.001). Conclusion: The prevalence of SICM was 20% in patients with sepsis, and the occurrence of SICM was associated with significantly higher short-term mortality.
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Affiliation(s)
- Daisuke Hasegawa
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Yoshiko Ishisaka
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Tetsuro Maeda
- Division of Pulmonary and Critical Care, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Kazuki Nishida
- Department of Biostatistics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Ryota Sato
- Department of Critical Care Medicine, The Queen's Medical Center, Honolulu, HI, USA
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Zhang H, Zhang D, Wang X, Liu Y, Lian H, Zhang Q, Zhao H, Chen X, Liu D. Prognostic implication of a novel right ventricular injury score in septic patients. ESC Heart Fail 2023; 10:1205-1213. [PMID: 36683014 PMCID: PMC10053157 DOI: 10.1002/ehf2.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 01/24/2023] Open
Abstract
AIMS We aim to investigate the prognostic value of a right ventricular (RV) injury score based on the concept of RV dilation, RV systolic dysfunction, and RV-pulmonary arterial (PA) decoupling in septic patients and to explore whether the RV injury (RVI) score can be used to grade the severity of RV dysfunction in these patients. METHODS AND RESULTS Septic patients admitted to the ICU were prospectively included. We collected haemodynamic and echocardiographic parameters as well as prognostic information. RV dilation was defined as right and left ventricular end-diastolic area ratio (R/LVEDA) > 2/3. RVSD was defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, right ventricular fractional area change (FAC) < 35%, or peak velocity of tricuspid annulus via tissue Doppler (S') < 10 cm/s. RV-PA decoupling was represented by the TAPSE/pulmonary arterial systolic pressure (PASP) ratio. RVI score were determined by the presence of the following findings: RVSD, RV dilation, and RV-PA decoupling, that is, one point for each finding. A total of 327 patients were enrolled in this study, among whom 276 survived and 51 died at 30 days after admission. Overall, 18.0% had RV dilation, 35.8% had RVSD, and 21.4% had RV-PA decoupling, with an appreciable overlap present. A multivariate Cox regression analysis showed that RV dilation (HR: 2.19, 95% CI: 1.19-4.01, P = 0.011), RVSD (HR: 2.25, 95% CI: 1.23-4.13, P = 0.009) and RV-PA decoupling (HR: 2.08, 95% CI: 1.19-3.65, P = 0.011) were independently associated with a 30 day mortality. Furthermore, RVI score was also an independent predictor, displayed additive effect with respect to 30 day mortality (RVI score 1 vs. RVI score 0, HR: 2.94, 95% CI: 1.20-7.20, P = 0.018; RVI score 2 vs. RVI score 0, HR: 3.20, 95% CI: 1.28-7.98, P = 0.013; RVI score 3 vs. RVI score 0, HR: 7.17, 95% CI: 2.65-19.38, P < 0.001), and had the best performance in model goodness of fit, discrimination and variance explained than the other RV indices. CONCLUSIONS The RVI score was independently related to 30 day mortality and had the potential to grade the severity of RV dysfunction in septic patients.
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Affiliation(s)
- Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dingding Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Liu
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Hui Lian
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Zhao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiukai Chen
- School of Medicine, Pittsburgh Heart, Lung, Blood and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ehrman RR, Bredell BX, Harrison NE, Favot MJ, Haber BD, Welch RD, Levy PD, Sherwin RL. Increasing illness severity is associated with global myocardial dysfunction in the first 24 hours of sepsis admission. Ultrasound J 2022; 14:32. [PMID: 35900610 PMCID: PMC9334514 DOI: 10.1186/s13089-022-00282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background Septic cardiomyopathy was recognized more than 30 years ago, but the early phase remains uncharacterized as no existing studies captured patients at the time of Emergency Department (ED) presentation, prior to resuscitation. Therapeutic interventions alter cardiac function, thereby distorting the relationship with disease severity and outcomes. The goal of this study was to assess the impact of illness severity on cardiac function during the first 24 h of sepsis admission. Methods This was a pre-planned secondary analysis of a prospective observational study of adults presenting to the ED with suspected sepsis (treatment for infection plus either lactate > 2 mmol/liter or systolic blood pressure < 90 mm/Hg) who received < 1L IV fluid before enrollment. Patients had 3 echocardiograms performed (presentation, 3, and 24 h). The primary outcome was the effect of increasing sepsis illness severity, defined by ED Sequential Organ Failure Assessment (SOFA) score, on parameters of cardiac function, assessed using linear mixed-effects models. The secondary goal was to determine whether cardiac function differed between survivors and non-survivors, also using mixed-effects models. Results We enrolled 73 patients with a mean age of 60 (SD 16.1) years and in-hospital mortality of 23%. For the primary analysis, we found that increasing ED SOFA score was associated with worse cardiac function over the first 24 h across all assessed parameters of left-ventricular systolic and diastolic function as well as right-ventricular systolic function. While baseline strain and E/e' were better in survivors, in the mixed models analysis, the trajectory of Global Longitudinal Strain and septal E/e′ over the first 24 h of illness differed between survivors and non-survivors, with improved function at 24 h in non-survivors. Conclusions In the first study to capture patients prior to the initiation of resuscitation, we found a direct relationship between sepsis severity and global myocardial dysfunction. Future studies are needed to confirm these results, to identify myocardial depressants, and to investigate the link with adverse outcomes so that therapeutic interventions can be developed. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00282-6.
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Tucker RV, Williams K, Theyyunni N, Fung CM. Sepsis-Induced Cardiomyopathy Detected With Focused Cardiac Ultrasound in the Emergency Department. J Emerg Med 2022; 63:e91-e99. [DOI: 10.1016/j.jemermed.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/04/2022] [Accepted: 06/04/2022] [Indexed: 12/05/2022]
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Ehrman RR, Favot MJ, Harrison NE, Khait L, Ottenhoff JE, Welch RD, Levy PD, Sherwin RL. Early echocardiographic assessment of cardiac function may be prognostically informative in unresuscitated patients with sepsis: A prospective observational study. PLoS One 2022; 17:e0269814. [PMID: 35802886 PMCID: PMC9270056 DOI: 10.1371/journal.pone.0269814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose The goal of this study was to explore the association cardiac function at Emergency Department (ED) presentation prior to the initiation of resuscitation, and its change at 3-hours, with adverse outcomes in patients with sepsis. Methods This was a prospective observational study of patients presenting to an urban ED with suspected sepsis. Patients had a point-of-care echocardiogram performed prior to initiation of resuscitation and again 3 hours later. Left-ventricular (LV) parameters recorded included e’, and E/e’, and ejection fraction (EF); right-ventricular (RV) function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Logistic and generalized linear regression were used to assess the association of echocardiographic parameters and ≥ 2-point increase in SOFA score at 24 hours (primary outcome) and 24-hours SOFA score and in-hospital mortality (secondary outcomes). Results For ΔSOFA ≥ 2 and 24-hour SOFA score, declining LVEF was associated with better outcomes in patients with greater baseline SOFA scores, but worse outcomes in patients with lower baseline scores. A similar relationship was found for ΔTAPSE at 3 hours. Reduced LVEF at presentation was associated with increased mortality after adjusting for ED SOFA score (odds-ratio (OR) 0.76 (CI 0.60–0.96). No relationship between diastolic parameters and outcomes was found. IVF administration was similar across ΔLVEF/TAPSE sub-groups. Conclusions Our results suggest that early change in LV and RV systolic function are independently prognostic of sepsis illness severity at 24-hours. Further study is needed to determine if this information can be used to guide treatment and improve outcomes.
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Affiliation(s)
- Robert R. Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- * E-mail:
| | - Mark J. Favot
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nicholas E. Harrison
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Lyudmila Khait
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jakob E. Ottenhoff
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Robert D. Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Phillip D. Levy
- Department of Emergency Medicine, Integrative Biosciences Center, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Robert L. Sherwin
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
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Wang L, Wang Z, Liu X, Zhang Y, Wang M, Liang X, Li G. Effects of extracellular histones on left ventricular diastolic function and potential mechanisms in mice with sepsis. Am J Transl Res 2022; 14:150-165. [PMID: 35173835 PMCID: PMC8829607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Extracellular histone (EH) is involved in the development of septic myocardial injury (SMI). In this study, we explored whether EH could induce left ventricular diastolic dysfunction (LVDD) in sepsis, and investigated the potential mechanisms through in vivo and in vitro experiments using animal models. METHODS The ratio between E-wave and A-wave (E/A ratio), left ventricular end diastolic volume, and isovolumic relaxation time (IVRT) were measured in cecal ligation and perforation (CLP)- and EH-treated male C57BL/6J mice using echocardiography. The protein and mRNA levels of apoptosis-related proteins (cleaved caspase-3, Bcl-2, and Bax) and cardiac troponin T (cTnT) in the left ventricular tissue/cardiomyocytes were measured using enzyme-linked immunosorbent assay, qRT-PCR, and western blotting. Cardiomyocyte apoptosis was detected by flow cytometry. RESULTS CLP mice presented with LVDD, which was accompanied by increased circulating histones, cTnT and Bax protein levels. Circulating histones were correlated with cTnT, Bax, IVRT, and E/A ratio in CLP mice. Intraperitoneal injection of EH resulted in LVDD in mice. EH induced cardiomyocyte apoptosis, and histone neutralizing agents improved SMI and protected mice against CLP- and EH-induced death. CONCLUSION EH is involved in septic LVDD, and this alteration might be associated with EH-induced apoptosis. EH may serve as a potential therapeutic target for SMI.
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Affiliation(s)
- Lijun Wang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical UniversityTianjin 300211, People’s Republic of China
- Department of Emergency Medicine, Tianjin Medical University General HospitalTianjin 300052, People’s Republic of China
| | - Ziyi Wang
- Department of Emergency Medicine, Tianjin Medical University General HospitalTianjin 300052, People’s Republic of China
- School of Clinical Medicine, Tsinghua UniversityBeijing 100084, People’s Republic of China
| | - Xing Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical UniversityTianjin 300211, People’s Republic of China
| | - Yue Zhang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical UniversityTianjin 300211, People’s Republic of China
| | - Manman Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical UniversityJining 272000, Shandong, People’s Republic of China
| | - Xue Liang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical UniversityTianjin 300211, People’s Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical UniversityTianjin 300211, People’s Republic of China
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Meng JB, Hu MH, Zhang M, Hu GP, Zhang W, Hu SJ. The Correlation Between Whole Blood Copper (Cu), Zinc (Zn) Levels and Cu/Zn Ratio and Sepsis-Induced Left Ventricular Systolic Dysfunction (SILVSD) in Patients with Septic Shock: A Single-Center Prospective Observational Study. Int J Gen Med 2021; 14:7219-7234. [PMID: 34737617 PMCID: PMC8558506 DOI: 10.2147/ijgm.s335348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to explore relationships between whole blood copper (Cu), zinc (Zn) and Cu/Zn ratio and cardiac dysfunction in patients with septic shock. Subjects and Methods Between April 2018 and March 2020, septic shock patients with sepsis-induced left ventricular systolic dysfunction (SILVSD, left ventricular ejection fraction, LVEF<50%) and with no sepsis-induced myocardial dysfunction (non-SIMD, septic shock alone and LVEF>50%) and controls were prospectively enrolled. Whole blood Cu and Zn levels were measured using flame atomic absorption spectrophotometry. Results Eighty-six patients with septic shock including both 41 SILVSD and 45 non-SIMD and 25 controls were studied. Whole blood Cu levels and Cu/Zn ratio were significantly higher and Zn levels were lower in SILVSD compared with non-SIMD and controls (Cu, p=0.009, <0.001; Zn, p=0.029, <0.001; Cu/Zn ratio, p=0.003, <0.001). Both increased whole blood Cu and Cu/Zn ratio and reduced Zn were associated with lower LVEF (all p<0.001) and higher amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (Cu, p=0.002; Zn, p<0.001; Cu/Zn ratio, p<0.001) and had predictive values for SILVSD (Cu, AUC=0.666, p=0.005; Zn, AUC=0.625, p=0.039; Cu/Zn ratio, AUC=0.674, p=0.029). Whole blood Cu levels and Cu/Zn ratio were increased but Zn levels were reduced in non-survivors compared with survivors (Cu, p<0.001; Zn, p<0.001; Cu/Zn ratio, p<0.001). Whole blood Cu and Zn displayed the value of predicting 28-day mortality (Cu, AUC = 0.802, p<0.001; Zn, AUC=0.869, p<0.001; Cu/Zn ratio, AUC=0.902, p<0.001). Conclusion Findings of the study suggest that whole blood Cu levels and Cu/Zn ratio are increased in SILVSD patients and positively correlated with cardiac dysfunction, while whole blood Zn levels are reduced and negatively associated with cardiac dysfunction. Moreover, both whole blood Cu, Zn and Cu/Zn ratio might distinguish between SILVSD and non-SIMD in septic shock patients and predict 28-day mortality. Trial Registration Registered at http://www.chictr.org.cn/ChiCTR1800015709.
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Affiliation(s)
- Jian-Biao Meng
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, People's Republic of China.,Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People's Republic of China
| | - Ma-Hong Hu
- Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People's Republic of China
| | - Ming Zhang
- Intensive Care Unit, Hangzhou Cancer Hospital, Hangzhou, Zhejiang Province, 310002, People's Republic of China
| | - Gong-Pai Hu
- Department of Ultrasonography, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People's Republic of China
| | - Wei Zhang
- Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People's Republic of China
| | - Shen-Jiang Hu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, People's Republic of China
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Ince ME, Turgut K, Naseri A. Echocardiographic Assessment of Left Ventricular Systolic and Diastolic Functions in Dogs with Severe Sepsis and Septic Shock; Longitudinal Study. Animals (Basel) 2021; 11:ani11072011. [PMID: 34359139 PMCID: PMC8300373 DOI: 10.3390/ani11072011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Sepsis is associated with cardiovascular changes. The aim of the study was to determine sepsis-induced myocardial dysfunction in dogs with severe sepsis and septic shock using transthoracic echocardiography. Clinical, laboratory and cardiologic examinations for the septic dogs were performed at admission, 6 and 24 h, and on the day of discharge from the hospital. Left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and both types of the dysfunction were present in 13%, 70%, and 9% of dogs with sepsis, respectively. Dogs with LV diastolic dysfunction had a worse outcome and short-term mortality. Transthoracic echocardiography can be used for monitoring cardiovascular dysfunction in dogs with sepsis. Abstract The purpose of this study was to monitor left ventricular systolic dysfunction (LVSD) and diastolic dysfunction (LVDD) using transthoracic echocardiography (TTE) in dogs with severe sepsis and septic shock (SS/SS). A prospective longitudinal study using 23 dogs with SS/SS (experimental group) and 20 healthy dogs (control group) were carried out. All the clinical, laboratory and cardiologic examinations for the experimental dogs were performed at admission, 6 and 24 h after the start of treatment and on the day of discharge. LVSD was described as LV ejection fraction (LVEF) < 50%. LVDD was determined when the septal mitral annulus early diastolic velocity (LVEm) was <8 cm/s. LVSD and LVDD were present in 3 and 16 dogs with SS/SS, respectively, with both types of dysfunction present in 2 of the dogs. Although all the dogs with LVSD survived, 8 dogs with LVDD did not. The survival period was significantly shorter in dogs with an LVEm < 8 cm/s (1.3 ± 1.4 days). In conclusion, LVDD, rather than LVSD, was a common cardiovascular abnormality in the septic dogs, and this may be a negative prognostic factor. TTE is a useful tool for the identifying and monitoring of myocardial dysfunction in the dogs with SS/SS.
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Affiliation(s)
- Mehmet Ege Ince
- Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99100 Nicosia, North Cyprus, Turkey;
- Correspondence: or ; Tel.: +90-533-822-92-50
| | - Kursad Turgut
- Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99100 Nicosia, North Cyprus, Turkey;
| | - Amir Naseri
- Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, 42130 Konya, Turkey;
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Pan G, Fan X, Bian J, He Z, Yue J, Sun H, Zou F, Chao C, Chao Y, Fu Y, Wang X, Chen S. Application and significance of PiCCO monitoring technique combined with troponin I detection in fluid resuscitation of elderly patients with septic myocardial dysfunction. Am J Transl Res 2021; 13:6846-6854. [PMID: 34306435 PMCID: PMC8290674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study was designed to demonstrate the predictive value of Pulse indicate Contour Cardiac Output (PiCCO) monitoring technique combined with troponin I (cTnI) detection in septic myocardial dysfunction (SMD) of the elderly. METHODS One hundred and nineteen elderly patients with SMD treated in our hospital from March 2016 to September 2019 were enrolled and allocated into the joint group (JG; 64 cases) for capacity management of fluid resuscitation under the guidance of PiCCO monitoring technique and cTnI detection, and the control group (CG; 55 cases) for conventional capacity management. Clinical indicators, hemodynamics, improvement of myocardial injury markers and inflammatory factors 6 h and 36 h post intervention, fluid balance 6 h, 12 h and 36 h post intervention, drug consumption (norepinephrine), treatment effect and 28-day hospitalization mortality were compared between the two groups. RESULTS After resuscitation, the urine volume per hour and the fluid resuscitation volume were higher while the blood lactic acid (BLA) expression was lower in JG as compared to CG. JG presented a remarkably lower central venous pressure (CVP) than CG after resuscitation, with notably higher mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2). In comparison with CG, JG displayed dramatically lower cTnI and N-terminal pro-brain natriuretic peptide (NT-ProBNP) 6 h and 36 h post intervention, as well as evidently reduced interleukin-6 (IL-6), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). After 36 h of intervention, the fluid balance was evidently lower in JG than in CG. JG showed statistically less use of norepinephrine, less time of mechanical ventilation and ICU stay, and noticeably lower incidence of multiple organ dysfunction syndrome (MODS), as well as dramatically lower 28-day hospitalization mortality than CG post intervention. CONCLUSIONS PiCCO monitoring technique combined with cTnI detection is high-performing in fluid resuscitation of elderly patients with SMD, which can meliorate the myocardial function of patients, reduce medication and facilitate disease recovery.
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Affiliation(s)
- Guojun Pan
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Xiuli Fan
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Jie Bian
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Zemin He
- Department of Emergency, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Jiajun Yue
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Hua Sun
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Fei Zou
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Chenglei Chao
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Yiqun Chao
- Department of Emergency, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Ying Fu
- Department of Emergency, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Xiao Wang
- Department of Emergency, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
| | - Shuhua Chen
- Department of Critical Care Medicine, Changzhou Fourth People’s HospitalChangzhou 213000, Jiangsu Province, China
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Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The heart is one of the most important oxygen delivery organs, and dysfunction significantly increases the mortality of the body. Hence, the heart has been studied in sepsis for over half a century. However, the definition of sepsis-induced cardiomyopathy is not unified yet, and the conventional conception seems outdated: left ventricular systolic dysfunction (LVSD) along with enlargement of the left ventricle, recovering in 7 to 10 days. With the application of echocardiography in intensive care units, not only LVSD but also left ventricular diastolic dysfunction, right ventricular dysfunction, and even diffuse ventricular dysfunction have been seen. The recognition of sepsis-induced cardiomyopathy is gradually becoming complete, although our understanding of it is not deep, which has made the diagnosis and treatment stagnate. In this review, we summarize the research on sepsis-induced cardiomyopathy. Women and young people with septic cardiomyopathy are more likely to have LVSD, which may have the same mechanism as stress cardiomyopathy. Elderly people with ischemic cardiomyopathy and hypertension tend to have left ventricular diastolic dysfunction. Patients with mechanical ventilation, acute respiratory distress syndrome or other complications of increased right ventricular afterload mostly have right ventricular dysfunction. Diffuse cardiac dysfunction has also been shown in some studies; patients with mixed or co-existing cardiac dysfunction are more common, theoretically. Thus, understanding the pathophysiology of sepsis-induced cardiomyopathy from the perspective of critical care echocardiography is essential.
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Sanfilippo F, Huang S, Messina A, Franchi F, Oliveri F, Vieillard-Baron A, Cecconi M, Astuto M. Systolic dysfunction as evaluated by tissue Doppler imaging echocardiography and mortality in septic patients: A systematic review and meta-analysis. J Crit Care 2020; 62:256-264. [PMID: 33461118 DOI: 10.1016/j.jcrc.2020.12.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/06/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Septic induced cardiomyopathy has a wide spectrum of presentation, being associated with systolic and/or diastolic dysfunction. There is currently no evidence of association between left ventricular (LV) systolic dysfunction and mortality in septic patients. METHODS We conducted a systematic review and meta-analysis to investigate the association between systolic wave (s') obtained with Tissue Doppler Imaging (TDI) and mortality in septic patients. Secondary outcome was the association of LV ejection fraction with mortality. RESULTS In the primary analysis we included a total of 13 studies (1197 patients, mortality 39.9%); overall s' wave was not significantly different between survivors and non-survivors (Standardized Mean Difference 0.20, 95%Confidence-Interval - 0.18, 0.59). This result was confirmed also in sub-groups analyses according to regional criteria of TDI sampling. A post-hoc analysis including only septic shock patients confirmed that s' wave was not associated with mortality. Several sensitivity analyses confirmed these results. We found no evidence of publication bias. The secondary analysis (11 studies, 1081 patients, mortality 36.7%) showed that LV ejection fraction was not associated with mortality (Mean Difference 0.98, 95% Confidence-Interval - 1.79,3.75). CONCLUSIONS There is no association between mortality and LV systolic function as evaluated by TDI s' wave in septic patients.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico - San Marco University Hospital, Catania, Italy.
| | - Stephen Huang
- Intensive Care Unit, Nepean Clinical School, University of Sydney, Kingswood, NSW, Australia
| | - Antonio Messina
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100 Siena, Italy
| | - Francesco Oliveri
- Department of Anesthesia and Intensive Care, Policlinico - San Marco University Hospital, Catania, Italy
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise, Boulogne-Billancourt, INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, Policlinico - San Marco University Hospital, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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Kim JS, Kim YJ, Kim M, Ryoo SM, Kim WY. Association between right ventricle dysfunction and poor outcome in patients with septic shock. Heart 2020; 106:1665-1671. [PMID: 32641318 DOI: 10.1136/heartjnl-2020-316889] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Sepsis-induced myocardial dysfunction (SIMD) can involve both the left and right ventricles. However, the characteristics and outcomes across various manifestations of SIMD remain unknown. METHODS This was a retrospective cohort study using a prospective registry of septic shock from January 2011 and April 2017. Patients with clinically presumed cardiac dysfunction underwent echocardiography within 72 hours after admission and were enrolled (n=778). SIMD was classified as left ventricle (LV) systolic/diastolic and right ventricle (RV) dysfunction, which were defined based on the American Society of Echocardiography criteria. The primary outcome was 28-day mortality. RESULTS Of the 778 septic shock patients who underwent echocardiography, 270 (34.7%) showed SIMD. The median age was 67.0 years old, and the male was predominant (57.3%). Among them, 67.3% had LV systolic dysfunction, 40.7% had RV dysfunction and 39.3% had LV diastolic dysfunction. Although serum lactate level and sequential organ failure assessment score were not significantly different between groups, SIMD group showed higher troponin I (0.1 vs 0.1 ng/mL; p=0.02) and poor clinical outcomes, including higher 28-day mortality (35.9 vs 26.8%; p<0.01), longer intensive care unit length of stay (5 vs 2 days; p<0.01) and prolonged mechanical ventilation (9 vs 4 days; p<0.01). Multivariate analysis showed that isolated RV dysfunction was an independent risk factor of 28-day mortality (OR 2.26, 95% CI 1.04 to 4.91). CONCLUSIONS One-third of patients with septic shock showed various myocardial dysfunctions. LV systolic dysfunction was common; however, only RV dysfunction was associated with short-term mortality.
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Affiliation(s)
- June-Sung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Muyeol Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
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Dong J, White S, Nielsen K, Banchs J, Wang J, Botz GH, Nates JL. Tricuspid Annular Plane Systolic Excursion is a Predictor of Mortality for Septic Shock. Intern Med J 2020; 51:1854-1861. [PMID: 32618101 DOI: 10.1111/imj.14957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Cardiac dysfunction is a common sequela in patients with sepsis and multi-organ dysfunction. Echocardiography is commonly used in the investigation of circulatory failure. We aimed to evaluate the prognostic value of echocardiographic parameters in patients with septic shock. METHODS This study was a retrospective trial. We included patients who were admitted to ICU with septic shock. The patients' echocardiograms, clinical data, and outcomes were obtained from their medical records. Associations between echo-cardiogram variables and mortality were assessed using logistic regression, controlled for age, sex, BMI, and the interval between the ICU admission and echocardiogram. The utility of statistically significant echocardiogram variables to predict mortality were assessed using receiver operating characteristic (ROC) curves. RESULTS The outcomes presented that Tricuspid Annular Plane Systolic Excursion(TAPSE) was statistically significantly associated with both ICU (p = 0.02) and 90-day (p = 0.001) mortality. From the ROC curves, TAPSE emerged a significant and moderate predictor for 90-day (area under curve (AUC) = 0.69, 95% CI = 0.565-0.814) and in-ICU mortality (AUC = 0.762, 95% CI = 0.652-0.871). The optimal cut-off for TAPSE was 2.1 cm for both 90-day mortality (sensitivity of 80% and specificity and 58%) and in-ICU mortality (sensitivity of 69% and specificity of 77%). CONCLUSION TAPSE was associated with increased mortality in those with sepsis and suspicion of cardiac dysfunction. This is a hypothesis generating paper that an association may be present and requires significant more work with expansion to the entire population base. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jun Dong
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA.,Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Intensive Care Unit department, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Seth White
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA
| | - Kirsten Nielsen
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Aarhus N, Denmark
| | - Jose Banchs
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA
| | - Gregory H Botz
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA
| | - Joseph L Nates
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit #112, Houston, Texas, 77030, USA
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Zhang H, Lian H, Zhang Q, Chen X, Wang X, Liu D. Prognostic implications of tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio in septic shock patients. Cardiovasc Ultrasound 2020; 18:20. [PMID: 32532300 PMCID: PMC7293130 DOI: 10.1186/s12947-020-00198-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/07/2020] [Indexed: 01/05/2023] Open
Abstract
Background To explore the association between the ratio of tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP), and long- and short-term outcomes in mechanically ventilated septic shock patients. Methods Septic shock patients admitted to the intensive care unit (ICU) were screened for enrollment. Echocardiographic parameters including TAPSE and tricuspid regurgitation velocity, haemodynamic and respiratory parameters, and prognostic data were obtained. Results One hundred eighteen subjects were enrolled in this study, among whom 75 survived and 43 died at the one-year follow-up. ROC curve analysis revealed that the TAPSE/PASP ratio was able to assess one-year all-cause mortality with an area under the curve of 0.817 (95% CI: 0.739–0.896, p < 0.001) and the optimal cutoff value was 0.50 mm/mmHg. Kaplan-Meier survival analysis showed that one-year all-cause mortality was significantly higher in patients with TAPSE/PASP ≤0.5 mm/mmHg than in patients with TAPSE/PASP > 0.5 mm/mmHg (log-rank 32.934, p < 0.001). According to the Cox regression survival analyses, the TAPSE/PASP ratio was independently associated with one-year all-cause mortality (HR 0.007, 95% CI:0.000–0.162, p = 0.002) and ICU mortality (HR 0.027, 95% CI:0.001–0.530, p = 0.017). According to the multivariable analysis, the TAPSE/PASP ratio was an independent variable associated with mechanical ventilation (MV) duration (standard coefficient − 0.240, p = 0.010). Conclusion The TAPSE/PASP ratio demonstrated prognostic value for one-year all-cause mortality, ICU mortality and MV duration in mechanically ventilated septic shock patients.
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Affiliation(s)
- Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Hui Lian
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiukai Chen
- Pittsburgh Heart, Lung, Blood and Vascular Institute, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
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Shin DG, Kang MK, Seo YB, Choi J, Choi SY, Choi S, Cho JR, Lee N. Factors associated with abnormal left ventricular ejection fraction (decreased or increased) in patients with sepsis in the intensive care unit. PLoS One 2020; 15:e0229563. [PMID: 32155161 PMCID: PMC7064219 DOI: 10.1371/journal.pone.0229563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sepsis-induced cardiomyopathy (SIC) is known to show cardiac dysfunction in patients with sepsis. Both a decrease or an increase in ejection fraction (EF), an indicator of cardiac function, can occur. The purpose of this study was to identify factors associated with abnormal left ventricular (LV) function measured by EF in patients with sepsis in the intensive care unit (ICU). METHODS This was a retrospective study performed from November 2016 to December 2018. Three-hundred and sixty-six patients (mean age, 73 ± 13 years; 191 [52%] men) admitted to the ICU with sepsis were included. Patients were classified into three categories according to LV EF (group 1 -[EF<50%, n = 36], group 2 -[50≤EF<70%, n = 252], and group 3 -[EF≥70%, n = 78]). Echocardiographic assessment was performed within 48 hours of diagnosis of sepsis. We analyzed clinical factors including mortality, echocardiographic findings, and laboratory parameters. RESULTS Decreased LV EF occurred in 36 (10%) patients and hyper-dynamic EF developed in 78 (21%) patients. Of 366 patients, 103 (28%) patients died. Baseline characteristics were similar in the three groups, except female sex an indicator of abnormal EF. Mortality rates were also similar in the three groups; however, mortality rates were significantly higher in patients with abnormal EF (decreased or increased vs. normal). Echocardiographic parameters were significantly different in the three groups, in terms of LV systolic parameters and chamber size. Small left atrium (LA) and small LV were significantly associated with abnormal EF (especially in patients with increased EF). High brain natriuretic peptide was associated with decreased EF. Among these factors, female sex and small LA were significantly associated with abnormal EF in the multiple regression analysis. CONCLUSION Our findings highlight that female sex and small cardiac size are associated with abnormal EF, and therefore, death. Therefore, female patients and patients with small LA should be monitored closely when they present with sepsis.
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Affiliation(s)
- Dong Geum Shin
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Min-Kyung Kang
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
- * E-mail:
| | - Yu Bin Seo
- Division of Infection, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Jaehuk Choi
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Seon Yong Choi
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Seonghoon Choi
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Jung Rae Cho
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Namho Lee
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
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17
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Preoperative elevated E/e' (≥ 15) with preserved ejection fraction is associated with the development of postoperative heart failure in intermediate-risk non-cardiac surgical patients. J Anesth 2020; 34:250-256. [PMID: 31897609 PMCID: PMC7098923 DOI: 10.1007/s00540-019-02728-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/21/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Left ventricular diastolic dysfunction is an independent risk factor for adverse cardiovascular morbidities and mortalities in cardiovascular and high-risk surgical patients. However, there were only a few investigations among intermediate-risk surgical patients. This study aimed to investigate postoperative heart failure (HF) in intermediate-risk surgical patients who had preoperative diastolic dysfunction with preserved ejection fraction (EF). METHODS Consecutive patients underwent intermediate-risk surgery between January 2016 and December 2018 were retrospectively evaluated. Patients with preserved EF were divided into three groups using one of the parameters of diastolic function: the ratio of early diastolic filling velocity to the peak diastolic velocity of mitral medial annulus (E/e') ≥ 15, E/e' between 8 and 15, and E/e' < 8. Postoperative HF was defined as clinical symptoms and radiological evidence and low SpO2 less than 93%. The primary outcome was the incidence of postoperative HF and its relation to preoperative E/e'. Chi-squared test, unpaired t test with Welch's correction, and multivariate logistic regression were used for analysis. RESULTS In total, 965 patients were included in the final analysis. Postoperative HF developed in 36/965 (3.7%) patients with preserved EF. The incidence of postoperative HF was stratified according to the E/e', and the rates of HF occurrence in patients with E/e' < 8, 8-15, and ≥ 15 were 1.8%, 2.7%, and 15%, respectively (P < 0.01). CONCLUSION Preoperative elevated E/e' (≥ 15) was associated with the development of postoperative HF in intermediate-risk surgical patients with preserved EF.
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Ince ME, Turgut K, Akar A, Naseri A, Sen I, Süleymanoglu H, Ertan M, Sagmanligil V. Prognostic importance of tissue Doppler imaging of systolic and diastolic functions in dogs with severe sepsis and septic shock. Acta Vet Hung 2019; 67:517-528. [PMID: 31842599 DOI: 10.1556/004.2019.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The goal of this study was to determine the distribution of left ventricular (LV) systolic and diastolic dysfunctions and their prognostic value in canine parvovirus-infected dogs suffering from severe sepsis and septic shock (SS/SS). Twenty dogs with SS/SS (experimental group) and 18 healthy dogs (control group) were used in the study. Systolic and diastolic dysfunction was present in three (15%) and 14 (70%) diseased dogs, respectively, with both types of dysfunction present in two (10%) of the patients. These dogs were split into two groups: survivors (Sv, n = 14) and non-survivors (non-Sv, n = 6). The pulsed wave tissue Doppler (PW-TDI) septal mitral annulus systolic velocity (LVS'), an index of systolic dysfunction, had a high sensitivity and specificity to differentiate Sv and non-Sv animals, with values of 83.3% (95% CI: 41.6-98.4) and 83.3% (95% CI: 59.8-94.8), respectively, at an optimum cut-off point of ≥ 9.90. The PW-TDI septal early mitral annulus early-diastolic peak velocity (E'), an index of diastolic dysfunction, had the best sensitivity and specificity to differentiate Sv and non-Sv dogs, with values of 100% (95% CI: 55.2-100) and 100% (95% CI: 78.9-100), respectively, at an optimum cut-off point of ≤ 6.50. Therefore, diastolic dysfunction determined by E' is a good independent outcome predictor.
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Affiliation(s)
- Mehmet Ege Ince
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Kursad Turgut
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Aybars Akar
- 2Department of Internal Medicine, Faculty of Veterinary Medicine, Mehmet Akif Ersoy University, Turkey
| | - Amir Naseri
- 3Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Ismail Sen
- 4Department of Internal Medicine, Faculty of Veterinary Medicine, Kyrgyz Turkish Manas University, Bishkek, Kyrgyzstan
| | - Havva Süleymanoglu
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Merve Ertan
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Vedat Sagmanligil
- 5Department of Physiology, Faculty of Veterinary Medicine, Near East University, Nicosia, North Cyprus, Turkey
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Lautz AJ, Zingarelli B. Age-Dependent Myocardial Dysfunction in Critically Ill Patients: Role of Mitochondrial Dysfunction. Int J Mol Sci 2019; 20:ijms20143523. [PMID: 31323783 PMCID: PMC6679204 DOI: 10.3390/ijms20143523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
Myocardial dysfunction is common in septic shock and post-cardiac arrest but manifests differently in pediatric and adult patients. By conventional echocardiographic parameters, biventricular systolic dysfunction is more prevalent in children with septic shock, though strain imaging reveals that myocardial injury may be more common in adults than previously thought. In contrast, diastolic dysfunction in general and post-arrest myocardial systolic dysfunction appear to be more widespread in the adult population. A growing body of evidence suggests that mitochondrial dysfunction mediates myocardial depression in critical illness; alterations in mitochondrial electron transport system function, bioenergetic production, oxidative and nitrosative stress, uncoupling, mitochondrial permeability transition, fusion, fission, biogenesis, and autophagy all may play key pathophysiologic roles. In this review we summarize the epidemiologic and clinical phenotypes of myocardial dysfunction in septic shock and post-cardiac arrest and the multifaceted manifestations of mitochondrial injury in these disease processes. Since neonatal and pediatric-specific data for mitochondrial dysfunction remain sparse, conclusive age-dependent differences are not clear; instead, we highlight what evidence exists and identify gaps in knowledge to guide future research. Finally, since focal ischemic injury (with or without reperfusion) leading to myocardial infarction is predominantly an atherosclerotic disease of the elderly, this review focuses specifically on septic shock and global ischemia-reperfusion injury occurring after resuscitation from cardiac arrest.
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Affiliation(s)
- Andrew J Lautz
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Basilia Zingarelli
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA.
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20
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Havaldar AA. Evaluation of sepsis induced cardiac dysfunction as a predictor of mortality. Cardiovasc Ultrasound 2018; 16:31. [PMID: 30501628 PMCID: PMC6267025 DOI: 10.1186/s12947-018-0149-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/20/2018] [Indexed: 01/21/2023] Open
Abstract
Background Sepsis is characterized by life threatening organ dysfunction with dysregulated immune response. Cardiac dysfunction seen in sepsis is unique as it is reversible within 7–10 days. Initial study by Parker et al. in 1984, showed, paradoxically lower ejection fraction in survivors of septic shock. Subsequent meta-analysis did not support that survivors had lower ejection fraction. Aim of our study was to assess the sepsis induced cardiac dysfunction by 2D echocardiography and Troponin I. Methods After obtaining institutional ethical committee approval (ref 125/2016), a prospective observational study was done in an university medical college from February 2016 to April 2016. Inclusion criteria were patients diagnosed with sepsis by new sepsis definition. Pregnant patients and patients with poor echo window were excluded. Echocardiographic assessment was done within 48 h of diagnosis of sepsis by standard methods. Primary outcome was ICU mortality and secondary outcome was ICU length of stay. Statistical analysis was done using STATA™ (Version14, College station TX). Results Fifty eight patients were screened, ten were excluded due to poor echo window. Baseline characteristics were similar in survivors and non survivors, except APACHE II, SOFA age and cumulative fluid balance. Echocardiographic parameters, mitral annular plane systolic excursion (MAPSE), E/e’ and LV systolic function assessed by visual gestalt method were found to be statistically significant. Parameters found significant in bivariate analysis were used as a covariate in logistic regression. APACHE II and MAPSE were significant co-variates in logistic regression with ROC (0.95) and calibration was satisfactory (chi2(df8),1.98, p = 0.98). Conclusions Sepsis induced cardiac dysfunction assessed by echocardiography showed measurement of MAPSE when combined with APACHE II was a good predictor of mortality. Among the echocardiographic parameters MAPSE alone was a good predictor of mortality. Results of this study need further validation from larger study.
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Ehrman RR, Sullivan AN, Favot MJ, Sherwin RL, Reynolds CA, Abidov A, Levy PD. Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:112. [PMID: 29724231 PMCID: PMC5934857 DOI: 10.1186/s13054-018-2043-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sepsis is a common condition encountered by emergency and critical care physicians, with significant costs, both economic and human. Myocardial dysfunction in sepsis is a well-recognized but poorly understood phenomenon. There is an extensive body of literature on this subject, yet results are conflicting and no objective definition of septic cardiomyopathy exists, representing a critical knowledge gap. OBJECTIVES In this article, we review the pathophysiology of septic cardiomyopathy, covering the effects of key inflammatory mediators on both the heart and the peripheral vasculature, highlighting the interconnectedness of these two systems. We focus on the extant literature on echocardiographic and laboratory assessment of the heart in sepsis, highlighting gaps therein and suggesting avenues for future research. Implications for treatment are briefly discussed. CONCLUSIONS As a result of conflicting data, echocardiographic measures of left ventricular (systolic or diastolic) or right ventricular function cannot currently provide reliable prognostic information in patients with sepsis. Natriuretic peptides and cardiac troponins are of similarly unclear utility. Heterogeneous classification of illness, treatment variability, and lack of formal diagnostic criteria for septic cardiomyopathy contribute to the conflicting results. Development of formal diagnostic criteria, and use thereof in future studies, may help elucidate the link between cardiac performance and outcomes in patients with sepsis.
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Affiliation(s)
- Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA.
| | - Ashley N Sullivan
- Department of Emergency Medicine, Wayne State University School of Medicine, St. John Hospital and Medical Center, 22101 Moross Rd, Detroit, MI, 48236, USA
| | - Mark J Favot
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA
| | - Robert L Sherwin
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA
| | - Christian A Reynolds
- Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Aiden Abidov
- Division of Cardiology, Wayne State University School of Medicine, John D. Dingell VA Medical Center, 3990 John R. 4 Hudson, Detroit, MI, 48377, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Detroit Receiving Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA
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Vallabhajosyula S, Pruthi S, Shah S, Wiley BM, Mankad SV, Jentzer JC. Basic and advanced echocardiographic evaluation of myocardial dysfunction in sepsis and septic shock. Anaesth Intensive Care 2018; 46:13-24. [PMID: 29361252 DOI: 10.1177/0310057x1804600104] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20%-65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction. Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction. This review summarises the current scope of literature focused on sepsis-related myocardial dysfunction and highlights the use of basic and advanced echocardiographic techniques for the diagnosis of sepsis-related myocardial dysfunction and the management of sepsis and septic shock.
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Clancy DJ, Scully T, Slama M, Huang S, McLean AS, Orde SR. Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock. Ann Intensive Care 2017; 7:121. [PMID: 29260409 PMCID: PMC5736511 DOI: 10.1186/s13613-017-0342-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 12/07/2017] [Indexed: 12/29/2022] Open
Abstract
Background Left ventricular diastolic dysfunction is suggested to be associated with higher mortality in severe sepsis and septic shock, yet the methods of diagnosis described in the literature are often inconsistent. The recently published 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines offer the opportunity to apply a simple pragmatic diagnostic algorithm for the detection of diastolic dysfunction; however, it has not been tested in this cohort. Aims We sought to assess the applicability in septic patients of recently published 2016 ASE/EACVI guidelines on diastolic dysfunction compared with the 2009 ASE guidelines. Our hypothesis was that there would be poor agreement in classifying patients. Methods Prospective observational study includes patients identified as having severe sepsis and septic shock. Patients underwent transthoracic echocardiography on day 1 and day 3 of their ICU admission. Patients with normal and abnormal (ejection fraction < 52%) systolic function had their diastolic function stratified according to both the 2009 ASE and 2016 ASE/EACVI guidelines. Results On day 1 echocardiography, of the 62 patients analysed, 37 (60%) had diastolic dysfunction according to the 2016 ASE/EACVI guideline with a further 23% having indeterminate diastolic function, compared to the 2009 ASE guidelines where only 13 (21%) had confirmed diastolic dysfunction with 46 (74%) having indeterminate diastolic dysfunction. On day 3, of the 55 patients studied, 22 patients (40%) were defined as having diastolic dysfunction, with 6 (11%) having indeterminate diastolic dysfunction according to the 2016 ASE/EACVI guidelines, compared to the 2009 guidelines where 11 (20%) were confirmed to have diastolic dysfunction and 41 (75%) had indeterminate diastolic function. Systolic dysfunction was identified in 18 of 62 patients (29%) on day 1 and 18 of 55 (33%) on day 3. These patients were classified as having abnormal diastolic function in 94 and 89% with the 2016 guidelines on day 1 and day 3, respectively, compared with 50 and 28% using the 2009 guidelines. The 2016 guidelines had less patients with indeterminate diastolic function on days 1 and 3 (11 and 6%) compared to the 2009 guidelines (50 and 72%). Normal systolic function was identified in 44 patients on day 1 and 37 on day 3. In this group, abnormal diastolic function was present in 45 and 54% on days 1 and 3 according to the 2016 ASE/EACVI guidelines, compared with 9 and 16% using the 2009 guidelines, respectively. In those with normal systolic function, the 2016 guidelines had less indeterminate patients with 30 and 16% on days 1 and 3, respectively, compared to 84 and 76% in the 2009 guidelines. Conclusion The 2016 ASE/EACVI diastolic function guidelines identify a significantly higher incidence of dysfunction in patients with severe sepsis and septic shock compared to the previous 2009 guidelines. Although the new guidelines seem to be an improvement, issues remain with the application of guidelines using traditional measures of diastolic dysfunction in this cohort. Electronic supplementary material The online version of this article (10.1186/s13613-017-0342-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Michel Slama
- Medical ICU, Amiens University Hospital, Amiens, France
| | - Stephen Huang
- ICU, Nepean Hospital, Kingswood, NSW, 2747, Australia
| | | | - Sam R Orde
- ICU, Nepean Hospital, Kingswood, NSW, 2747, Australia.
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Narváez I, Canabal A, Martín C, Sánchez M, Moron A, Alcalá J, Giacoman S, Magro M. Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock. Med Intensiva 2017; 42:283-291. [PMID: 29100618 DOI: 10.1016/j.medin.2017.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/11/2017] [Accepted: 08/26/2017] [Indexed: 12/13/2022]
Abstract
OBJETIVE The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution. DESIGN Prospective cohort study. PARTICIPANTS We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock. PRINCIPAL VARIABLES OF INTEREST Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed. AMBIT Intensive medical and surgical Care Service for Adults in University Hospital. RESULTS The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07]. CONCLUSIONS SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event.
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Affiliation(s)
- I Narváez
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España.
| | - A Canabal
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - C Martín
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España
| | - M Sánchez
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - A Moron
- Universidad de Castilla La Mancha, Ciudad Real, España
| | - J Alcalá
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España
| | - S Giacoman
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España
| | - M Magro
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
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Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M, Fletcher N. Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth 2017; 119:583-594. [DOI: 10.1093/bja/aex254] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Popelová JR, Tomková M, Tomek J. NT-proBNP predicts mortality in adults with transposition of the great arteries late after Mustard or Senning correction. CONGENIT HEART DIS 2017; 12:448-457. [DOI: 10.1111/chd.12466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/18/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jana Rubáčková Popelová
- Department of Cardiac Surgery; Hospital Na Homolce; Prague Czech Republic
- Pediatric Heart Centre, Faculty Hospital Motol; Prague Czech Republic
| | - Markéta Tomková
- Department of Cardiac Surgery; Hospital Na Homolce; Prague Czech Republic
- Nuffield Department of Medicine; University of Oxford; Oxford United Kingdom
| | - Jakub Tomek
- Department of Cardiac Surgery; Hospital Na Homolce; Prague Czech Republic
- Department of Physiology, Anatomy and Genetics; University of Oxford; Oxford United Kingdom
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Dantas VCDS, Costa ELV. A look at the diastolic function in severe sepsis and septic shock. Rev Bras Ter Intensiva 2016; 27:307-8. [PMID: 26761465 PMCID: PMC4738813 DOI: 10.5935/0103-507x.20150052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bridges E, McNeill MM, Munro N. Research in Review: Advancing Critical Care Practice. Am J Crit Care 2016; 26:77-88. [PMID: 27965233 DOI: 10.4037/ajcc2017609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients. The new sepsis definitions highlight the importance of detecting and providing care to patients with sepsis outside of critical care areas. Chimeric antigen receptor T-cell therapy is an example of the advancement of research in genomics and personalized medicine and of the need to understand the care implications of these therapies. Other research topics include interprofessional collaboration and shared decision-making as well as nurses' role in family conferences. Resources such as policies related to medical futility and inappropriate care and the American Association of Critical-Care Nurses' healthy work environment standards may inform conversations and provide strategies to address these complex issues.
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Affiliation(s)
- Elizabeth Bridges
- Elizabeth Bridges is a professor at University of Washington School of Nursing and a clinical nurse researcher at University of Washington Medical Center, Seattle, Washington. Margaret M. McNeill is a clinical nurse specialist, perianesthesia, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is a senior acute care nurse practitioner, National Institutes of Health, Bethesda, Maryland
| | - Margaret M. McNeill
- Elizabeth Bridges is a professor at University of Washington School of Nursing and a clinical nurse researcher at University of Washington Medical Center, Seattle, Washington. Margaret M. McNeill is a clinical nurse specialist, perianesthesia, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is a senior acute care nurse practitioner, National Institutes of Health, Bethesda, Maryland
| | - Nancy Munro
- Elizabeth Bridges is a professor at University of Washington School of Nursing and a clinical nurse researcher at University of Washington Medical Center, Seattle, Washington. Margaret M. McNeill is a clinical nurse specialist, perianesthesia, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is a senior acute care nurse practitioner, National Institutes of Health, Bethesda, Maryland
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Suárez JC, López P, Mancebo J, Zapata L. Diastolic dysfunction in the critically ill patient. Med Intensiva 2016; 40:499-510. [PMID: 27569679 DOI: 10.1016/j.medin.2016.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022]
Abstract
Left ventricular diastolic dysfunction is a common finding in critically ill patients. It is characterized by a progressive deterioration of the relaxation and the compliance of the left ventricle. Two-dimensional and Doppler echocardiography is a cornerstone in its diagnosis. Acute pulmonary edema associated with hypertensive crisis is the most frequent presentation of diastolic dysfunction critically ill patients. Myocardial ischemia, sepsis and weaning failure from mechanical ventilation also may be associated with diastolic dysfunction. The treatment is based on the reduction of pulmonary congestion and left ventricular filling pressures. Some studies have found a prognostic role of diastolic dysfunction in some diseases such as sepsis. The present review aims to analyze thoroughly the echocardiographic diagnosis and the most frequent scenarios in critically ill patients in whom diastolic dysfunction plays a key role.
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Affiliation(s)
- J C Suárez
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Calle de Sant Quintí, 89, 08026 Barcelona, Spain
| | - P López
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Calle de Sant Quintí, 89, 08026 Barcelona, Spain
| | - J Mancebo
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Calle de Sant Quintí, 89, 08026 Barcelona, Spain
| | - L Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Calle de Sant Quintí, 89, 08026 Barcelona, Spain.
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Potz BA, Sellke FW, Abid MR. Endothelial ROS and Impaired Myocardial Oxygen Consumption in Sepsis-induced Cardiac Dysfunction. JOURNAL OF INTENSIVE AND CRITICAL CARE 2016; 2:20. [PMID: 27135058 PMCID: PMC4847432 DOI: 10.21767/2471-8505.100020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sepsis is known as the presence of a Systemic Inflammatory Response Syndrome (SIRS) in response to an infection. In the USA alone, 750,000 cases of severe sepsis are diagnosed annually. More than 70% of sepsis-related deaths occur due to organ failure and more than 50% of septic patients demonstrate cardiac dysfunction. Patients with sepsis who develop cardiac dysfunction have significantly higher mortality, and thus cardiac dysfunction serves as a predictor of survival in sepsis. We have very little understanding about the mechanisms that result in cardiac dysfunction in the setting of sepsis. At present, the factors involved in sepsis-related cardiac dysfunction are believed to include the following: persistent inflammatory changes in the vascular endothelium and endocardium leading to circulatory and micro vascular changes, increase in endothelial reactive oxygen species (ROS), abnormal endothelium-leukocyte interaction resulting in a feed-forward loop for inflammatory cytokines and ROS, contractile dysfunction of the heart due to autonomic dysregulation, metabolic changes in myocardium leading to impaired oxygen delivery and increased oxygen consumption, mitochondrial dysfunction, and persistent inflammatory signaling. In this review article, we will briefly discuss the clinical challenges and our current understanding of cardiac dysfunction in sepsis. Major focus will be on the pathological changes that occur in vascular endothelium, with an emphasis on endocardium, and how endothelial ROS, impaired endothelium-leukocyte interaction, and microcirculatory changes lead to cardiac dysfunction in sepsis. The importance of the ongoing quest for the clinical biomarkers for cardiac dysfunction will also be discussed.
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Affiliation(s)
- Brittany A Potz
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, USA
| | - Frank W Sellke
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, USA
| | - M Ruhul Abid
- Cardiovascular Research Center, Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, USA
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