Therapy of Dispelling Stasis， Removing Toxin， and Promoting Urination （Xuebijing Injection Combined with Modified Linggui Zhugantang） Affects Prognosis of Sepsis-induced Cardiomyopathy / 中国实验方剂学杂志

ObjectiveTo evaluate the effect of the therapy of dispelling stasis， removing toxin， and promoting urination （modified Linggui Zhugantang combined with Xuebijing injection） on the prognosis of sepsis-induced cardiomyopathy （SICM）. MethodA total of 96 patients were randomly assigned into an observation group and a control group， with 48 patients in each group. The patients in the control group received sepsis bundle， and those in the observation group additionally received the therapy of dispelling stasis， removing toxin， and promoting urination （intravenous drip of Xuebijing injection and oral administration of modified Linggui Zhugantang）. The course of treatment in both groups was 7 days. The disease and prognosis indicators ［28-day mortality， intensive care unit （ICU） length of stay， major adverse cardiac events （MACE）， acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）， sequential organ failure assessment （SOFA） score， and mortality in emergency department sepsis （MEDS） score］， cardiac function indicators ［left ventricular ejection fraction （LVEF）， E/A ratio of peak velocity blood flow from left ventricular relaxation in early diastole （the E wave） to peak velocity flow in late diastole caused by atrial contraction （the A wave）， E/e′ ratio of mitral peak velocity of early filling （E） to early diastolic mitral annular velocity （e′）， and afterload-corrected cardiac performance （ACP）］， myocardial injury markers ［high-sensitivity cardiac troponin T （hs-cTnT）， N-terminal pro-brain natriuretic peptide （NT-proBNP）， heart-type fatty acid-binding protein （H-FABP）， and high mobility group box-1 （HMGB-1）］， hemodynamic indicators ［extravascular lung water index （EVLWI）， global end-diastolic volume index （GEDVI）， cardiac index （CI）， and systemic vascular resistance index （SVRI）］， and TCM syndrome scores were assessed and compared between the two groups. ResultThe 28-day mortality and the incidence of MACE in the observation group were slightly lower than those in the control group. The ICU length of stay in the observation group was shorter than that in the control group （P<0.05）. After treatment， APACHE Ⅱ， SOFA， MEDS， syndrome score of stasis-caused internal obstruction， E/e′ ratio， hs-cTnT， NT-proBNP， H-FABP， and HMGB1 decreased compared with those before treatment （P<0.05）， while LVEF， E/A ratio， and ACP increased （P<0.05）. Moreover， the changes were more significant in the observation group （P<0.05）. On days 3， 5， and 7 after treatment， the EVLWI and SVRI in the observation group were lower than those in the control group （P<0.05）， while CI showed an opposite trend （P<0.05）. The observation group had higher GEDVI than the control group on days 3 and 5 after treatment （P<0.05）. ConclusionOn the basis of conventional bundle therapy， modified Linggui Zhugantang combined with Xuebijing injection with the effect of dispelling stasis， removing toxin， and promoting urination can inhibit the generation of myocardial injury markers and improve hemodynamics to shorten the length of ICU stay， mitigate the TCM syndrome， and reduce the risk of death， thereby improving the prognosis of SICM.

Progress on clinical diagnosis and treatment of sepsis-induced cardiomyopathy / 中国小儿急救医学

Although sepsis-induced cardiomyopathy(SICM) has been recognized as a distinct entity since 1984, there is still no commonly agreed upon diagnostic criteria.SICM has become a focus of many studies on the strategies of pathogenesis, diagnosis and management during the last two decades.SICM is likely under diagnosed which can lead to poor prognosis.There continues to be a dearth of large clinical trials evaluating the treatment of SICM and current consensus focusing on supportive measures such as vasopressors and inotropes by hemodynamic monitoring and tissue perfusion.Serial echocardiography allowed early diagnosis SICM and optimal adjustment of therapy, individualized work-up and management of these patients is crucial to improve prognosis.

The role of Drp1 mediated mitochondrial dynamics balance in sepsis induced cardiomyopathy / 中华急诊医学杂志

Objective:To analyze the effect of inhibiting excessive mitochondrial fission mediated by dynamic related protein 1 (Drp1) on the function of injured cells and mitochondria in the septic myocardium, and to explore the protective effect of maintaining mitochondrial dynamic balance in the pathogenesis of sepsis induced cardiomyopathy(SIC).Methods:Rat H9C2 cardiomyocytes were cultured and stimulated with lipopolysaccharide (LPS) to establish a model of SIC. Mitochondrial division inhibitor 1 (Mdivi-1) was given 30 min before LPS stimulation. They were divided into the control group, LPS stimulated group (LPS), Mdivi-1 control group (Mdivi-1), and LPS+Mdivi-1 intervention group (LPS+Mdivi-1). CCK-8 was used to detect the cell viability, and lactate dehydrogenase (LDH) was used to detect cellular damage. A MitoTracker probe was used to observe mitochondrial morphology by laser scanning confocal microscopy, JC-1 staining was used to detect mitochondrial membrane potential level, a DCFH-DA probe was used to detect total ROS level, and an AnnexinV-FITC/PI probe was used to detect the cell apoptosis ratio. The expression levels of mitochondrial fission protein Drp1 and fusion proteins Optic Atrophy 1(Opa1) and Mitofusin2 (Mfn2) were detected by real-time PCR and Western blot. One-way ANOVA was used to compare the differences between groups, and the LSD- t test was used for pairwise comparisons between groups. Results:Compared with the control group, cell viability, the average length of mitochondria and the mitochondrial membrane potential were decreased, and ROS production, the cell apoptosis rate and LDH were increased in the LPS group (all P<0.05). After Mdivi-1 intervention, compared with the LPS-stimulated group, the cell viability was increased, myocardial cell damage was reduced, the average length of mitochondria was prolonged, mitochondrial dysfunction was alleviated, and the cell apoptosis rate was inhibited in the LPS+Mdivi-1 group (all P<0.05). Conclusions:Mdivi-1 might inhibit mitochondrial fission mediated by Drp1, maintain mitochondrial dynamic balance, alleviate mitochondrial dysfunction and protect myocardial cells from LPS-induced injury.

Clinical significance of plasma thrombin-antithrombin complex levels in patients with sepsis-induced cardiomyopathy / 中华检验医学杂志

Objective:To investigate the clinical significance of plasma thrombin-antithrombin complex (TAT) levels in patients with sepsis-induced cardiomyopathy(SIC).Methods:One hundred and seven sepsis patients who were admitted to intensive care units (ICU) of the 908th Hospital of Chinese PLA Logistical Support Force were enrolled in the study. Patients were divided into sepsis group ( n=79) and the sepsis-induced cardiomyopathy group ( n=28) according to whether the cardiac ultrasound examination in 2 hours after admission, and the differences of each indicators between the two groups were compared including acute physiological and chronic health score (APACHEⅡ), lactate, blood routine, liver and kidney function, cardiac troponin I, N-terminal?pro-brain?natriuretic?peptide (NT-pro BNP), conventional coagulation tests and molecular markers of coagulation [tissue plasminogen activator-inhibitor complex (t-PAIC), thrombomodulin (TM), TAT, plasmin-α2-plasmin inhibitor complex (PIC)].Logistical?regression?was?used?to analyze the?risk?factors?for sepsis-induced cardiomyopathy and the receiver operating characteristic (ROC) curve was to analyze their cut-off values. The effect of low-molecular-weight heparin anticoagulation therapy on sepsis patients with TAT>8.26 ng/ml was evaluated by Kaplan-Meier analysis. Results:Compared with the cardiac troponin I[0.02(0.01, 0.09) ng/ml], NT-proBNP [1 118.09 (333.25, 2687.00) pg/ml], lactate[1.35(0.90, 2.60) mmol/L], TAT[6.50(3.94, 12.14) ng/ml], PIC[1.256 (0.668, 2.045) μg/ml] and t-PAIC[10.50 (6.70, 21.30) ng/ml] in sepsis group, the cardiac troponin I [0.75(0.01, 6.02) ng/ml], NT-proBNP[12 125.14(4 185.89, 33 611.62) pg/ml], lactate[2.35(1.43, 4.34) mmol/L], TAT[19.85 (9.08, 45.78) ng/ml], PIC[2.115 (0.878, 4.114) μg/ml] and t-PAIC [22.03(15.61,33.20) ng/ml] levels in the sepsis-induced cardiomyopathy group were significantly increased ( P<0.05). Logistical regression showed that positive NT-pro BNP and elevated TAT levels were independent risk factors for sepsis-induced cardiomyopathy. ROC curve analysis showed that the area under the curve of plasma TAT level for predicting sepsis-induced cardiomyopathy was 0.78. The sensitivity and specificity at the cut-off value of plasma TAT level with 8.26 ng/ml were 0.82 and 0.63, respectively. Conclusions:The elevated TAT level was an independent risk factor for the development of sepsis-induced cardiomyopathy. Low-molecular-weight heparin anticoagulation therapy can improve the 28-day survival rate of sepsis patients with TAT>8.26 ng/ml.

The application value of afterload-related cardiac performance in patients with sepsis-induced cardiomyopathy / 中华急诊医学杂志

Objective@#To investigate the application value of afterload-related cardiac performance(ACP) in patients with sepsis-induced cardiomyopathy.@*Methods@#A total of 148 patients with septic shock admitted by the department of critical care of Wuhan fourth hospital from April 2013 to March 2018 were retrospectively included, all included patients were divided into LVEF < 50% group and LVEF≥50% group according to left ventricular ejection fraction (LVEF), the mortality rate at 28 days and ACP value were compared in the 2 groups. All included patients were divided into normal group (ACP > 80%), mild heart function impairment group (60% < ACP≤80%), moderate heart function impairment group (40% < ACP≤60%), and severe heart function impairment group (ACP≤40%) according to ACP value, the mortality rate at 28 days was compared in the 4 groups. The measurement data were compared by grouped t test, the rates were compared by chi-square test.@*Results@#The mortality rate was 58.2% in the LVEF < 50% group, and 30.9% in the LVEF≥50% group, with statistically significant differences (χ2=11.171, P<0.01). The values of ACP in the LVEF < 50% group were (39.3±16.4) %, and those in the LVEF≥50% group were (69.1±14.9) %, with statistically significant differences (t=11.571, P<0.01).The mortality rate was 14.81% in the normal group, 44.00% in the mild, 58.82% in the moderate and 90.00% in the severe group. The differences between the normal group and the mild and moderate groups were statistically significant, while those between the severe group and the mild and moderate groups were statistically significant.@*Conclusion@#Afterload-related cardiac performance is of great value for the diagnosis and prognosis in patients with sepsis-induced cardiomyopathy.

The application value of afterload-related cardiac performance in patients with sepsis-induced cardiomyopathy / 中华急诊医学杂志

Objective To investigate the application value of afterload-related cardiac performance(ACP) in patients with sepsis-induced cardiomyopathy.Methods A total of 148 patients with septic shock admitted by the department of critical care of Wuhan fourth hospital from April 2013 to March 2018 were retrospectively included,all included patients were divided into LVEF ＜ 50％ group and LVEF ≥ 50％ group according to left ventricular ejection fraction (LVEF),the mortality rate at 28 days and ACP value were compared in the 2 groups.All included patients were divided into normal group (ACP ＞ 80％),mild heart function impairment group (60％ ＜ ACP ≤ 80％),moderate heart function impairment group (40％ ＜ ACP ≤ 60％),and severe heart function impairment group (ACP ≤ 40％) according to ACP value,the mortality rate at 28 days was compared in the 4 groups.The measurement data were compared by grouped t test,the rates were compared by chi-square test.Results The mortality rate was 58.2％ in the LVEF ＜ 50％ group,and 30.9％ in the LVEF ≥ 50％ group,with statistically significant differences (x2=11.171,P＜0.01).The values of ACP in the LVEF ＜ 50％ group were (39.3±16.4) ％,and those in the LVEF ≥ 50％ group were (69.1±14.9) ％,with statistically significant differences (t=l 1.571,P＜0.01).The mortality rate was 14.81％ in the normal group,44.00％ in the mild,58.82％ in the moderate and 90.00％ in the severe group.The differences between the normal group and the mild and moderate groups were statistically significant,while those between the severe group and the mild and moderate groups were statistically significant.Conclusion Aflerload-related cardiac performance is of great value for the diagnosis and prognosis in patients with sepsis-induced cardiomyopathy.

Progress of pathogenesis in sepsis-induced cardiomyopathy / 中国小儿急救医学

Sepsis-induced cardiomyopathy( SIC) is a reversible myocardial dysfunction in the early stage of sepsis. The incidence and mortality of SIC have been increasing in the following years. So it is signif-icant for early diagnosis and treatment to recognize the pathogenesis of SIC. The latest research progress of the pathogenesis of SIC will be stated in this review,from the aspects of myocardial depressant factors,nitric oxide,cellular metabolism disorder,ionic imbalance,etc.

Sepsis-induced cardiomyopathy complicated with cardiogenic shock patients supported with extracorporeal membrane oxygenation / 中华危重病急救医学

Sepsis-induced cardiomyopathy is a reversible myocardial dysfunction due to sepsis, which may be severe enough to complicate cardiogenic shock, and without effective drug and with high mortality during the acute phase. A case of sepsis-induced cardiomyopathy complicated with cardiogenic shock was treated in the intensive care unit (ICU) of Shunde Hospital Southern Medical University. A 37 years old female patient was admitted because she had suffered repeated fever for 5 days, chest tightness and abdominal pain for 3 days. At the same time, there were severe cardiac depression and abdominal infection, which could be explained by the monismtheory of sepsis cardiomyopathy. The cardiogenic shock patient was not improved after antibiotic therapy and hemodynamic support, extracorporeal membrane oxygenation (ECMO) support was prescribed. The circulation failure was smoothly got through with ECMO and was transfer from ICU to ordinary ward. Computed tomographic angiography (CTA) of abdominal aorta and colonoscopy indicated lesions of small intestine. The diagnosis of infection and bleeding in ileum diverticulum was confirmed during the operation and the lesions was removed. She recovered and was discharged 1 week after operation. Through the case review, we aim to improve the awareness of sepsis-induced cardiomyopathy and the value of ECMO support in cardiogenic shock.

The value of left ventricular Tei Index in evaluating the cardiac function and prognosis of patients with sepsis-induced cardiomyopathy / 中华急诊医学杂志

Objective To determine whether left ventricular Tei Index evaluate the cardiac function and prognosis of patients with sepsis-induced cardiomyopathy (SIC).Methods A total of 86 patients with septic shock combined with SIC in the emergency department of Beijing Chaoyang Hospital affiliated to Capital Medical University from July 2014 to June 2016 were recruited and divided into non-survival group (n=35) and survival group (n=51) according to 28-day follow-up.Left ventricular Tei Index, BNP, cTNI and left ventricular ejection fraction within the first 24 h after admisson were detected and compared between the two groups.The correlations of left ventricular Tei Index to BNP, cTNI and ejection fraction were analyzed.The receiver operating characteristic curves (ROC) were constructed to analysize the value of Tei Index in evaluating the cardiac function and prognosis.Results The patientsin the non-survival group had a higher Tei Index compared with that in the survival group [(0.75±0.13) vs.(0.51±0.09), P<0.05].The Tei Index of SIC patients was significantly positively correlated with BNP and cTNI (both P<0.05), and significantly negatively correlated with ejection fraction (P<0.05).The AUC of Tei Index for predicting 28-day mortality in SIC patients was high comapred with that of BNP, cTNI and ejection fraction.Conclusion The left ventricular Tei Index has a reliable value in evaluating the cardiac function and prognosis of patients with SIC.