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Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

World Journal of Cardiology 2024年第3期16卷 126-136页

作者： Ayman El-Menyar Bianca M Wahlen Department of Trauma and Vascular Surgery Clinical ResearchHamad Medical CorporationDoha 3050Qatar Department of Clinical Medicine Weill Cornell Medical CollegeDoha 24144Qatar Department of Anesthesiology Hamad Medical CorporationDoha 3050Qatar

The post-resuscitation period is recognized as the main predictor of cardiopul-monary resuscitation(CPR)outcomes.The first description of post-resuscitation syndrome and stony heart was published over 50 years ago.Major manifestations may include but are not limited to,persistent precipitating pathology,systemic ischemia/reperfusion response,post-cardiac arrest brain injury,and finally,post-cardiac arrest myocardial dysfunction(PAMD)after successful resuscitation.Why do some patients initially survive successful resuscitation,and others do not?Also,why does the myocardium response vary after resuscitation?These ques-tions have kept scientists busy for several decades since the first successful resuscitation was described.By modifying the conventional modalities of resu-scitation together with new promising agents,rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal,stony heart.Community awareness and staff education are crucial for shortening the resuscitation time and improving short-and long-term outcomes.Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes.This review extensively addresses the underlying pathophysiology,management,and outcomes of post-resuscitation syndrome.The pattern,management,and outcome of PAMD and post-cardiac arrest shock are different based on many factors,including in-hospital cardiac arrest vs out-of-hospital cardiac arrest(OHCA),witnessed vs unwitnessed cardiac arrest,the underlying cause of arrest,the duration,and protocol used for CPR.Although restoring spontaneous circulation is a vital sign,it should not be the end of the game or lone primary outcome;it calls for better understanding and aggressive multi-disciplinary interventions and care.The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

关键词： Cardiac arrest Out-of-hospital cardiac arrest In-hospital cardiac arrest Post-resuscitation myocardial dysfunction Cardiopulmonary resuscitation Stony heart

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Association of poly(ADP-ribose) polymerase activity in circulating mononuclear cells with myocardial dysfunction in patients with septic shock

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Chinese Medical Journal 2014年第15期127卷 2775-2778页

作者： Li Li Hu Bangchuan Gong Shijin Yu Yihua Dai Haiwen Yan Jing Intensive Care Unit Zhejiang Hospital Hangzhou Zhejiang 310013China Intensive Care Unit Zhejiang Provincial People's HospitalHangzhou Zhejiang 310014 China

Background Severe sepsis and septic shock are the leading causes of morbidity and mortality in hospitalized patients.This study aimed to investigate the association of poly（ADP-ribose） polymerase-1 （PARP-1） activity in circulating mononuclear cells with myocardial dysfunction in patients with septic shock.Methods A total of 64 patients with septic shock were divided into the survival group （n=41） and the nonsurvival group （n=23） according to mortality at 28 days after enrollments.PARP-1 activity in circulating mononuclear cells,brain natriuretic peptide,Acute Physiology and Chronic Health Evaluation Ⅱ score,the cardiac index （CI）,the cardiac function index （CFI）,global ejection fraction （GEF）,and the left ventricular contractility index （dp/dt max） were measured after admission to the intensive care unit.Results PARP-1 activity in circulating mononuclear cells of nonsurvival patients with septic shock was significantly higher than that in survival patients.PARP-1 activity in circulating mononuclear cells was strongly,negatively correlated with the CI,the CFI,GEE and dp/dt max.Multiple Logistic regression analysis showed that PARP-1 activity in circulating mononuclear cells was an independent risk factor of myocardial dysfunction.The optimal cutoff point of PARP-1 activity for predicting 28-day mortality was 942 nmol/L with a sensibility of 78.2% and specificity of 65.1%.Conclusion PARP-1 activity in circulating mononuclear cells is significantly associated with myocardial dysfunction and may have prognostic value in patients with septic shock.

关键词： poly（ADP-ribose） polymerase myocardial dysfunction septic shock prognosis

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Pathophysiology of sepsis-induced myocardial dysfunction

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Journal of Medical Colleges of PLA(China) 2016年第4期31卷 202-211页

作者： Xiu-Xiu Lv Hua-Dong Wang Department of Pathophysiology Key Laboratory of State Administration of Traditional Chinese Medicine of the People’s Republic of ChinaSchool of MedicineJinan University

Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality.In the clinical setting,it was once believed that myocardial dysfunction was not a major pathological process in the septic patients,at least in part,due to the unavailability of suitable clinical markers to assess intrinsic myocardial function during sepsis.Although sepsis-induced myocardial dysfunction has been studied in clinical and basic research for more than 30 years,its pathophysiology is not completely understood,and no specific therapies for this disorder exist.The purpose of this review is to summarize our current knowledge of sepsis-induced myocardial dysfunction with a special focus on pathogenesis and clinical characteristics.

关键词： Sepsis myocardial dysfunction Pathogenesis Clinical manifestation

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Prognosis evaluation of BNP combined with Ee＇ in patients with sepsis-induced myocardial dysfunction

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South China Journal of Cardiology 2017年第2期18卷 93-98,149页

作者：唐钟祥张燕华黄惠平朱智勇陈海敏李烽辉王颖菁彭志允林辉文曾昭上刘伟枫彭环庆 Department of Critical Care Medicine Guangdong Hospital of Integrated Traditional Chinese and Western Medicine (Traditional Chinese Medicine Hospital of Nanhai District) Foshan 528200 Guangdong China

Background Sepsis-induced myocardial dysfunction is a common complication and the main cause of mor- tality in patients with sepsis. At present, there is still lack of specific early diagnosis index of the disease. Our study was aimed to investigate the diagnosis and prognosis evaluation value of b-type natriuretic peptide （BNP） combined with the ratio of early diastolic transmitral inflow velocity （E） to early diastolic mitral annulus velocity （e＇）（Ee＇） in sepsis-induced myocardial dysfunction, so as to apply them as early warning indicators of the disease. Methods Sixty-six cases of patients with sepsis were selected and divided into disorder group （myocardial dys- function, n=28） and normal group （normal myocardial function, n=38）. Ee＇ of patients at the same time of LVEF detection, plasma BNP levels and APACHE ]l score and the 28 d survival rate of the two groups were also deter- mined and compared. The correlations of between plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction with LVEF, APACHE l] score and 28 d survival rate were analyzed, and the value of them in combi- nation for predicting the 28 d survival rate was analyzed. Results Compared with the normal group, Plasma BNP levels, Ee＇ and APACHE 1] scores in the disorder group were increased （P 〈 0.05）. The 28 d survival rate of the patients in the disorder group was lower than that in the normal group （42.68% vs. 73.68%; P 〈 0.05）. Com- pared with the survival patients in the disorder group, plasma BNP levels, Ee＇ and APACHE I[ scores of the dead patients in disorder group were higher, while LVEF in the dead patient in disorder group was lower （P 〈 0.05）. Spearman unconditional correlation analysis and Logistic multiple regression analysis model results showed that plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction were correlated with LVEF, 28d sur- vival rate and APACHE lI score. ROC curve analysis showed that values of plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction were better i

关键词： brain natriuretic peptide combination the ratio of early diastolic transmitral inflow velocity （E）to early diastolic mitral annulus velocity （e＇） sepsis myocardial dysfunction prognosis

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Age-adjusted NT-proBNP could help in the early identification and follow-up of children at risk for severe multisystem inflammatory syndrome associated with COVID-19(MIS-C)

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World Journal of Clinical Cases 2022年第29期10卷 10435-10450页

作者： Moises Rodriguez-Gonzalez Ana Castellano-Martinez Division of Pediatric Cardiology Puerta del Mar University HospitalCadiz 11009Spain Division of Pediatric Nephrology Puerta del Mar University HospitalCadiz 11009Spain

BACKGROUND Multisystem inflammatory syndrome in children(MIS-C) has emerged as a new disease associated with COVID-19 that presents in acute critically ill children with acute cardiovascular dysfunction.AIM To determine whether the age-adjusted N-terminal pro-brain natriuretic peptide(NT-proBNP) value(Z-log-NT-proBNP) is associated with severe MIS-C and myocardial dysfunction.METHODS A retrospective study was conducted which included children with MIS-C managed at our institution between April 1,2020,and February 28,2022.We divided the population into groups depending on severity based on pediatric intensive care unit(PICU) admission.We compared Z-log-NT-proBNP values across these groups and analyzed Z-log-NT-proBNP dynamics during the onemonth follow-up.RESULTS We included 17 participants [median age 3(2-9) years] and seven(41%) required PICU admission.All(100%) of these cases presented very high(Z-log > 4) levels of NT-proBNP at the time of admission compared to only 5(50%) patients with non-severe MIS-C(P = 0.025).NT-proBNP was significantly correlated with highsensitive Troponin I levels(P = 0.045),Ross modified score(P = 0.003) and left ventricle ejection fraction(P = 0.021).CONCLUSION Raised NT-proBNP,specifically very high values(Z-log-NT-proBNP > 4) could help in the early identification of MIS-C patients with myocardial dysfunction requiring inotropic support and PICU admission.

关键词： Multisystem inflammatory syndrome associated with COVID-19 COVID-19 SARS-CoV-2 NT-proBNP Echocardiography myocardial dysfunction Children

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Septic cardiomyopathy: Diagnosis and management

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Journal of Intensive Medicine 2022年第1期2卷 8-16页

作者： Florence Boissier Nadia Aissaoui Service de Médecine Intensive Réanimation CHU de PoitiersPoitiers 86021France Universitéde Poitiers Poitiers INSERM CIC 1402(ALIVE group)France Service de Médecine Intensive Réanimation Hôpital CochinAPHPParis 75014France Universitéde Paris Paris Cardiovascular Research CenterINSERM U970Paris 75015France

There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been established.SCM may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular dysfunction.Physicians should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require vasopres-sors.Echocardiography is currently the gold standard for diagnosis of SCM.Left ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial contractility.Therefore,repeated echocardiography evaluation is mandatory.Evaluation of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and monitoring.Use of inotropes remains uncertain,and heart rate control could be an option in some patients.

关键词： Septic shock myocardial dysfunction Echocardiography Septic cardiomyopathy

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Astragaloside IV Attenuates Polymicrobial Sepsis-Induced Cardiac dysfunction in Rats via IKK/NF-κB Pathway

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Chinese Journal of Integrative Medicine 2021年第11期27卷 825-831页

作者： HUANG Xin ZHANG Min-zhou LIU Bo MA Shi-yu YIN Xin GUO Li-heng Intensive Care Research Team of Traditional Chinese Medicine Guangdong Provincial Hospital of Chinese Medicinethe Second Clinical Collage of Guangzhou University of Chinese MedicineGuangzhou510120China Department of Critical Care Medicine Guangdong Provincial Hospital of Chinese Medicinethe Second Clinical Collage of Guangzhou University of Chinese MedicineGuangzhou510120China Department of Radiology Guangdong Provincial Hospital of Chinese Medicinethe Second Clinical Collage of Guangzhou University of Chinese MedicineGuangzhou510120China

Objective To evaluate the protective effects of Astragaloside IV(AST)in a rat model of myocardial injury induced by cecal ligation and puncture(CLP).Methods The model of sepsis-induced cardiac dysfunction was induced by CLP.Using a random number table,50 specific pathogen free grade of Sprague Dawley rats were randomized into 5 groups:the sham group(sham),the model group(CLP,18 h/72 h)and AST group(18 h/72 h).Except the sham group,the rats in other groups received CLP surgery to induce sepsis.CLP groups received intragastric administration with normal saline after CLP.AST groups received intragastric administration with AST solution(40 mg/kg)once a day.The levels of inflammatory mediators and oxidative stress markers in the serum of the septic rats were determined via enzyme-linked immunosorbent assay(ELISA)at different time point,such as interleukin 6(IL-6),IL-10,high mobility group box-1 protein B1(HMGB-1),superoxide dismutase(SOD),and malondialdehyde(MDA).Cardiac function was determined by echocardiography.Moreover,changes in myocardial pathology were evaluated using hematoxylin and eosin staining.The levels of lactate dehydrogenase(LDH)and creatine kinase-MB(CK-MB)were analysed to determine the status of CLP-induced myocardium.In addition,the apotosis of myocardial cells was analysed by terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL).The protein levels of B-cell lymphoma-2(Bcl-2),Bcl-2-associated X(Bax),IκB kinaseα(IKKα),nuclear factor kappa B p65(NF-κB p65)were detected by Western blot analysis.Moreover,survival rate was investigated.Results AST improved the survival rate of CLP-induced rats by up to 33.3%(Pmyocardial apoptosis and the ratio of Bcl-2/Bax in the myocardium,as well as the histological alterations of myocardium(P<0.01 or P<0.05);the generation

关键词： Astragaloside IV cecal ligation and puncture myocardial dysfunction

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Cardiovascular impact of COVID-19 with a focus on children: A systematic review

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World Journal of Clinical Cases 2020年第21期8卷 5250-5283页

作者： Moises Rodriguez-Gonzalez Ana Castellano-Martinez Helena Maria Cascales-Poyatos Alvaro Antonio Perez-Reviriego Pediatric Cardiology Division Puerta del Mar University HospitalCadiz 11009Spain Biomedical Research and Innovation Institute of Cadiz Puerta del Mar University HospitalCadiz 11009Spain Pediatric Nephrology Division Puerta del Mar University HospitalCadiz 11009Spain Pediatrics Division Motril-San Antonio Primary Care CenterMotril 18600Spain Pediatrics Division UGC Pediatria AG Sur GranadaSanta Ana HospitalMotril 18600Spain

BACKGROUND Since the beginning of the pandemic,coronavirus disease-2019(COVID-19)in children has shown milder cases and a better prognosis than adults.Although the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in adults.AIM To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic emergency.METHODS Multiple searches in MEDLINE,PubMed were performed using the search terms“COVID-19”or“SARS-CoV-2"were used in combination with“myocardial injury”or"arrhythmia"or“cardiovascular involvement”or"heart disease"or"congenital heart disease"or“pulmonary hypertension”or"long QT"or“cardiomyopathies”or“channelopathies”or"Multisystem inflammatory system"or"PMIS"or“MIS-C”or”Pediatric multisystem inflammatory syndrome"or"myocarditis"or"thromboembolism to identify articles published in English language from January 1st,2020 until July 31st,2020.The websites of World Health Organization,Centers for Disease control and Prevention,and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control recommendations.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts concerning the subject were reviewed by the authors,and the data were extracted using a standardized collection tool.Data were subsequently analyzed with descriptive statistics.For Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19(PMIS),multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed patients.RESULTS A total of 193 articles were included.Most publications used in this review were single case reports,small case

关键词： COVID-19 SARS-CoV-2 Congenital heart diseases myocardial dysfunction Pediatric Multisystem Inflammatory Syndrome Cardiac Biomarkers

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Effects of short-acting β-adrenergic blocker on B-type natriuretic peptide at early stage of postresuscitation in rabbits

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Chinese Medical Journal 2006年第10期119卷 864-867页

作者： LI Xiang LI Pei-jie HE Yun-fen ZENG Hong LI Zi-li ZHANG Zheng-yi CAO Wen YANG Lan Department of Emergency Centre Second Hospital LanzhouUniversity Lanzhou 730000 China Department of Geratology First People Hospital of JiujiangJiujiang 332000 China Department of Emergency Centre Beijing Chaoyang HospitalBeijing 100043 China

Postresuscitation myocardial dysfunction is reversible heart failure and B-type natriuretic peptide （BNP） is a biochemical marker of ventricular disorders secreted from ventricle, which can be used to assess the status of left ventricular function. This study investigated the effect of β-adrenergic blocker on concentration of BNP and cardiac function after cardiopulmonary resuscitation in rabbits.

关键词： cardiac arrest cardiopulmonary resuscitation myocardial dysfunction B-type natriuretic peptide adrenergic blocker

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Evaluation of Ventricular-vascular Coupling in Patients with Type 2 Diabetes Mellitus Using 2-Dimensional Speckle Tracking Imaging

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2014年第6期34卷 929-934页

作者：李朝军杜联芳罗向红 Department of Ultrasound First People’s Hospital Affiliated to Shanghai Jiaotong University Department of Echocardiography First People’s Hospital Affiliated to Shanghai Jiaotong University

The elastic and functional coupling of heart and vessels makes the stroke work （SW） of the heart optimal. Speckle tracking imaging （STI） can evaluate the myocardial strain and function. We studied ventricular-vascular coupling in 80 diabetic patients with different systolic function using STI. The patients were divided into two groups according to ejection fraction （EF）： the diabetes mel- litus with normal EF （DMN） group and the diabetes mellitus with abnormal EF （DMA） group. Forty-two volunteers served as control group. The relative wall thickness （RWT）, left ventricular mass index （LVMI）, stroke volume （SV）, SW, rate-pressure product （RPP）, systemic vascular resis- tance index （SVRI）, left ventricular end-systolic elastance （Ees）, effective arterial elasticity （Ea） and ventricular-vascular coupling index （VVI） were measured and calculated by conventional echocardi- ography. The longitudinal strain （LS） at basement （LSBA）, papillary muscle （LSvM） and cardiac apex （LSAv） was assessed with STI. It was found：（A） compared with control group, in DMN and DMA groups, LSBA, LSvM and LSAp decreased, and they were lower in DMA group. （B） VVI, RPP and SVRI increased, and they were higher in DMN group; Ees decreased, and it was lower in DMA group. （C） LSBA, LSpM, and LSAv had negative correlation with VVI. LSAp, RWT, LVMI and SW were independent predictors for VVI. The area under the receiver operating characteristic （ROC） curves was used for identification of DMA and DMN with LSBA, LSpM, and LSAp, and the area under the ROC of LSAp was the largest. This study supports that myocardial LS could reflect the ventricu- lar-vascular coupling. Different segments had an order to “respond to” the state of the coupling, and the cardiac apex might be the earliest.

关键词： ventricular-vascular coupling type 2 diabetes myocardial dysfunction echocardiography speckle tracking imaging

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