Systematic Evaluation and Meta-Analysis of the Efficacy and Safety of Shenfu Injection in the Treatment of Septic Cardiomyopathy

Objective:To evaluate the efficacy and safety of Shenfu injection in the treatment of septic cardiomyopathy.Methods:Literatures on Shenfu injection for the treatment of sepsis published from the establishment of each database to December 31,2020,were searched by computer;Cochrane risk-of-bias tool was used for evaluating the quality of literatures,and Review Manager 5.4 software was used for meta-analysis.Results:Twenty random controlled trials(RCTs)were included,with a total of 1,179 patients;the meta-analysis showed that the routine treatment of Western medicine combined with Shenfu injection can reduce the 28-day mortality,the length of hospital stay,cardiac troponin I(cTnI),and N-terminal pro-brain natriuretic peptide(NT-proBNP)as well as improve the left ventricular ejection fraction(LVEF)with low incidence of adverse reactions.Conclusion:Western medicine combined with Shenfu injection can further reduce myocardial injury in patients with sepsis and improve cardiac function as well as the prognosis of patients with septic cardiomyopathy.

Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

Background Sepsis is a life-threatening organ dysfunction,and septic cardiomyopathy(SCM)may complicate the course of the disease.Infection with multidrug-resistant(MDR)pathogens has been linked with worse outcomes.This study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes.Method This retrospective study included patients with sepsis/septic shock,hospitalized,and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection onset.The patients were divided into two groups:non-MDR-SCM group and MDR-SCM group.The cardiac function was compared between the two groups.Result A total of 62 patients were included in the study.Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group.Twenty-six patients(41.9%)presented with left ventricular(LV)systolic dysfunction,and≤35%right ventricular fractional area change(RVFAC)was present in 56.4%.LV systolic function was more severely impaired in the non-MDR-SCM group(left ventricular ejection fraction,35.8%±4.9%vs.45.6%±2.4%,P=0.049;LV outflow tract velocity time integral,[10.1±1.4]cm vs.[15.3±0.74]cm,P=0.001;LV-Strain,–9.02%±0.9%vs.–14.02%±0.7%,P=0.001).The MDR-SCM group presented with more severe right ventricular(RV)dilatation(right ventricular end-diastolic area/left ventricular end-diastolic area,0.81±0.03 vs.0.7±0.05,P=0.042)and worse RV systolic function(RVFAC,32.3%±1.9%vs.39.6%±2.7%,P=0.035;tricuspid annular plane systolic excursion,[15.9±0.9]mm vs.[18.1±0.9]mm,P=0.165;systolic tissue Doppler velocity measured at the lateral tricuspid annulus,[9.9±0.5]cm/s vs.[13.1±0.8]cm/s,P=0.002;RV-strain,–11.1%±0.7%vs.–15.1%±0.9%,P=0.002).Conclusion SCM related to MDR infection presents with RV systolic dysfunction predominance,while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.

Septic cardiomyopathy: Diagnosis and management

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.

Septic cardiomyopathy:characteristics,evaluation,and mechanism

Sepsis is a common clinical disease;if there is no early active treatment,it is likely to develop into multiple organ dysfunction syndrome and even cause death.Septic cardiomyopathy is a complication of sepsis-related cardiovascular failure,characterized by reversible left ventricular dilatation and decreased ventricular systolic and/or diastolic function.At present,echocardiography and biomarkers are often used to screen septic cardiomyopathy in clinics.Although there is still a lack of clear diagnostic criteria for septic cardiomyopathy,according to existing studies,the pathogenesis of several septic cardiomyopathy has been clarified,such as immune response caused by infection and mitochondrial dysfunction.This review summarizes the characteristics,pathophysiology,and diagnosis of septic cardiomyopathy and focuses on the mechanisms of infection immunity and mitochondrial dysfunction.

Bedside emergency surgical decompression and venoarterial extra-corporeal membrane oxygenation for obstructive uropathy with uroseptic cardiomyopathy-induced arrest:A case report

Background:Septic shock combined with septic cardiomyopathy greatly increases the risk of mortality in elderly patients.Patients with a rapid deteriorating state unresponsive to standard resuscitation may benefit from extra-corporeal membrane oxygenation(ECMO).In cases where obstructive uropathies lead to urosepsis,emergent decompression with double-J(D-J)stenting may be necessitated. Case Presentation:We report the case of a 72-year-old woman who arrived at the emergency department and rapidly deteriorated into a state of shock.During the process of resuscitation,emergent biochemical and ultrasound results suggested septicemia and septic cardiomyopathy due to urinary tract infection caused by ureteric stone obstruction.She was transferred to the intensive care unit to be put on venoarterial ECMO after failed resuscitation.Given the suspected diagnosis,it was decided that an emergent bedside digital disposable flexible ureteroscopy(ddFURS)and D-J catheterization to be performed as rescue decompression procedure.The patient was suc-cessfully stabilized with received antibiotic and continuous renal replace-ment therapy(CRRT)before being transferred to the cardiology department to correct her arrhythmia.She was weaned off CRRT and was able to walk without the need of aids upon discharge. Conclusion:Uroseptic cardiomyopathy can rapidly progress to renal and cardiac failure.Emergent decompression with ddFURS and D-J stenting can be performed effectively even in a patient with venoarterial ECMO for res-cuing uroseptic cardiomyopathy-induced arrest secondary to obstructive uropathy.Short-term outcomes were favorable.However,long-term prog-nosis remains to be elucidated.

Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom

Sepsis and septic shock remain the leading causes of death in intensive care units.Some patients with sepsis fail to respond to routine treatment and rapidly progress to refractory respiratory and circulatory failure,necessitating extracorporeal membrane oxygenation(ECMO).However,the role of ECMO in adult patients with sepsis has not been fully established.According to existing studies,ECMO may be a viable salvage therapy in carefully selected adult patients with sepsis.The choice of venovenous,venoarterial,or hybrid ECMO modes is primarily determined by the patient’s oxygenation and hemodynamics(distributive shock with preserved cardiac output,septic cardiomyopathy(left,right,or biventricular heart failure),or right ventricular failure caused by acute respiratory distress syndrome).Veno-venous ECMO can be used in patients with sepsis and severe acute respiratory distress syndrome when conventional mechanical ventilation fails,and early application of veno-arterial ECMO in patients with sepsis-induced refractory cardiogenic shock may be critical in improving their chances of survival.When ECMO is indicated,the choice of an appropriate mode and determination of the optimal timing of initiation and weaning are critical,particularly in an experienced ECMO center.Furthermore,some special issues,such as ECMO flow,anticoagulation,and antibiotic therapy,should be noted during the management of ECMO support.

Sepsis-related cardiomyopathy:Not an easy task for ICU physicians

Sepsis-induced myocardial dysfunction is common.In addition to acute coronary syndrome,at least two types of left ventricular dysfunction can occur in septic patients:typical septic cardiomyopathy(SC)and sepsis-related takotsubo cardiomyopathy(ST).Although the definition of septic cardiomyopathy is based on left ventricular(LV)systolic dysfunction,both ventricles can be affected.In this context,it has been increasingly recognized that right ventricular(RV)systolic dysfunction is associated with long-term prognosis in septic patients.Unlike typical SC,ST patients usually displayed LV apical and circumferential mid-ventricular hypokinesia and basal hypercontractility.Timely and precise evaluation of heart dysfunction in sepsis patients is not easy but obviously mandatory.Further studies are still warranted regarding the mechanism,evaluation,and management of septic cardiomyopathy.