Category Archives: Cardiology

Sepsis-Associated Myocardial Dysfunction: Summary

Unfortunately, the usefulness of BNP in this setting is not yet defined. While using BNP testing in the ICU, physicians must be aware of the low specificity for CHF, meaning left heart failure, in this setting. On the other hand, a given BNP level does not sufficiently reflect LVEF and cannot replace invasive monitoring in patients with sepsis. Thus, a thorough echocardiographic evaluation is preferable … Continue reading

Sepsis-Associated Myocardial Dysfunction: Research

The fact that even in healthy people raised levels of cTnT, and cTnI, as well as BNP are found after prolonged strenuous exercise, and that after a triathlon LVEF, fractional shortening, and stroke volume have been shown to be significantly different from prerace values despite unchanged preload and even decreased afterload, and to recover to baseline levels within 48 h, strengthens the assumption that transient … Continue reading

Sepsis-Associated Myocardial Dysfunction: Relationship Between Cardiac Troponins and Natriuretic Peptides

Cardiac troponins and natriuretic peptides provide different information about myocardial dysfunction. Troponin release indicates minimal myocyte damage or loss of cell membrane integrity, and thus gives structural information, whereas BNP reflects wall stress, and thus provides functional information. Raised levels of both cardiac troponins and natriuretic peptides have been found in patients with a variety of conditions associated with overload or the damage of either … Continue reading

Sepsis-Associated Myocardial Dysfunction: Results

Recent data have suggested that NT-proBNP might be a better, but by no means perfect marker of myocardial dysfunction and prognosis in patients with severe sepsis and septic shock compared to BNP (Table 4). After a pilot study had reported markedly elevated NT-proBNP levels in six patients with septic shock, the study by Roch et al evaluated NT-proBNP levels in 39 patients with septic shock … Continue reading

Sepsis-Associated Myocardial Dysfunction: Other Natriuretic Peptides

The absolute mean BNP values in patients with subarachnoid hemorrhage are low compared to those in patients with decompensated CHF and many patients with severe sepsis or septic shock, whereas the median NT-proBNP values in stroke patients range between 1,618 and 4,589 pg/mL, which is higher than the recently proposed cutoff of 1,500 pg/mL as a discriminating marker for an adverse short-term outcome in patients … Continue reading

Sepsis-Associated Myocardial Dysfunction: NT-proBNP Values

A much higher impact of renal function on BNP levels was found by Forfia and associates, who reported fourfold greater BNP levels in patients with impaired renal function (estimated creatinine clearance, < 60 mL/min) compared to patients with normal renal function despite similar PCWP values, cardiac index, and LVEF. Interestingly, BNP was better correlated with PCWP in patients with preserved renal function compared to those … Continue reading

Sepsis-Associated Myocardial Dysfunction: Septic Shock

There has been one study that has reported moderately elevated BNP levels in patients with ARDS. BNP levels were correlated with pulmonary and systemic vascular resistance but not with PaO2 or the PaO2/fraction of inspired oxygen ratio. Another report has documented the normalization of very high BNP levels in a patient with severe ARDS following successful therapy. In addition, the influence of catecholamine therapy has … Continue reading

Sepsis-Associated Myocardial Dysfunction: Critically Ill Patients

Although wall stress is thought to be the major stimulus for BNP release, data from the abovementioned studies in critically ill patients and also more recent data obtained from patients with CHF refute the hypothesis that BNP level could serve as a reliable indicator for PCWP. Volume resuscitation could theoretically cause BNP release by the elevation of both left-sided and right-sided filling pressures. In fact, … Continue reading

Sepsis-Associated Myocardial Dysfunction: Correlations

In three studies, markedly elevated BNP levels, but very weak correlations (r = 0.4) or even no significant correlations, between PCWP and BNP have been found in ICU patients requiring invasive monitoring, of whom a considerable percentage had sepsis (Table 3). Of particular interest are the findings by Jefic and coworkers, who found that BNP level could not differentiate high vs low PCWP respiratory failure. … Continue reading

Sepsis-Associated Myocardial Dysfunction: BNP Levels

In contrast to the data obtained by Witthaut et al, Tung et al did not find a correlation between BNP level and cardiac index in 49 patients with different forms of shock who had a PAC in place. Interestingly, BNP level was also not correlated with PCWP, but a BNP level of < 350 pg/mL had a very high negative predictive value for the presence … Continue reading