BackgroundMyocardial dysfunction is recognized in sepsis. We hypothesized that mechanical left (LV) and right (RV) ventricular function analysed using 2-dimensional speckle-tracking echocardiography in a cohort of early severe sepsis or septic shock patients, would be different to that of a group of critically ill, non-septic patients.MethodsCritically ill adult patients with early, severe sepsis/septic shock (n = 48) and major trauma patients with no sepsis (n = 24) were included retrospectively, as well as healthy controls (n = 16). Standard echocardiographic examinations, including right (RV) left (LV) volumes and mitral, aortic and pulmonary vein Doppler flow profiles, were retrospectively identified and the studies were then reanalysed for assessment of myocardial strain using speckle-tracking echocardiography. Endocardial tracing of the LV was performed in apical four-chamber (4-Ch), two-chamber (2-Ch), apical long-axis (3-Ch) and apical views of RV determining the longitudinal LV and RV free wall strain in each subject.ResultsIn septic patients, heart rate was significantly higher (p = 0.009) and systolic (p < 0.001) and mean arterial pressures (p < 0.001), as well as systemic vascular resistance (p < 0.001) were significantly lower when compared to the non-septic trauma group. Ninety-three per cent of the septic patients and 50 % of the trauma patients were treated with norepinephrine (p < 0.001). LV ejection fraction (LVEF) was lower in the septic patients (p = 0.019). In septic patients with preserved LVEF (>50 %, n = 34), seventeen patients (50 %) had a depressed LV global longitudinal function, defined as a LV global strain > −15 %, compared to two patients (8.7 %) in the non-septic group (p = 0.0014). In septic patients with preserved LVEF, LV global and RV free wall strain were 14 % (p = 0.014) and 17 % lower (p = 0.008), respectively, compared to the non-septic group with preserved LVEF. There were no significant differences between groups with respect to LV end-diastolic or end-systolic volumes, stroke volume, or cardiac output. There were no signs of diastolic dysfunction from the mitral or pulmonary vein Doppler profiles in the septic patients.ConclusionsLV and RV systolic function is impaired in critically ill patients with early septic shock and preserved LVEF, as detected by Speckle-tracking 2D echocardiography. Strain imaging may be useful in the early detection of myocardial dysfunction in sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-015-0025-4) contains supplementary material, which is available to authorized users.

The cardiac biomarkers, hsTnT and NTproBNP, are increased early after SAH and levels are considerably higher in patients with SIC. These biomarkers are useful for screening of SIC, which could make earlier diagnosis and treatment of SIC in SAH patients possible.

Background Myocardial deformation imaging using speckle-tracking echocardiography to assess global longitudinal strain (GLS) is today considered a more sensitive measure of left ventricular (LV) systolic function than ejection fraction. General anesthesia and positive pressure ventilation (PPV) are known to change the right ventricular (RV) and LV loading conditions. However, little is known about the effects of anesthesia and PPV on RV free wall and LV GLS. We studied the influence of general anesthesia and PPV on RV and LV longitudinal strain in patients without myocardial disease. Methods Twenty-one patients scheduled for non-cardiac surgery were included. The baseline examination was performed on the un-premedicated patients within 60 min of anesthesia. The second examination was performed 10–15 min after induction of anesthesia (propofol, remifentanil), intubation and start of PPV. The examinations included apical four-, two- and three-chamber projections, mitral and aortic Doppler flow velocities and tissue Doppler velocities of tricuspid and mitral annulus. LV end-systolic elastance (Ees) and aortic elastance were determined (Ea). Results General anesthesia and PPV reduced the mean arterial blood pressure (− 29%, p <  0.0019), stroke volume index (− 13%, p <  0.001) and cardiac index (− 23%, p <  0.001). RV end-diastolic area index and LV end-diastolic volume index decreased significantly, while systemic vascular resistance was not significantly affected. Ees decreased significantly with the induction of anaesthesia (− 23%, p = 0.002), while there was a trend for a decrease in Ea ( p = 0.053). The ventriculo-arterial coupling, Ea/Ees, was not significantly affected by the anesthetics and PPV. The LV GLS decreased from − 19.1 ± 2.3% to − 17.3 ± 2.9% ( p <  0.001) and RV free wall strain decreased from − 26.5 ± 3.9% to − 24.1 ± 4.2% ( p = 0.001). One patient (5%) had at baseline a LV GLS > − 16% compared with 6 patients (28%) during general anesthesia and PPV. Three patients (14%) had a RV free wall strain > − 24% compared to 8 patients (38%) during general anesthesia and PPV. Conclusions General anesthesia and PPV reduces systolic LV and RV function to levels considered indicating dysfunction in a substantial proportion of patients without myocardial disease.

A patient with advanced myeloid metaplasia was treated with alpha-interferon (29 months) with a remarkable response. He had anaemia, thrombocytopenia and hepatosplenomegaly with infarction. The initial bone marrow showed replacement with fibrosis with no evident haemopoietic cells. Post-therapy, the patient became asymptomatic, transfusion independent and had normal blood counts. The repeat bone marrow was 30% cellular with 1 + reticulin and no fibrosis. Treatment was well tolerated without appreciable side-effects. These results indicate that prolonged therapy with alpha-interferon can improve haemopoiesis and reverse marrow fibrosis.

Background:The prevalence and importance of cardiac dysfunction in critically ill patients with COVID-19 in Sweden is not yet established. The aim of the study was to assess the prevalence of cardiac dysfunction and elevated pulmonary artery pressure (PAP), and its influence on mortality in patients with COVID-19 in intensive care in Sweden. Methods:This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 h from admission and again after 4 to 7 days. Cardiac dysfunction was defined as left ventricular (LV) dysfunction (ejection fraction <50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (defined as TAPSE <17 mm or visually assessed moderate/severe RV dysfunction). Results:We included 132 patients, of whom 127 (96%) were intubated. Cardiac dysfunction was found in 42 (32%) patients. Most patients had cardiac dysfunction at the first assessment (n = 35) while a few developed cardiac dysfunction later (n = 7) and some changed type of dysfunction (n = 3). LV dysfunction was found in 21 and | 607 HOLMQVIST eT aL.

A BS TRACT: Background: Synaptic dysfunction and degeneration are central contributors to the pathogenesis and progression of parkinsonian disorders. Therefore, identification and validation of biomarkers reflecting pathological synaptic alterations are greatly needed and could be used in prognostic assessment and to monitor treatment effects. Objective: To explore candidate biomarkers of synaptic dysfunction in Parkinson's disease (PD) and related disorders. Methods: Mass spectrometry was used to quantify 15 synaptic proteins in two clinical cerebrospinal fluid (CSF) cohorts, including PD (n 1 = 51, n 2 = 101), corticobasal degeneration (CBD) (n 1 = 11, n 2 = 3), progressive supranuclear palsy (PSP) (n 1 = 22, n 2 = 21), multiple system atrophy (MSA) (n 1 = 31, n 2 = 26), and healthy control (HC) (n 1 = 48, n 2 = 30) participants, as well as Alzheimer's disease (AD) (n 2 = 23) patients in the second cohort.Results: Across both cohorts, lower levels of the neuronal pentraxins (NPTX; 1, 2, and receptor) were found in PD, MSA, and PSP, compared with HC. In MSA and PSP, lower neurogranin, AP2B1, and complexin-2 levels compared with HC were observed. In AD, levels of 14-3-3 zeta/delta, beta-and gamma-synuclein were higher compared with the parkinsonian disorders. Lower pentraxin

Septic shock is defined as a subset of sepsis, characterised by, after adequate volume resuscitation, the need of vasopressors in order to maintain a normal mean arterial pressure (MAP) ≥65 mmHg. 1Myocardial dysfunction is commonly seen in sepsis also involving the right ventricle (RV). The number of studies on RV function in sepsis by conventional echocardiography is limited. Using American Society of Echocardiography criteria, 2 an RV dysfunction has been described in septic shock. 3,4 Furthermore, it was recently shown that the incidence of isolated right and combined right and left ventricular dysfunction in sepsis/septic shock were 47% and 53%, respectively. 5Norepinephrine administration increases arterial pressure due to its vasoconstrictor effect and is recommended as the first-choice vasopressor in this group of patients. 6 Concerns have been raised regarding a potentially negative effect of norepinephrine on myocardial function due to a norepinephrine-induced increase in left ventricular (LV) afterload. 7 The RV afterload is frequently elevated Background: In this observational study, the effects of norepinephrine-induced changes in mean arterial pressure (MAP) on right ventricular (RV) systolic function, afterload and pulmonary haemodynamics were studied in septic shock patients. We hypothesised that RV systolic function improves at higher doses of norepinephrine/ MAP levels.Methods: Eleven patients with septic shock requiring norepinephrine after fluid resuscitation were included <24 hours after ICU arrival. Study enrolment and insertion of a pulmonary artery catheter was performed after written informed consent from the next of kin. Norepinephrine infusion was titrated to target mean arterial pressures (MAP) of 60, 75 and 90 mmHg in a random sequential order. At each target MAP, strain-and conventional echocardiographic-and pulmonary haemodynamic variables were measured. RV afterload was assessed as effective pulmonary arterial elastance, (E pa ) and pulmonary vascular resistance index, (PVRI). RV free wall peak strain was the primary end-point. Results:At highest compared to lowest norepinephrine dose/MAP level, RV free wall peak strain increased from −19% to −25% (32%, P = .003), accompanied by increased tricuspid annular plane systolic excursion (22%, P = .01). At the highest norepinephrine dose/MAP, RV end-diastolic area index (16%, P < .001), central venous pressure (38%, P < .001), stroke volume index (7%, P = .001), mean pulmonary artery pressure (19%, P < .001) and RV stroke work index (15%, P = .045) increased, with no effects on PVRI or E pa . Cardiac index did not change, assessed by thermodilution (P = .079) and echocardiography (P = .054). Conclusions:Higher doses of norepinephrine to a target MAP of 90 mm Hg improved RV systolic function while RV afterload was not affected. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dalla K, Bech-Hanssen O, RickstenS-E...

In this thesis, strain echocardiography by two-dimensional speckle tracking imaging (AD-STI), was used for the evaluation of left ventricular (LV) and right ventricular (RV) function in critically ill patients with septic shock and subarachnoid haemorrhage.The aims were to: 1) investigate the value of strain echocardiography for the early detection of LV and RV dysfunction not diagnosed with conventional echocardiography in severe sepsis and septic shock, 2) to study the effects of norepinephrine on RV systolic function and pulmonary hemodynamics in patients with norepinephrine-dependent septic shock 3) evaluate the use of strain echocardiography for detection of myocardial injury in patients with subarachnoid haemorrhage (SAH) and 4) study the impact of general anaesthesia and positive pressure ventilation (PPV) on RV and LV myocardial longitudinal strain.The main findings were that LV and RV systolic performances, as detected by 2D-STI, were impaired to a greater extent in septic patients with preserved ejection fraction, when compared to critically ill, nonseptic patients with preserved ejection fraction (PEF). In septic shock, norepinephrine-induced increases in mean arterial pressure (MAP), improves RV performance without affecting pulmonary vascular resistance (PVR). The diagnostic performance of global LV strain and regional LV strain to detect myocardial injury in patients with subarachnoid haemorrhage is not superior to that of conventional echocardiography. Finally, general anaesthesia with PPV decreases absolute values of LV and RV longitudinal strain in patients with no heart disease.In conclusion, strain imaging is useful in the early detection of myocardial dysfunction in sepsis and evaluation of the vasopressor therapy. It does not have better diagnostic performance in detecting global or regional systolic dysfunction in patients with SAH than conventional echocardiography. The impact of anaesthesia and PPV should be taken into consideration when strain imaging is used in ICU patients.