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Casper E, El Wakeel L, Sabri N, Khorshid R, Fahmy SF. Melatonin: A potential protective multifaceted force for sepsis-induced cardiomyopathy. Life Sci 2024; 346:122611. [PMID: 38580195 DOI: 10.1016/j.lfs.2024.122611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Sepsis is a life-threatening condition manifested by organ dysfunction caused by a dysregulated host response to infection. Lung, brain, liver, kidney, and heart are among the affected organs. Sepsis-induced cardiomyopathy is a common cause of death among septic patients. Sepsis-induced cardiomyopathy is characterized by an acute and reversible significant decline in biventricular both systolic and diastolic function. This is accompanied by left ventricular dilatation. The pathogenesis underlying sepsis-induced cardiomyopathy is multifactorial. Hence, targeting an individual pathway may not be effective in halting the extensive dysregulated immune response. Despite major advances in sepsis management strategies, no effective pharmacological strategies have been shown to treat or even reverse sepsis-induced cardiomyopathy. Melatonin, namely, N-acetyl-5-methoxytryptamine, is synthesized in the pineal gland of mammals and can also be produced in many cells and tissues. Melatonin has cardioprotective, neuroprotective, and anti-tumor activity. Several literature reviews have explored the role of melatonin in preventing sepsis-induced organ failure. Melatonin was found to act on different pathways that are involved in the pathogenesis of sepsis-induced cardiomyopathy. Through its antimicrobial, anti-inflammatory, and antioxidant activity, it offers a potential role in sepsis-induced cardiomyopathy. Its antioxidant activity is through free radical scavenging against reactive oxygen and nitrogen species and modulating the expression and activity of antioxidant enzymes. Melatonin anti-inflammatory activities control the overactive immune system and mitigate cytokine storm. Also, it mitigates mitochondrial dysfunction, a major mechanism involved in sepsis-induced cardiomyopathy, and thus controls apoptosis. Therefore, this review discusses melatonin as a promising drug for the management of sepsis-induced cardiomyopathy.
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Affiliation(s)
- Eman Casper
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Lamia El Wakeel
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Nagwa Sabri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Ramy Khorshid
- Department of Cardiovascular and Thoracic Surgery, Ain Shams University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sarah F Fahmy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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Poelaert J, Lapage K. Letter to the Editor: Isolated diastolic dysfunction is associated with increased mortality in critically ill patients. J Crit Care 2023:154354. [PMID: 37353439 DOI: 10.1016/j.jcrc.2023.154354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Jan Poelaert
- Dept of Anesthesiology, ICU and Chronic Pain Therapy, General Hospital Maria Middelares, B9000 Ghent, Belgium; Vrije Universiteit Brussel VUB, B1090 Jette, Belgium.
| | - Koen Lapage
- Dept of Anesthesiology, ICU and Chronic Pain Therapy, General Hospital Maria Middelares, B9000 Ghent, Belgium
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Plack DL, Royer O, Couture EJ, Nabzdyk CG. Sepsis Induced Cardiomyopathy Reviewed: The Case for Early Consideration of Mechanical Support. J Cardiothorac Vasc Anesth 2022; 36:3916-3926. [DOI: 10.1053/j.jvca.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023]
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Kyle B, Zawadka M, Shanahan H, Cooper J, Rogers A, Hamarneh A, Sivaraman V, Anwar S, Smith A. Consensus Defined Diastolic Dysfunction and Cardiac Postoperative Morbidity Score: A Prospective Observational Study. J Clin Med 2021; 10:jcm10215198. [PMID: 34768718 PMCID: PMC8584550 DOI: 10.3390/jcm10215198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Diastolic dysfunction is associated with major adverse outcomes following cardiac surgery. We hypothesized that multisystem endpoints of morbidity would be higher in patients with diastolic dysfunction. A total of 142 patients undergoing cardiac surgical procedures with cardiopulmonary bypass were included in the study. Intraoperative assessments of diastolic function according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines using transesophageal echocardiography were performed. Cardiac Postoperative Morbidity Score (CPOMS) on days 3, 5, 8, and 15; length of stay in ICU and hospital; duration of intubation; incidence of new atrial fibrillation; 30-day major adverse cardiac and cerebrovascular events were recorded. Diastolic function was determinable in 96.7% of the dataset pre and poststernotomy assessment (n = 240). Diastolic dysfunction was present in 70.9% (n = 88) of measurements before sternotomy and 75% (n = 93) after sternal closure. Diastolic dysfunction at either stage was associated with greater CPOMS on D5 (p = 0.009) and D8 (p = 0.009), with CPOMS scores 1.24 (p = 0.01) higher than in patients with normal function. Diastolic dysfunction was also associated with longer durations of intubation (p = 0.001), ICU length of stay (p = 0.019), and new postoperative atrial fibrillation (p = 0.016, OR (95% CI) = 4.50 (1.22–25.17)). We were able to apply the updated ASE/EACVI guidelines and grade diastolic dysfunction in the majority of patients. Any grade of diastolic dysfunction was associated with greater all-cause morbidity, compared with patients with normal diastolic function.
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Affiliation(s)
- Bonnie Kyle
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
| | - Mateusz Zawadka
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
- NIHR Biomedical Research Centre, William Harvey Research Institute, Barts, Queen Mary University of London, London E1 4NS, UK;
- 2 Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-091 Warsaw, Poland
- Polish National Agency for Academic Exchange, 00-635 Warsaw, Poland
- Correspondence: ; Tel.: +48-5992-002
| | - Hilary Shanahan
- Department of Anaesthesia and Critical Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB2 0AY, UK;
| | - Jackie Cooper
- NIHR Biomedical Research Centre, William Harvey Research Institute, Barts, Queen Mary University of London, London E1 4NS, UK;
| | - Andrew Rogers
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
| | - Ashraf Hamarneh
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
| | - Vivek Sivaraman
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
| | - Sibtain Anwar
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
- NIHR Biomedical Research Centre, William Harvey Research Institute, Barts, Queen Mary University of London, London E1 4NS, UK;
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Andrew Smith
- Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (B.K.); (A.R.); (A.H.); (S.A.); (A.S.)
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Chebl RB, Berbari I, Safa R, Shami A, Sabra M, Jamali S, Makki M, Tamim H, Dagher GA. Clinical Outcome of Septic Patients With Heart Failure With Preserved Ejection Fraction Presenting to the Emergency Department of a Tertiary Hospital: A Retrospective Cohort Study. Front Med (Lausanne) 2020; 7:517999. [PMID: 33195290 PMCID: PMC7662680 DOI: 10.3389/fmed.2020.517999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 10/06/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Patients with heart failure with preserved ejection fraction (HFpEF) may be at a higher risk of mortality from sepsis than patients without heart failure. Objective: The aim of this study is to compare sepsis-related morbidity and mortality between patients with HFpEF and patients without heart failure presenting to the emergency department (ED) of a tertiary medical center. Design: Single-center retrospective cohort study conducted at an academic ED between January 1, 2015 and December 31, 2018. Patients: Patients with a diagnosis of sepsis were included. Main Measures: Bivariate and multivariate analyses were performed to look at differences in demographics, infection, and treatment parameters as well as outcomes of patients with sepsis. The primary outcome of the study was in-hospital mortality. Secondary outcomes included ED mortality, lengths of stay, and treatment differences between both groups. Key Results: A total of 1,092 patients presented with sepsis to the ED, of which 305 (27.93%) had HFpEF. There was no significant difference in in-hospital mortality between the two groups (40.7% vs. 37.4%; p = 0.314). However, there was a significant increase in ED mortality for septic HFpEF patients compared to non-heart failure patients (2.4 vs. 0.4%; p = 0.003). Septic HFpEF patients presenting to the ED were older than non-heart failure patients (76.84 vs. 68.44 years old; p < 0.0001). On the other hand, there was no significant increase in the use of vasopressors in the first 24 h between both groups. There was a significantly higher rate of intubation in the first 48 h for septic HFpEF patients (17.5 vs. 8.9%; p < 0.0001). Finally, there was significantly less intravenous fluid requirement at 6 h (1.94 L vs. 2.41L; p < 0.0001) and 24 h (3.11 L vs. 3.54L; p = 0.004) for septic patients with HFpEF compared to non-heart failure patients. Conclusion: Septic HFpEF patients experienced an increase in ED mortality, intubation, and steroid use compared to septic non-heart failure patients.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Iskandar Berbari
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Rawan Safa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Ali Shami
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Mohammad Sabra
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Sarah Jamali
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Maha Makki
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Hani Tamim
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beiru, Lebanon
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Zawadka M, Marchel M, Andruszkiewicz P. Diastolic dysfunction of the left ventricle - a practical approach for an anaesthetist. Anaesthesiol Intensive Ther 2020; 52:237-244. [PMID: 32419432 PMCID: PMC10172939 DOI: 10.5114/ait.2020.94486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/21/2020] [Indexed: 01/06/2024] Open
Abstract
Bedside point-of-care echocardiography is being increasingly incorporated in peri-operative assessment and in intensive care units. Because of availability of tissue Doppler imaging in the modern ultrasound machines there has been an increased interest in research of diastolic function of left ventricle. The diastolic function is crucial for the hemodynamically effective function of the heart. Diastolic dysfunction is a well-established risk factor of the major adverse cardiac events during perioperative period, complications during weaning from ventilator and prognostic factor of mortality in septic shock.
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Affiliation(s)
- Mateusz Zawadka
- 2 Department of Anaestesiology and Intensive Therapy, Medical University of Warsaw, Warsaw, Poland
| | - Michał Marchel
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Andruszkiewicz
- 2 Department of Anaestesiology and Intensive Therapy, Medical University of Warsaw, Warsaw, Poland
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Nabzdyk CS, Couture EJ, Shelton K, Cudemus G, Bittner EA. Sepsis induced cardiomyopathy: Pathophysiology and use of mechanical circulatory support for refractory shock. J Crit Care 2019; 54:228-234. [PMID: 31630071 DOI: 10.1016/j.jcrc.2019.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
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