A circulating myocardial depressant substance in humans with septic shock. Septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance

J E Parrillo, C Burch, J H Shelhamer, M M Parker, C Natanson, W Schuette, J E Parrillo, C Burch, J H Shelhamer, M M Parker, C Natanson, W Schuette

Abstract

We have previously described a subpopulation of patients with septic shock who had a reversible depression of radionuclide-determined left ventricular ejection fraction (EF). To investigate the mechanism of this myocardial depression, an in vitro model of mammalian myocardial cell performance was established employing primary spontaneously beating rat myocardial cells. The contraction of a single cardiac cell was quantitated by recording the changes in area occupied by the cell during contraction and relaxation. In 20 septic shock patients during the acute phase, the mean left ventricular EF was decreased (mean = 0.33, normal mean = 0.50), and serum obtained during this acute phase induced a mean (+/- standard error of the mean) 33 +/- 4% decrease in extent and 25 +/- 4% decrease in velocity of myocardial cell shortening during contraction (P less than 0.001). In contrast, serum obtained from 11 of these same patients before shock (n = 2) or after recovery (n = 9) of the left ventricular EF (mean = 0.50) showed a return toward normal in extent and velocity of shortening (P less than 0.001). Sera from 17 critically ill nonseptic patients, from 10 patients with structural heart disease as a cause for a depressed EF, and from 12 healthy laboratory personnel, induced no significant changes in in vitro myocardial cell performance. In 20 patients during the acute phase of septic shock, the decreased EF in vivo demonstrated a significant correlation (r = +0.52, P less than 0.01) with a decrease in the extent of myocardial cell shortening in vitro. The quantitative and temporal correlation between the decreased left ventricular EF and this serum myocardial depressant substance argues for a pathophysiologic role for this depressant substance in producing the reversible cardiomyopathy seen during septic shock in humans.

References

    1. Medicine (Baltimore). 1973 Jul;52(4):287-94
    1. N Engl J Med. 1974 Oct 3;291(14):733-4
    1. Circ Shock Suppl. 1979;1:43-51
    1. Biochim Biophys Acta. 1977 Mar 28;491(1):275-85
    1. Biochim Biophys Acta. 1966 Jan 25;115(1):15-22
    1. Ann Surg. 1970 May;171(5):663-78
    1. Klin Wochenschr. 1982 Jul 15;60(14):713-6
    1. J Clin Invest. 1956 Nov;35(11):1191-8
    1. Circulation. 1979 Dec;60(6):1259-69
    1. N Engl J Med. 1972 Aug 10;287(6):261-7
    1. Circ Shock. 1979;6(2):147
    1. Dev Biol. 1967 Sep;16(3):216-49
    1. Chest. 1981 Nov;80(5):579-86
    1. AMA Arch Intern Med. 1951 Oct;88(4):467-88
    1. N Engl J Med. 1983 Mar 10;308(10):545-52
    1. Chest. 1978 May;73(5):583-91
    1. Am J Physiol. 1971 Jun;220(6):1581-5
    1. Am J Cardiol. 1973 Aug;32(2):162-6
    1. J Trauma. 1973 Mar;13(3):181-94
    1. Ann Surg. 1967 Apr;165(4):504-17
    1. Ann Intern Med. 1984 Apr;100(4):483-90
    1. Am J Physiol. 1970 May;218(5):1423-7
    1. Am J Med. 1973 Apr;54(4):421-32
    1. Prog Cardiovasc Dis. 1981 Jan-Feb;23(4):279-98
    1. Exp Cell Res. 1963 Feb;29:451-65
    1. Nature. 1971 Jun 25;231(5304):531-2
    1. Circ Shock. 1978;5(1):85-94
    1. N Engl J Med. 1977 Apr 14;296(15):839-44
    1. Fed Proc. 1970 Nov-Dec;29(6):1836-47
    1. Science. 1960 Jun 3;131(3414):1674-5
    1. Am J Surg. 1977 Apr;133(4):512-21
    1. J Gen Physiol. 1979 Oct;74(4):479-94
    1. Circ Shock Suppl. 1979;1:9-22
    1. Circ Res. 1975 Jun;36(6):727-34
    1. Ann Intern Med. 1965 May;62:966-78
    1. Ann Surg. 1967 Oct;166(4):543-62
    1. Int J Cardiol. 1985 Mar;7(3):314-21

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