title: A circulating myocardial depressant substance is associated with cardiac dysfunction and peripheral hypoperfusion (lactic acidemia) in patients with septic shock.
abstract: 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.affiliation: Critical Care Medicine Department, National Institutes of Health, Bethesda 20892.
authors.forename: J M
authors.initials: JM
authors.lastname: Reilly
authors.forename: R E
authors.initials: RE
authors.lastname: Cunnion
authors.forename: C
authors.initials: C
authors.lastname: Burch-Whitman
authors.forename: M M
authors.initials: MM
authors.lastname: Parker
authors.forename: J H
authors.initials: JH
authors.lastname: Shelhamer
authors.forename: J E
authors.initials: JE
authors.lastname: Parrillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001775:Blood Circulation; D002302:Cardiac Output; D002933:Cineradiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007773:Lactates / Q000097:blood*; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009201:Myocardial Depressant Factor / Q000097:blood*; D010455:Peptides / Q000097:blood*; D011446:Prospective Studies; D011875:Radionuclide Angiography; D051381:Rats; D012772:Shock, Septic / Q000097:blood*; D014655:Vascular Resistance
chemical_list: D007773:Lactates; D009201:Myocardial Depressant Factor; D010455:Peptides; D019344:Lactic Acid