Sepsis: Going to the Heart of the Matter

Author(s)

Celes, Mara R. N. ^[1] ; Prado, Cibele M. ^[1] ; Rossi, Marcos A. ^[1]

Affiliation

^[1] Univ Sao Paulo, Dept Pathol, Fac Med Ribeirao Preto, Lab Cellular & Mol Cardiol, BR-14049900 Ribeirao Preto, SP - Brazil

• Document type: Review article
• Source: PATHOBIOLOGY; v. 80, n. 2, p. 70-86, 2013.
• Web of Science Citations: 46

Abstract

Although myocardial depression is the predominant cause of death in severe sepsis/septic shock, it remains disputed whether the functional changes are a consequence of structural alterations. If we look at myocardial dysfunction from the perspective of a critically ill patient, there are a few questions to be asked: What causes myocardial dysfunction? What is the pathophysiology of cardiac dysfunction and death? Is there something that could be done to prevent the outcome? Each of these questions is interrelated and the answers will be more easily addressed if we continue to understand the basic mechanisms that are implicated. The principal mechanisms proposed for the pathogenesis of myocardial dysfunction support a prominent role for functional rather than anatomical abnormalities. However, attempts to reduce the high mortality in septic patients by manipulating the functional alterations have provided limited success. In recent years, the concept of septic cardiomyopathy has evolved, which implies alterations in the myocardial phenotype. This review includes an overview on the activation of the immune system and therapeutic approaches in sepsis, myocardial structural changes in the human septic heart, experimental models of sepsis, and cellular, molecular and functional myocardial changes seen in a variety of experimental sepsis models. The abnormal parameters discussed may emerge as therapeutic targets, for which modulation might provide beneficial effects on cardiovascular outcome and mortality in sepsis in the future. Copyright (C) 2012 S. Karger AG, Basel (AU)

• FAPESP's process: 10/19216-5 - Hypertension, cardiac hypertrophy and cardiac failure and dystrophin glycoproteins
• Grantee: Cibele Maria Prado Zinni
• Support Opportunities: Scholarships in Brazil - Young Researchers
• FAPESP's process: 09/54010-1 - Sepsis and septic shock: functional and morphological changes in the heart. An experimental study in mice
• Grantee: Helio Cesar Salgado
• Support Opportunities: Multi-user Equipment Program
• FAPESP's process: 09/17787-8 - High blood pressure, cardiac hypertrophy, heart failure and dystrophin-glycoprotein complex
• Grantee: Cibele Maria Prado Zinni
• Support Opportunities: Research Grants - Young Investigators Grants