Document Detail


A circulating myocardial depressant substance is associated with cardiac dysfunction and peripheral hypoperfusion (lactic acidemia) in patients with septic shock.
MedLine Citation:
PMID:  2707065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Using spontaneously beating rat myocardial cells as an in vitro model of myocardial depression, recent studies demonstrated that septic shock patients' sera frequently contain a myocardial depressant substance (MDS) that is associated with a reversible decrease in left ventricular ejection fraction (LVEF). To further characterize MDS, 50 consecutive patients with possible septic shock were studied serially from shock onset until recovery or death. Thirty-four patients had criteria diagnostic of septic shock, and 16 had a nonseptic critical illness. Of the 34, 14 met strict criteria for circulating MDS, with a mean inhibition of 35 percent (range 20 percent to 62 percent). Compared with those patients not exhibiting significant MDS activity, the 14 MDS-positive patients had a lower mean minimal EF (28 percent vs 39 percent, p less than 0.01), a greater mean decrease in EF (22.1 percent vs 8.8 percent, p = 0.002), a higher pulmonary artery wedge pressure (16.8 vs 11.9 mm Hg, p less than 0.01), greater LV dilatation (162 vs 118 ml/m2, p = 0.02), and a higher circulating mean peak lactic acid (6.9 vs 2.7 mmol/L, p less than 0.01). In the 14 MDS-positive patients, the in vitro myocardial cell depression had a negative correlation with the in vivo EF (r = -060, p less than 0.05). These findings suggest that a circulating MDS is a cause of the myocardial depression frequently accompanying human septic shock.
Authors:
J M Reilly; R E Cunnion; C Burch-Whitman; M M Parker; J H Shelhamer; J E Parrillo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  95     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1989 May 
Date Detail:
Created Date:  1989-06-05     Completed Date:  1989-06-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1072-80     Citation Subset:  AIM; IM    
Affiliation:
Critical Care Medicine Department, National Institutes of Health, Bethesda 20892.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Animals
Blood Circulation*
Cardiac Output
Cineradiography
Female
Heart / physiopathology*,  radionuclide imaging
Humans
Lactates / blood*
Lactic Acid
Male
Middle Aged
Myocardial Contraction
Myocardial Depressant Factor / blood*
Peptides / blood*
Prospective Studies
Radionuclide Angiography
Rats
Shock, Septic / blood*
Vascular Resistance
Chemical
Reg. No./Substance:
0/Lactates; 0/Myocardial Depressant Factor; 0/Peptides; 50-21-5/Lactic Acid
Comments/Corrections
Comment In:
Chest. 1990 Jun;97(6):1502-3   [PMID:  2347245 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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