Left ventricular function during sepsis

Artucio, Hernán; Digenio, Andrés; Pereyra, Måximo

doi:10.1097/00003246-198904000-00005

Cited by 26 publications

(15 citation statements)

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“…In our series, gram-positive or gram-negative bacteremia was found, respectively, in 22.4% (11/49) and 42.9% (21/49) of the patients with elevated cTnI levels. Second, because of the pathognomic changes (increased catabolism and cardiac output, increased oxygen demand, decreased coronary perfusion pressure, and impaired oxygen delivery and extraction), bacterial myocarditis or diffuse myocardial ischemic changes might occur during sepsis or SIRS (31)(32)(33)(34)(35)(36)(37). In a human post mortem study, McGovern et al (37) demonstrated the presence of large areas of myofibrillar necrosis in the septic myocardium.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Troponin I Levels Are a Risk Factor for Mortality and Multiple Organ Failure in Noncardiac Critically Ill Patients and Have an Additive Effect to the Apache Ii Score in Outcome Prediction

Yuan²,

Chen³

et al. 2004

Shock

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Cardiac troponin I (cTnI) is a specific marker of myocardial damage used in the diagnosis of acute coronary syndrome (ACS). Recent studies have shown that cTnI levels can also be elevated in patients without ACS, such as in sepsis and trauma patients, and that this is associated with an adverse prognosis. We have evaluated the clinical implications and prognostic significance of serum cTnI levels in noncardiac critically ill patients in a prospective observational study in a general medical intensive care unit at a tertiary-level hospital. A total of 108 consecutive patients without ACS or other cardiac disease was enrolled. Serum cTnI levels were measured on admission using enzyme-linked immunoabsorbant assay kits. Clinical laboratory parameters and outcome were compared between patients with elevated and normal cTnI levels. The prognostic significance of cTnI levels and the Acute Physiology And Chronic Health Evaluation (APACHE) II score was also analyzed. Forty-nine patients (45%) had elevated cTnI levels and 59 (55%) had normal levels. Compared with patients with normal cTnI levels, patients with elevated levels had a higher incidence of new failure of two or more organs, had a lower left ventricular ejection fraction during admission, were more likely to be associated with bacteremia, and had a higher intensive care unit mortality; they also had a significantly shorter survival over a 180-day follow up, before and after stratification by the APACHE II score. Multiple organ failure was the leading cause of mortality in patients with elevated cTnI levels. By multivariate analysis, elevated cTnI levels, a high APACHE II score, and underlying cancer were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE II score plus elevated cTnI levels than in patients with a high APACHE II score or elevated cTnI levels alone. In conclusion, elevated serum cTnI levels is a risk factor for multiple organ failure and mortality in noncardiac critically ill patients, and the cTnI levels and APACHE II score have an additive effect in outcome prediction.

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Section: Discussionmentioning

confidence: 99%

Cardiac Troponin I Levels Are a Risk Factor for Mortality and Multiple Organ Failure in Noncardiac Critically Ill Patients and Have an Additive Effect to the Apache Ii Score in Outcome Prediction

Yuan²,

Chen³

et al. 2004

Shock

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“…The fact that left ventricular dysfunction is common in acutely ill patients even outside the setting of HIV may also have distorted the prevalence rates. 39 HIV-associated cardiomyopathy has been shown to be associated with more advanced immunosuppression and lower CD4 lymphocyte counts and is independently associated with death. A study from Scotland noted that the median survival to AIDS-related death is 101 days in patients with dilated cardiomyopathy as opposed to the 472 days in their CD4-matched controls.…”

Section: Cardiomyopathymentioning

confidence: 99%

Impact of Human Immunodeficiency Virus Infection on Cardiovascular Disease in Africa

Ntsekhe

Hakim

2005

Circulation

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Background— Human immunodeficiency virus (HIV) infection is the single greatest health challenge facing Africa today. However, the impact of the HIV epidemic on the cardiovascular system in Africans has received scant attention in the world literature. Methods and Results— We searched MEDLINE (January 1, 1980, to December 31, 2004) and reference lists of literature on HIV and the heart in Africa and contacted experts in the field. The search for this review yielded 22 articles involving HIV and the cardiovascular system from 8 countries in Africa. Conclusions— The available information suggests that there are unique features in the etiology, presentation, and spectrum of HIV-associated cardiovascular disorders in people living in Africa. First, pericardial disease may be the initial manifestation of HIV infection in the early stages of the illness. Second, the etiology of cardiac disease tends to reflect the prevalent infectious diseases, such as tuberculosis. Third, unique cardiovascular disorders such as aneurysm of large vessels have been reported in association with HIV infection in several parts of Africa. Finally, the HIV/AIDS pandemic has put pressure on the meager healthcare resources and fragile infrastructure in many African countries, making the diagnosis and treatment of heart disease unrelated to HIV even more difficult.

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“…12,20 The clinical significance of the more marked myocardial depression occuring with SIRS in nonsurviving horses warrants further investigation. Early use of hemodynamic monitoring during the course of severe sepsis and septic shock with the implementation of early goal directed therapy has significantly lowered mortality in human ICUs.…”

Section: Resultsmentioning

confidence: 99%

“…Since PEP and ET change in opposite directions with systolic dysfunction, PEP/ET is known to be more sensitive for predicting systolic dysfunction than either of these parameters alone. 20 In an early study in people with sepsis, a high PEP/ET on admission also carried a poor prognosis, 40 and this ratio could be used as in human ICUs to identify horses with severe LV systolic dysfunction and a high risk of death.…”

Section: Discussionmentioning

confidence: 99%

“…17 Nevertheless, serum concentrations of cardiac biomarkers (ie, cardiac tropinin T, 18 amino-terminal pro-brain natriuretic peptide), 19 and echocardiographic and Doppler parameters of left ventricular (LV) systolic and diastolic function proved to be strongly associated with outcome in people with septic shock. 4,5,11,12,[20][21][22] A moderate increase in serum cardiac tropinin I in the postoperative period has also recently been associated with a poor outcome in 34 horses undergoing emergency laparotomy. 23 A previous echocardiographic study has suggested a systolic dysfunction in colic horses with clinical signs of endotoxic shock.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of echocardiographic and Doppler parameters in horses admitted for colic complicated by systemic inflammatory response syndrome

Borde

Amory

Grulke

et al. 2014

J Vet Emergen Crit Care

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Objective -To assess the prognostic value of echocardiographic parameters of left ventricular (LV) function in horses with systemic inflammatory response syndrome (SIRS). Design -Prospective observational study. Setting -Veterinary teaching hospital. Animals -Forty-one horses admitted for colic with clinical evidence of SIRS. Interventions -All horses underwent Doppler echocardiographic examination on admission. LV echocardiographic parameters, including pulsed-wave tissue Doppler imaging parameters, were compared between nonsurvivors (n = 29) and horses that survived to discharge (n = 12). Measurements and Main Results -With comparable heart rate and LV preload estimate, LV stroke volume index, the velocity time integral, deceleration time, ejection time of Doppler aortic flow, and peak early diastolic myocardial velocity were lower in the nonsurviving than in the surviving horses, while pre-ejection period to ejection time ratio (PEP/ET) of Doppler aortic flow and the peak early diastolic filling velocity to peak early diastolic myocardial velocity ratio (E/Em) were higher (P < 0.05). A cut-off value of 0.26 for PEP/ET predicted mortality with 100% sensitivity and 42% specificity (area under the receiver operating characteristic curve: 0.71), whereas a cut-off value of 2.67 for E/Em predicted mortality with 100% sensitivity and 83% specificity (area under the receiver operating characteristic curve: 0.89). Conclusions -Echocardiography may provide prognostic information in colic horses with clinical evidence of SIRS. Especially, PEP/ET and E/Em could be useful markers of systolic and diastolic dysfunction, respectively, to detect horses with a high risk of death requiring more intensive cardiovascular monitoring as it has been reported in human patients with septic shock. (J Vet Emerg Crit Care 2014; 24(3): 302-310)

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Left ventricular function during sepsis

Cited by 26 publications

References 0 publications

Cardiac Troponin I Levels Are a Risk Factor for Mortality and Multiple Organ Failure in Noncardiac Critically Ill Patients and Have an Additive Effect to the Apache Ii Score in Outcome Prediction

Cardiac Troponin I Levels Are a Risk Factor for Mortality and Multiple Organ Failure in Noncardiac Critically Ill Patients and Have an Additive Effect to the Apache Ii Score in Outcome Prediction

Impact of Human Immunodeficiency Virus Infection on Cardiovascular Disease in Africa

Prognostic value of echocardiographic and Doppler parameters in horses admitted for colic complicated by systemic inflammatory response syndrome

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