The Role of BCL2 Protein and Tumour Protein p53 in Septic Cardiomyopathy

2019 ◽  
Vol 70 (11) ◽  
pp. 3842-3846
Author(s):  
Peter Michael Reil ◽  
Teodor Traian Maghiar ◽  
Karlheinz Seidl ◽  
Ciprian Borza ◽  
Vharoon Nunkoo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Ventricular Ejection Fraction ◽  
P53 Expression ◽  
Protein P53 ◽  
Bcl2 Protein

A decreased left ventricular ejection fraction (LVEF) was observed in patients suffering from septic shock with normalization of systolic function after 10 days.�Similar courses of reversible myocardial dysfunction due to the systemic inflammatory response syndrome were also encountered in other critical illnesses. Since the pathological and histological mechanisms are not fully understood, the present study tries to understand the septic cardiomyopathy related to the apoptotic pathway. Thestudy included a number of 29�cases of adults that died of septic shock being analysed for BCL2 and p53 expression rates of myocardial tissue. This is the first time the expression of BCL2 protein, p53 tumour protein were evaluated in septic shock and septic cardiomyopathy of humans.�There was a strong link between the increased expression of BCL2 and of p53 protein in cardiac muscle cells in the studied group (p=0.0300).�The study showed a significant correlation between markedly increased values and poor outcome.

The Role of BCL2 Protein and Tumour Protein p53 in Septic Cardiomyopathy

2019 ◽  
Vol 70 (11) ◽  
pp. 3842-3846
Author(s):  
Peter Michael Reil ◽  
Teodor Traian Maghiar ◽  
Karlheinz Seidl ◽  
Ciprian Borza ◽  
Vharoon Nunkoo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Ventricular Ejection Fraction ◽  
P53 Expression ◽  
Protein P53 ◽  
Bcl2 Protein

A decreased left ventricular ejection fraction (LVEF) was observed in patients suffering from septic shock with normalization of systolic function after 10 days.�Similar courses of reversible myocardial dysfunction due to the systemic inflammatory response syndrome were also encountered in other critical illnesses. Since the pathological and histological mechanisms are not fully understood, the present study tries to understand the septic cardiomyopathy related to the apoptotic pathway. Thestudy included a number of 29�cases of adults that died of septic shock being analysed for BCL2 and p53 expression rates of myocardial tissue. This is the first time the expression of BCL2 protein, p53 tumour protein were evaluated in septic shock and septic cardiomyopathy of humans.�There was a strong link between the increased expression of BCL2 and of p53 protein in cardiac muscle cells in the studied group (p=0.0300).�The study showed a significant correlation between markedly increased values and poor outcome.

Sequential Extracorporeal Therapy Collaborative Device and Timely Support for Endotoxic, Septic, and Cardiac Shock: A Case Report

2019 ◽  
Vol 49 (4) ◽  
pp. 502-508 ◽  
Author(s):  
Silvia De Rosa ◽  
Sara Samoni ◽  
Claudio Ronco
Keyword(s):  
Septic Shock ◽  
Myocardial Dysfunction ◽  
Endotoxic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Ventricular Ejection Fraction ◽  
Circulatory Insufficiency ◽  
Extracorporeal Therapy ◽  
Va Ecmo

We report a 49-year-old man, without prior medical history, consulted in the emergency department with a 5 day history of cough, fever, and dysuria. He was admitted to the intensive care unit due to septic shock. Critical care management was initiated, including mechanical ventilation and vasopressors. Endotoxic shock was suspected (endotoxin activity assay [EAA] 0.75), and 2 treatments with Polymyxin B hemoperfusion (Toraymyxin®, Toray Medical Co., Ltd., Tokyo, Japan) were performed in 48 h, alternate with high-volume hemofiltration sessions. Initial blood cultures were positive for Neisseria meningitidis (serogroup B), and a lumbar puncture was deferred because of the coagulopathy and a bleeding risk. The circulatory efficiency significantly improved after the second procedure of hemoperfusion, and the treatment resulted in a marked decrease in the serum endotoxin level (EAA <0.4). However, after 48 h, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 from admission. Continuous cytokine hemoadsorption (Cytosorb®, Cytosorbent Corporation, Monmouth Junction, NJ, USA) was incorporated into a VA-ECMO circuit for 48 h without a considerable improvement. For this reason, a 72-h continuous veno-venous hemodialysis session was started in which a high cutoff filter was used. Tachycardia and myocardial dysfunction improved by day 6, and VA-ECMO was withdrawn on the tenth day. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to the department of respiratory medicine on day 80, he was discharged from our hospital on day 113. Sequential extracorporeal therapy may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic shock using catecholamines and blockers.

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Septic Cardiomyopathy due to Legionella Pneumonia after Influenza Virus Infection

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Motohiro Asaki ◽  
Takamitsu Masuda ◽  
Yasuo Miki
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Altered Level ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Circulatory Insufficiency ◽  
Va Ecmo

A 57-year-old man presented to the emergency department with fever and progressive altered level of consciousness of 5 days’ duration. Three days before admission, influenza A was diagnosed at a clinic. On admission, his vital signs were unstable. Pneumonia was diagnosed through chest computed tomography, and urinary Legionella antigen test was positive. A diagnosis of septic shock due to Legionella and influenza pneumonia was made, and critical care management was initiated, including mechanical ventilation and vasopressors. However, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 since admission. Tachycardia and myocardial dysfunction improved by day 8, and VA-ECMO was withdrawn. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to a recovery hospital on day 108. VA-ECMO may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic cardiomyopathy using catecholamines and β-blockers. It may be necessary to adopt VA-ECMO at an appropriate time before the patient progresses to cardiopulmonary arrest.

scholarly journals Prognostic Accuracy of the Afterload-related Cardiac Performance for 7-day Mortality Among Critical Ill Patients With Septic Shock

2020 ◽  
Author(s):  
Wei-yan Chen ◽  
Li-li Tao ◽  
Qi Xu ◽  
Xing Wei ◽  
Min-sheng Chen
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Cardiac Performance ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Icu Mortality ◽  
Ventricular Ejection Fraction

Abstract BackgroundSeptic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnostic septic cardiomyopathy (SCM), still needs to be evaluated its impact on the prognosis for patients with septic shock. MethodsIn this observational retrospective study, 119 patients with septic shock undertaken PiCCO monitoring were evaluated for the effects of ACP on 7-day mortality, ICU mortality and hospital mortality. The ability of ACP, cardiac index (CI) and left ventricular ejection fraction (LVEF) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to assess the associations of ACP with 7-day mortality. Curve estimation was used to describe the relationship between hazard ratio (HR) of death and ACP.ResultsACP assessed at 12 hours (ACP12h) after septic shock [AUROC 0.86 (95% CI 0.79 to 0.93), P < 0.001] demonstrated significantly greater discrimination for 7-day mortality than CI [AUROC 0.67 (95% CI 0.57 to 0.78), P = 0.001 ] and LVEF [AUROC 0.53 (95% CI 0.43 to 0.64), P = 0.58] (all P < 0.001). Similarly, when adjusted with gender, APACHEII score, VIS and MAP as possible confounders, ACP12h still outperformed both CI12h and LVEF for discrimination of 7-day mortality (both P < 0.001). The superior discriminatory performance of ACP12h over both CI12h and LVEF was further maintained when considering ICU mortality and hospital mortality when considered in isolation or adjusted with the baseline prediction. Compared with normal ACP, HR for slight, moderate and severe impairment were 4.84 (1.96 to 11.96), 12.13 (4.83 to 30.43) and 32.70 (7.76 to 137.86), respectively. After adjustment for risk factor, decrease ACP still associated with increasing 7-day mortality (P = 0.001). Exponential relationship was observed between ACP12h and HR of 7-day death.ConclusionsOur results suggested that ACP may serve as a new tool for diagnosing SCM. In addition, the assessment of ACP at 12 hours after septic shock in ICU significantly improves 7-day mortality, ICU mortality and hospital mortality predictions when compared to CI and LVEF.

Veno-arterio-venous ECMO for septic cardiomyopathy: a single-centre experience

Perfusion ◽  
2018 ◽  
Vol 33 (1_suppl) ◽  
pp. 57-64 ◽  
Author(s):  
Dominik J. Vogel ◽  
Josie Murray ◽  
Adam Z. Czapran ◽  
Luigi Camporota ◽  
Nicholas Ioannou ◽  
...  
Keyword(s):  
Septic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Single Centre ◽  
Ventricular Ejection Fraction ◽  
Single Centre Experience ◽  
Extracorporeal Support

Introduction: The role of extracorporeal support for patients with septic shock remains unclear. Methods: We conducted a retrospective analysis of our single-centre experience with veno-arterio-venous extracorporeal membrane oxygenation (VAV ECMO) in adult patients with severe respiratory failure and septic cardiomyopathy. Clinical data was extracted from electronic medical records including a dedicated ECMO referral and follow-up database. Results: Twelve patients were commenced on VAV ECMO for septic cardiomyopathy for a median of four days (IQR 3.0 to 5.3) between 01/2014 and 12/2017. Five patients (41.7%) had a cardiac arrest prior to initiation of ECMO support. At baseline, median left ventricular ejection fraction was 16.25% (IQR 13.13 to 17.5) and median PaO2/FiO2 ratio was 9 kPa (IQR 6.5 to 12.0) [67.50 mmHg (IQR 48.75 to 90.00)]. The survival rate to hospital discharge for VAV ECMO was 75% in this cohort. None of the surviving patients died within the follow-up period (median six month). Conclusion: VAV ECMO is a feasible rescue strategy for a small proportion of patients with combined respiratory and cardiac failure secondary to septic shock with septic cardiomyopathy. We provide a detailed report of our experience with this technique. Further research is required comparing the different extracorporeal strategies directly to conventional resuscitation and against each other.

scholarly journals 276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanni Domenico Ciriello ◽  
Nunzia Borrelli ◽  
Giovanni Di Salvo ◽  
Jolanda Sabatino ◽  
Valentina Bucciarelli ◽  
...  
Keyword(s):  
Early Stage ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Accessory Pathway ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Wpw Syndrome ◽  
Paediatric Patients

Abstract Aims Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome. Methods and results Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls. Conclusions WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.

scholarly journals Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Concetta Zito ◽  
Luca Longobardo ◽  
Rodolfo Citro ◽  
Maurizio Galderisi ◽  
Lilia Oreto ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Systolic Function ◽  
Heart Diseases ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Special Focus ◽  
Ventricular Ejection Fraction ◽  
Standard Parameter

In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull’s-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

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