ENDOTOXEMIC MYOCARDIAL DYSFUNCTION: SUBENDOCARDIAL COLLAGEN DEPOSITION RELATED TO CORONARY DRIVING PRESSURE

Autor(es)

Soriano, Francisco Garcia ^[1] ; Guido, Maria Carolina ^[1] ; Barbeiro, Hermes Vieira ^[1] ; Caldini, Elia Garcia ^[2] ; Lorigados, Clara Batista ^[3] ; Nogueira, Antonio Carlos ^[4]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Dept Clin Med, BR-01246903 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Dept Anat Patol, BR-01246903 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Ortopedia & Traumatol, BR-01246903 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Univ Hosp, Div Clin Med UTI, BR-01246903 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Shock; v. 42, n. 5, p. 472-479, NOV 2014.
• Citações Web of Science: 7

Resumo

Sepsis impairs the autoregulation of myocardial microcirculatory blood flow, but whether this impairment is correlated with myocardial remodeling is unknown. This study investigated the role of coronary driving pressure (CDP) as a determinant of microcirculatory blood flow and myocardial fibrosis in endotoxemia and sepsis. The study is composed of two parts: a prospective experimental study and an observational clinical study. The experimental study was performed on male Wistar rats weighing 300 to 320 g. Endotoxemia was induced in rats by lipopolysaccharide (LPS) injection (10 mg.kg(-1) intraperitoneally). Hemodynamic evaluation was performed 1.5 to 24 h after LPS injection by measuring the mean arterial pressure, CDP, left ventricular end-diastolic pressure, dP/dtmax, and dP/dtmin. Microspheres were also infused into the left ventricle to measure myocardial blood flow, and myocardial tissue was histologically assessed to analyze collagen deposition. The CDP, mean arterial pressure, and myocardial blood flow were reduced by 55%, 30%, and 70%, respectively, in rats 1.5 h after LPS injection compared with phosphate buffer saline injection (P < 0.05). The CDP was significantly correlated with subendocardial blood flow (r = 0.73) and fibrosis (r = 0.8). Left ventricular function was significantly impaired in the LPS-treated rats, as demonstrated by dP/dtmax (6,155 +/- 455 vs. 3,746 +/- 406 mmHg.s(-1), baseline vs. LPS; P < 0.05) and dP/dtmin (-5,858 +/- 236 vs. -3,516 +/- 436 mmHg.s(-1), baseline vs. LPS; P < 0.05). The clinical study was performed on 28 patients with septic shock analyzed for CDP. The CDP data and histological slices were collected from septic patients. In addition, the clinical data demonstrated fibrosis and 45% CDP reduction in nonsurvivors compared with survivors. In conclusion, the left ventricular subendocardial blood flow was positively correlated with CDP, and higher CDP was negatively correlated with myocardial collagen deposition. Thus, early reductions in myocardial blood flow and CDP facilitate late myocardial fibrosis in rats and likely in humans. (AU)

• Processo FAPESP: 09/15530-0 - Sepse - estudo da resposta inflamatória: sinalização, participação das células do sistema imunológico, tolerância e intervenções terapêuticas
• Beneficiário: Francisco Garcia Soriano
• Linha de fomento: Auxílio à Pesquisa - Temático