Septic cardiomyopathy: hemodynamic quantification, occurrence, and prognostic implications

Werdan, Karl; Oelke, A.; Hettwer, Stefan; Nuding, Sebastian; Bubel, Sebastian; Hoke, Robert Sebastian; Ruß, Martin; Lautenschläger, Christine; Mueller-Werdan, Ursula; Ebelt, Henning

doi:10.1007/s00392-011-0292-5

Cited by 74 publications

(56 citation statements)

References 19 publications

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“…These results are consistent with those obtained in other conditions not associated with coronary artery disease, such as supraventricular tachyarrhythmias, acute pulmonary embolism, sepsis, stroke, and strenuous exercise [30][31][32][33]. The magnitude of the increase in troponin levels is generally less and persists for a shorter period of time compared with the troponin increases associated with acute myocardial infarction.…”

Section: Discussionsupporting

confidence: 91%

Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation

et al. 2012

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Section: Discussionsupporting

confidence: 91%

Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation

et al. 2012

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“…Recent studies revealed that the pharmacokinetics of echinocandins in special patient populations might impact clinical efficacy and safety (6). Septic cardiomyopathy is a wellknown organ dysfunction in sepsis, which is associated with reduced left ventricular contractility (19). Our study demonstrates cardiac depression and a reduced time to hemodynamic failure after administration of clinically used doses of anidulafungin (2.5 mg/kg BW) and caspofungin (0.875 mg/kg BW) in endotoxemic rats.…”

Section: Discussionmentioning

confidence: 57%

Cardiac Effects of Echinocandins in Endotoxemic Rats

Koch

Wolff

Henrich

et al. 2016

Antimicrob Agents Chemother

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cEchinocandins are known as effective and safe agents for the prophylaxis and treatment of different cohorts of patients with fungal infections. Recent studies revealed that certain pharmacokinetics of echinocandin antifungals might impact clinical efficacy and safety in special patient populations. The aim of our study was to evaluate echinocandin-induced aggravation of cardiac impairment in septic shock. Using an in vivo endotoxemic shock model in rats, we assessed hemodynamic parameters and time to hemodynamic failure (THF) after additional central-venous application of anidulafungin (2.5 mg/kg of body weight [BW]), caspofungin (0.875 mg/kg BW), micafungin (3 mg/kg BW), and control (0.9% sodium chloride). In addition, echinocandin-induced cytotoxicity was evaluated in isolated rat cardiac myocytes. THF of the animals in the caspofungin group (n ‫؍‬ 7) was significantly reduced compared to that in the control (n ‫؍‬ 6) (136 min versus 180 min; P ‫؍‬ 0.0209). The anidulafungin group (n ‫؍‬ 7) also showed a trend of reduced THF (136 min versus 180 min; log-rank test P ‫؍‬ 0.0578). Animals in the micafungin group (n ‫؍‬ 7) did not show significant differences in THF compared to those in the control. Control group animals and also micafungin group animals did not show altered cardiac output (CO) during our experiments. In contrast, administration of anidulafungin or caspofungin induced a decrease in CO. We also revealed a dose-dependent increase of cytotoxicity in anidulafungin-and caspofungin-treated cardiac myocytes. Treatment with micafungin did not cause significantly increased cytotoxicity. Further studies are needed to explore the underlying mechanism.

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“…Most clinical and experimental studies of cardiac function in sepsis have focused on evaluation of inotropic properties (2, 6-8). The presence of myocardial depression after adequate fluid resuscitation is characteristic of severe sepsis and indicative of intrinsic cardiac dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Impaired Heart Rate Regulation and Depression of Cardiac Chronotropic and Dromotropic Function in Polymicrobial Sepsis

Hoover

Ozment²,

Wondergem³

et al. 2015

Shock

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The scope of cardiac pathophysiology in sepsis has not been fully defined. Accordingly, we evaluated the effects of sepsis on heart rate (HR), HR variability, and conduction parameters in a murine model of sepsis. Electrocardiograms were recorded non-invasively from conscious mice before and after cecal ligation and puncture (CLP) or sham surgery. Responses of isolated atria to tyramine and isoproterenol were quantified to assess the functional state of sympathetic nerves and postjunctional sensitivity to adrenergic stimulation. CLP mice had lower HR compared to sham at 16-18 h post-surgery (Sham: 741±7 beats per min, CLP: 557±31 beats per min, n=6/group, P<0.001), and there was significant prolongation of the PR, QRS and QTc intervals. Slowing of HR and conduction developed within 4-6 h after CLP and were preceded by a decrease in HR variability. Treatment of CLP mice with isoproterenol (5 mg/kg, i.p.) at 25 h post-surgery failed to increase HR or decrease conduction intervals. The lack of in vivo response to isoproterenol cannot be attributed to hypothermia since robust chronotropic and inotropic responses to isoproterenol were evoked from isolated atria at 25 and 30° C. These findings demonstrate that impaired regulation of HR (i.e, reduced HR variability) develops before the onset of overt cardiac rate and conduction changes in septic mice. Subsequent time-dependent decreases in HR and cardiac conduction can be attributed to hypothermia and would contribute to decreased cardiac output and organ perfusion. Since isolated atria from septic mice showed normal responsiveness to adrenergic stimulation, we conclude that impaired effectiveness of isoproterenol in vivo can be attributed to reversible effects of systemic factors on adrenergic receptors and/or post-receptor signaling.

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Septic cardiomyopathy: hemodynamic quantification, occurrence, and prognostic implications

Abstract: By using the parameter "afterload-related cardiac performance, ACP", the impairment of cardiac function can be reliably quantified showing that septic cardiomyopathy occurs frequently and is of prognostic relevance in patients with septic MODS.

Cited by 74 publications

References 19 publications

Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation

Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation

Cardiac Effects of Echinocandins in Endotoxemic Rats

Impaired Heart Rate Regulation and Depression of Cardiac Chronotropic and Dromotropic Function in Polymicrobial Sepsis

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