Sepsis-induced Cardiomyopathy

Romero-Bermejo, Francisco José; Ruiz-Bailén, Manuel; Gil-Cebrian, Julian; Huertos-Ranchal, Maria J.

doi:10.2174/157340311798220494

Cited by 238 publications

(195 citation statements)

References 251 publications

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“…Of particular concern is cardiac dysfunction, which can be rapid onset and severe, but is typically reversible. The pathophysiology of acute cardiac toxicity in the setting of CRS is not clear, but resembles cardiomyopathy associated with sepsis 31 and stress cardiomyopathy, also called Takotsubo cardiomyopathy. 32 Neurologic symptoms occurring in the context of CRS are varied (Table 1) and may occur coincident with other symptoms of CRS or may arise when the other symptoms of CRS are resolving (case 3).…”

Section: Clinical Symptomatologymentioning

confidence: 99%

Current concepts in the diagnosis and management of cytokine release syndrome

Lee

Gardner

Porter

et al. 2014

Blood

2,240

2,449

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As immune-based therapies for cancer become potent, more effective, and more widely available, optimal management of their unique toxicities becomes increasingly important. Cytokine release syndrome (CRS) is a potentially life-threatening toxicity that has been observed following administration of natural and bispecific antibodies and, more recently, following adoptive T-cell therapies for cancer. CRS is associated with elevated circulating levels of several cytokines including interleukin (IL)-6 and interferon γ, and uncontrolled studies demonstrate that immunosuppression using tocilizumab, an anti-IL-6 receptor antibody, with or without corticosteroids, can reverse the syndrome. However, because early and aggressive immunosuppression could limit the efficacy of the immunotherapy, current approaches seek to limit administration of immunosuppressive therapy to patients at risk for life-threatening consequences of the syndrome. This report presents a novel system to grade the severity of CRS in individual patients and a treatment algorithm for management of CRS based on severity. The goal of our approach is to maximize the chance for therapeutic benefit from the immunotherapy while minimizing the risk for life threatening complications of CRS.

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Section: Clinical Symptomatologymentioning

confidence: 99%

Current concepts in the diagnosis and management of cytokine release syndrome

Lee

Gardner

Porter

et al. 2014

Blood

2,240

2,449

View full text Add to dashboard Cite

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“…The mean E, E/A, E′, and A′ were significantly lower in the group with diastolic dysfunction compared with the other two ( Table 4). The mean (sd) E/E′ (13 [3]) was significantly greater, and the IVRT significantly prolonged in the group with diastolic dysfunction compared with the other two (p < 0.0001) ( Table 4).…”

Section: Echocardiographic Variables and Clinical Course Of The Childmentioning

confidence: 96%

“…Severe sepsis is often characterized by sepsis-induced myocardial dysfunction (SIMD), which may be systolic, diastolic, or global (3,4) and plays a vital role in determining the immediate outcomes. Several animal and few human studies have emphasized systolic dysfunction as the proposed mechanism for development of septic shock (5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

Sankar

Das

Jain

et al. 2014

Pediatric Critical Care Medicine

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“…The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines and the guidelines of the Infectious Diseases Society of America recommend echinocandins for the primary treatment of candidemia (9,10). Development of septic cardiomyopathy reflects a crucial pathogenic part of hemodynamic instability in septic shock that aggravates tissue hypoperfusion and organ failure (11). Cardiac effects following echinocandin administration were seen in our ICU patients (12), in isolated rat hearts (Langendorff model) (13), and in isolated cardiomyocytes of rats (14).…”

mentioning

confidence: 91%

Cardiac Effects of Echinocandins after Central Venous Administration in Adult Rats

Koch

Uhle

Wolff

et al. 2015

Antimicrob Agents Chemother

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Echinocandins have become the agents of choice for early and specific antifungal treatment in critically ill patients. In vitro studies and clinical case reports revealed a possible impact of echinocandin treatment on cardiac function. The aim of our study was to evaluate echinocandin-induced cardiac failure. Using an in vivo rat model, we assessed hemodynamic parameters and time to hemodynamic failure after central venous application (vena jugularis interna) of anidulafungin (lowdose group, 2.5 mg/kg body weight [BW]; high-dose group, 25 mg/kg BW), caspofungin (low-dose group, 0.875 mg/kg BW; high-dose group, 8.75 mg/kg BW), micafungin (low-dose group, 3 mg/kg BW; high-dose group, 30 mg/kg BW), and placebo (0.9% sodium chloride). Left ventricular heart tissue was collected to determine mitochondrial enzyme activity via spectrophotometric measurements. mRNA expression of transcriptional regulators and primary mitochondrial transcripts, mitochondrial DNA (mtDNA) content, and citrate synthase activity were also explored. Animals receiving high-dose anidulafungin or caspofungin showed an immediate decrease in hemodynamic function. All of the subjects in these groups died during the observation period. Every animal in the untreated control group survived (P < 0.001). Hemodynamic failure was not noticed in the anidulafungin and caspofungin low-dose groups. Micafungin had no impact on cardiac function. In analyzing mitochondrial enzyme activity and mitochondrial transcripts, we found no association between echinocandin administration and the risk for hemodynamic failure. Further experimental studies are needed to elucidate the underlying mechanisms involved in cardiotoxic echinocandin effects. In addition, randomized controlled clinical trials are needed to explore the clinical impact of echinocandin treatment in critically ill patients.

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Sepsis-induced Cardiomyopathy

Cited by 238 publications

References 251 publications

Current concepts in the diagnosis and management of cytokine release syndrome

Current concepts in the diagnosis and management of cytokine release syndrome

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

Cardiac Effects of Echinocandins after Central Venous Administration in Adult Rats

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