Myocardial Dysfunction in Septic Shock | Journal Scan

Feb 11, 2015
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Authors:
Landesberg G, Levin PD, Gilon D, et al.
Citation:
Myocardial Dysfunction in Severe Sepsis and Septic Shock – No Correlation With Inflammatory Cytokines in Real-Life Clinical Setting. Chest 2015;Jan 15:[Epub ahead of print].
Summary By:
Daniel T. Eitzman, MD

Study Questions:

Do levels of circulating inflammatory cytokines correlate with myocardial dysfunction in sepsis?

Methods:

Serial echocardiograms, a panel of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α, and monocyte chemotactic protein-1), and cardiac biomarkers (high-sensitivity troponin T [hs-TnT], N-terminal pro–B-type natriuretic peptide [NT-proBNP]) were examined in 105 patients with severe sepsis and septic shock. Cytokines and biomarkers were tested for correlations with systolic and diastolic dysfunction, sepsis severity, and mortality.

Results:

Systolic dysfunction defined as left ventricular ejection fraction (LVEF) <50% and diastolic dysfunction defined as e’-wave <8 cm/sec on tissue-Doppler imaging (TDI) or E/e'-ratio were found in 13 (12%), 24 (23%), 53 (50%), and 26 (25%) patients, respectively. Approximately 42% of patients died in-hospital. Cytokines correlated with SOFA, APACHE-II scores, and predicted mortality. However, none of the cytokines correlated with LVEF or diastolic dysfunction. In contrast, NT-proBNP correlated with both reduced LVEF and reduced e'-wave velocity, and hs-TnT correlated with reduced e'-wave.

Conclusions:

Unlike cardiac biomarkers, none of the measured inflammatory cytokines correlated with systolic or diastolic myocardial dysfunction in severe sepsis or septic shock.

Perspective:

While this study did not find that serum levels of cytokines correlated with LV dysfunction, it does not rule out effects of cytokines, as local concentrations could be different than systemic concentrations, and/or downstream signaling pathways could be upregulated. It may also be that the subset of patients that develop LV dysfunction is somehow predisposed to cytokine effects in concert with other factors. In addition, there may be so much heterogeneity between patients that correlations are difficult to identify. Nonetheless, this study highlights the complexity of myocardial dysfunction in sepsis and reinforces aggressive treatment of the underlying infection.

Keywords: Biomarkers, Sepsis, Shock, Septic, Interleukin-6, Natriuretic Peptide, Brain, Troponin T, Systole, Heart Failure, Diagnostic Imaging, Tumor Necrosis Factor-alpha, Cytokines


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