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Value of Contrast Echocardiography for the Diagnosis of Hepatopulmonary Syndrome in Patients with Chronic Liver Disease Due to Hepatitis C Virus Amal S Bakir, Ghada El-Shahed Cardiac Output Measurement by a New Transesophageal Doppler Probe in Circulatory Shock Nashwa Abed, Mohamed Afify Interventional: Comparison between Double Intravenous Bolus, Intracoronary Bolus, and Conventional Intravenous Bolus Dose of Tirofiban in Patients with Acute Anterior Myocardial Infarction Treated by Primary Coronary Intervention Ahmed Ibrahim Nassar, Nagwa Nagi El-Mahallawy, Bassem Wadei Habib, Adel Gamal Hassanin, Iman Esmat, Haytham Galal Safety and Feasibility of Transradial Versus Transfemoral Approach for Diagnostic Coronary Angiography During Early Phase of the Learning Curve Mahmoud M Sabbah, Mohamed A Oraby, Gamela M Nasr, Ahmed A El Hawary Correlation between Clinical Presentation, ECG and Echocardio-Graphic Findings and Those of Angiography in Patients Undergoing Coronary Angiography Fathi A Maklady, Hanan M Kamal, Azza Z El-Eraky, Omar M Saleh Measurement of Fractional Flow Reserve (FFR) for Guiding Percutaneous Coronary Intervention in Clinical Practice Hussein Shaalan Coronary Heart Disease: Angiographic Coronary Artery Disease in Women with Chest Pain and History of Anxiety Disorders Khaled E Darahim, Mona I Awaad Depression Post Acute Coronary Syndromes: Incidence and Predictors Mona I Awaad, Khaled E Darahim Coronary Ectasia: Risk Markers and Risk Factors Mahmoud A Soliman, Hosam M El Ezzawy Valvular Heart Disease: Usefulness of 2-Dimensional Mitral Valve Leaflets Separation Index as a New Technique for Assessment of Mitral Stenosis Severity: Comparison with Planimetry and PHT Methods Hany Younan Laboratory: (B) Thrombin-Activatable Fibrinolysis Inhibitor Thr325Ile Polymorphism as a Risk Factor of Myocardial Infarction in Egyptians Hanan M Kamal, Amal S Ahmed, Manal S Fawzy, Faten A Mohamed, Amani A Elbaz Page 117 125 135 141 147 155 165 173 181 187 197
Egypt Heart J 62 (1): 1-5, March 2010 Myocardial Depression in Sepsis Syndrome Prognostic Value of Toll-Like Receptor 4 AHMED MOWAFY, MD; GAMAL HAMED, MD; SANAA ABD EL SHAFEE, MD Background: Myocardial dysfunction frequently accompanies severe sepsis and septic shock. Whereas myocardial depression was previously considered a preterminal event, it is now clear that cardiac dysfunction as evidenced by biventricular dilatation and reduced ejection fraction is present in most patients with severe sepsis and septic shock. Myocardial depression exists despite a fluid resuscitation-dependent hyperdynamic state that typically persists in septic shock patients until death or recovery. Cardiac function usually recovers within 7–10 days in survivors. Myocardial dysfunction appears to be due to circulating depressant factors (e.g. tumor necrosis factor alpha and IL-1ß). It was hypothesized that the Toll-like receptor 4 (TLR4) mediates myocardial dysfunction in sepsis through activation of cytokine production by monocytes/macrophages and through an increase in NO and TNF production by the myocytes themselves. Objective: To study the relationship between the Toll-like receptor 4 concentrations and myocardial dysfunction, clinical course and outcome of septic patients. Methods: A total of 20 septic patients were enrolled into the study. Excluded from our study were the patients known to have cardiac problems and those on immunosuppressive therapy. All included patients were subjected to the measurements of TLR4. Blood samples were withdrawn at day 1 of ICU admission. Our end points were length of ICU stay, Need for organ supportive measures (Inotropic/Vasopressor support and/or Mechanical ventilation) and final outcome for all patients until ICU discharge or demise or up to a total of 28 days. Results: Toll-like receptor-4 concentrations were elevated in patients who were admitted to the ICU with septic criteria. TLR-4 concentrations were higher in patients who needed Inotropic/Vasopressor support during their ICU stay than those who did not require it (p value = 0.015). TLR-4 concentrations were higher in patients who developed impaired ventricular function during their ICU stay than those with preserved systolic cardiac function (p value = 0.006) and were significantly higher in patients who died in the ICU than those who survived (p value = 0.024). Conclusion: Estimation of Toll-like receptor-4 level may be a potentially useful prognostic test for the evaluation of septic patients when admitted to the ICU and for the prediction of their adverse outcomes (e.g. impaired ventricular function, haemodynamic compromise with need for inotropic/vasopressor support and mortality). Key Words: Toll-like receptor-4 – Myocardial depression – Septic shock. Introduction Despite continuing advances in intensive care medicine, Sepsis represents a significant health problem. Severe sepsis and septic shock present high incidence of morbidity and mortality and are The Department of Critical Care, Cairo University. Manuscript received 11 Nov., 2009; revised 15 Dec., 2009; accepted 16 Dec., 2009. Address for Correspondence: Dr. Ahmed Mowafy, Critical Care Med. Department, Cairo University. 1 considered among the most important causes of death in the intensive care units [1]. The overall mortality is approximately 30%, rising to 50% or more in patient with septic shock, despite recent progress in understanding its pathophysiology and improvements in supportive intensive care [2]. Multiple organ systems are compromised during sepsis with several underlying mechanisms have been proposed. Myocardial dysfunction, a central component in the complex pathophysiology of sepsis, contributes to the high mortality associated with this disorder. Cardiac dysfunction starts during
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Youssef FM Nosir, et al reference.
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Mahmoud Soliman, et al Table 1: Cli
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Amal S Bakir & Ghada El-Shahed Pulm
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Comparison between Double Intraveno
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Safety & Feasibility of Transradial
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Safety & Feasibility of Transradial
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Fathi A Maklady, et al Table 2: The
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Hussein Shaalan Catheter findings:
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Depression Post Acute Coronary Synd
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Hany Younan Quantitative data were
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Hany Younan Image 1-A: MVA by PHT i
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