Circulation, Vol 73, 637-644, Copyright © 1986 by American Heart Association
RE Cunnion, GL Schaer, MM Parker, C Natanson and JE Parrillo
Reversible myocardial depression, manifested by ventricular dilatation and
decreased ejection fraction, is common in human septic shock. A proposed
mechanism, based on animal studies, is myocardial ischemia resulting from
inadequate coronary blood flow. Coronary flow observations have not been
reported for human septic shock. To determine whether myocardial depression
in human septic shock is associated with reduced coronary flow,
thermodilution coronary sinus catheters were placed in seven patients with
septic shock for measurements of coronary flow and myocardial metabolism.
Four of the seven patients developed myocardial depression. These patients
had coronary flow similar to or higher than that of control subjects and
similar to that of the other three patients, who did not develop myocardial
depression. None of the patients had net myocardial lactate production. In
general, compared with values in control subjects, the oxygen content
difference (arterial minus coronary sinus) was narrowed, and the fractional
extraction of arterial oxygen was diminished. This pattern of disordered
coronary autoregulation is analogous to the pattern of arteriovenous
shunting in other organs in patients with septic shock. The preservation of
coronary flow, the net myocardial lactate extraction, and the increased
availability of oxygen to the myocardium argue against global ischemia as
the cause of myocardial depression in human septic shock.
ARTICLES
The coronary circulation in human septic shock
This article has been cited by other articles:
 |
|
 |
|
  J. D. Hunter and M. Doddi Sepsis and the heart Br. J. Anaesth., January 1, 2010; 104(1): 3 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Ahmed, W. B Nelson, T. S Biring, C. M House, J. Marini, and R. Dahiya Acute coronary thrombosis in a patient with septic shock without any evidence of disseminated intravascular coagulation BMJ Case Reports, August 20, 2009; 2009(aug20_1): bcr0520091887 - bcr0520091887. [Abstract] [Full Text]
|
|
|
|
 |
|
 K. A. Bybee and A. Prasad Stress-Related Cardiomyopathy Syndromes Circulation, July 22, 2008; 118(4): 397 - 409. [Full Text] [PDF]
|
|
|
|
|
|
M.W. Merx and C. Weber Sepsis and the Heart Circulation, August 14, 2007; 116(7): 793 - 802. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Konrad, M. Haney, G. Johansson, M. Wanecek, E. Weitzberg, and A. Oldner Cardiac effects of endothelin receptor antagonism in endotoxemic pigs Am J Physiol Heart Circ Physiol, August 1, 2007; 293(2): H988 - H996. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Bateman, C. Tokunaga, T. Kareco, D. R. Dorscheid, and K. R. Walley Myocardial hypoxia-inducible HIF-1{alpha}, VEGF, and GLUT1 gene expression is associated with microvascular and ICAM-1 heterogeneity during endotoxemia Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H448 - H456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. C. Kane, C.-F. Lam, F. O'Cochlain, D. M. Hodgson, S. Reyes, X.-K. Liu, T. Miki, S. Seino, Z. S. Katusic, and A. Terzic Gene knockout of the KCNJ8-encoded Kir6.1 KATP channel imparts fatal susceptibility to endotoxemia FASEB J, November 1, 2006; 20(13): 2271 - 2280. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Maeder, T. Fehr, H. Rickli, and P. Ammann Sepsis-Associated Myocardial Dysfunction: Diagnostic and Prognostic Impact of Cardiac Troponins and Natriuretic Peptides Chest, May 1, 2006; 129(5): 1349 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Grandel, M. Hopf, M. Buerke, K. Hattar, M. Heep, L. Fink, R. M. Bohle, S. Morath, T. Hartung, S. Pullamsetti, et al. Mechanisms of Cardiac Depression Caused by Lipoteichoic Acids From Staphylococcus aureus in Isolated Rat Hearts Circulation, August 2, 2005; 112(5): 691 - 698. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kopterides, I. Mavrou, E. Kostadima, G. Gutierrez, L. S. Chawla, and D. H. Roberts Central or Mixed Venous Oxygen Saturation? Chest, August 1, 2005; 128(2): 1073 - 1075. [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Subla, S. A. Khan, D. Behl, and S. G. Peters Sepsis and Myocardial Depression in a Young Woman Mayo Clin. Proc., June 1, 2005; 80(6): 810 - 814. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Aghajani, D. Nordhaug, C. Korvald, T. Steensrud, K. Husnes, O. Ingebretsen, A. Revhaug, and T. Myrmel Mechanoenergetic inefficiency in the septic left ventricle is due to enhanced oxygen requirements for excitation-contraction coupling Cardiovasc Res, August 1, 2004; 63(2): 256 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Young The heart and circulation in severe sepsis Br. J. Anaesth., July 1, 2004; 93(1): 114 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.-L. Wong, F. O'Kirwan, N. Khan, J. Hannestad, K. H. Wu, D. Elashoff, G. Lawson, P. W. Gold, S. M. McCann, and J. Licinio Identification, characterization, and gene expression profiling of endotoxin-induced myocarditis PNAS, November 25, 2003; 100(24): 14241 - 14246. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Di Giantomasso, C. N. May, and R. Bellomo Vital Organ Blood Flow During Hyperdynamic Sepsis Chest, September 1, 2003; 124(3): 1053 - 1059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Lambermont, A. Ghuysen, P. Kolh, V. Tchana-Sato, P. Segers, P. Gerard, P. Morimont, D. Magis, J.-M. Dogne, B. Masereel, et al. Effects of endotoxic shock on right ventricular systolic function and mechanical efficiency Cardiovasc Res, August 1, 2003; 59(2): 412 - 418. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Belcher, J Mitchell, and T Evans Myocardial dysfunction in sepsis: no role for NO? Heart, June 1, 2002; 87(6): 507 - 509. [Full Text] [PDF]
|
|
|
|
|
|
U. Grandel, M. Reutemann, L. Kiss, M. Buerke, L. Fink, E. Bournelis, M. Heep, W. Seeger, F. Grimminger, and U. Sibelius Staphylococcal alpha -toxin provokes neutrophil-dependent cardiac dysfunction: role of ICAM-1 and cys-leukotrienes Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H1157 - H1165. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. McLean, M. Perretti, and A. Ahluwalia Kinin B1 receptors and the cardiovascular system: regulation of expression and function Cardiovasc Res, November 1, 2000; 48(2): 194 - 210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. ver Elst, H. D. Spapen, D. N. Nguyen, C. Garbar, L. P. Huyghens, and F. K. Gorus Cardiac Troponins I and T Are Biological Markers of Left Ventricular Dysfunction in Septic Shock Clin. Chem., May 1, 2000; 46(5): 650 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Jardin, T. Fourme, B. Page, Y. Loubieres, A. Vieillard-Baron, A. Beauchet, and J.-P. Bourdarias Persistent Preload Defect in Severe Sepsis Despite Fluid Loading: A Longitudinal Echocardiographic Study in Patients With Septic Shock Chest, November 1, 1999; 116(5): 1354 - 1359. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ishihara, J. A. Ward, O. Tasaki, B. A. Pruitt Jr., M. A. Javors, R. A. Cassidy, and D. W. Mozingo Biphasic changes in left ventricular function during hyperdynamic endotoxemia Am J Physiol Regulatory Integrative Comp Physiol, May 1, 1999; 276(5): R1516 - R1524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A.M Avontuur, H. A Bruining, and C. Ince Nitric oxide causes dysfunction of coronary autoregulation in endotoxemic rats Cardiovasc Res, August 1, 1997; 35(2): 368 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Fromm Jr and J. Varon Myocardial Injury in Critically III Patients JAMA, December 6, 1995; 274(21): 1672 - 1672. [Abstract] [PDF]
|
|
|
|
 |
|
 J. A. M. Avontuur, H. A. Bruining, and C. Ince Inhibition of Nitric Oxide Synthesis Causes Myocardial Ischemia in Endotoxemic Rats Circ. Res., March 1, 1995; 76(3): 418 - 425. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. E. Parrillo Pathogenetic Mechanisms of Septic Shock N. Engl. J. Med., May 20, 1993; 328(20): 1471 - 1478. [Full Text]
|
|
|
|
|
|
R. S. Hotchkiss and I. E. Karl Reevaluation of the Role of Cellular Hypoxia and Bioenergetic Failure in Sepsis JAMA, March 18, 1992; 267(11): 1503 - 1510. [Abstract] [PDF]
|
|
|
|
 |
|
 J. E. Parrillo, M. M. Parker, C. Natanson, A. F. Suffredini, R. L. Danner, R. E. Cunnion, and F. P. Ognibene Septic Shock in Humans: Advances in the Understanding of Pathogenesis, Cardiovascular Dysfunction, and Therapy Ann Intern Med, August 1, 1990; 113(3): 227 - 242. [Abstract] [PDF]
|
|
|
|
|
|
J. M. Isner and W. A. Dietz Cardiovascular Consequences of Recombinant DNA Technology: Interleukin-2 Ann Intern Med, December 15, 1988; 109(12): 933 - 935. [Abstract] [PDF]
|
|
|
|
|
|
E. C. Rackow, M. E. Astiz, and M. H. Weil Cellular Oxygen Metabolism During Sepsis and Shock: The Relationship of Oxygen Consumption to Oxygen Delivery JAMA, April 1, 1988; 259(13): 1989 - 1993. [Abstract] [PDF]
|
|