Characterization of Cardiac Dysfunction by Echocardiography in Early Severe Acute Pancreatitis

Thandassery, Ragesh B.; Choudhary, Nikhil; Bahl, Ajay; Kochhar, Rakesh

doi:10.1097/mpa.0000000000000820

Cited by 15 publications

(20 citation statements)

References 28 publications

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“…2 Clinically, SAP is often accompanied by acute renal insufficiency, acute lung injury (ALI), and hepatic impairment. 3,4 Late-stage SAP features multiple organ dysfunction syndromes (MODS), and uncontrolled SAP can result in multiple organ failure (MOF). 3 Despite its significant health effects and high mortality rate, there remains no satisfactory treatment for SAP.…”

Section: Introductionmentioning

confidence: 99%

Protective effects of Panax notoginseng saponins in a rat model of severe acute pancreatitis occur through regulation of inflammatory pathway signaling by upregulation of miR-181b

Liu

Huang

et al. 2018

Int J Immunopathol Pharmacol

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Panax notoginseng saponins are extracted from Chinese ginseng— Panax notoginseng Ledeb —and are known to have therapeutic anti-inflammatory effects. However, the precise mechanism behind their anti-inflammatory effects remains relatively unknown. To better understand how Panax notoginseng saponins exert their therapeutic benefit, we tested them in a rat model of severe acute pancreatitis (SAP). Rats received a tail vein injection of Panax notoginseng saponins and were administered 5% sodium taurocholate 2 h later. Pancreatic tissue was then harvested and levels of miR-181b, FSTL1, TREM1, TLR4, TRAF6, IRAK1, p-Akt, p-p38MAPK, NF-κBp65, and p-IκB-α were determined using Western blot and quantitative real-time polymerase chain reaction (qRT-PCR). Enzyme-linked immunosorbent assays were used to determine serum levels of tumor necrosis factor-α (TNF-α), TREM1, interleukin (IL)-6, ACAM-1, IL-8, and IL-12 and DNA-bound levels of NF-KB65 and TLR4 in pancreatic and ileum tissue. Serum levels of lipase and amylase, pancreatic myeloperoxidase (MPO) activity, and pancreatic water content were also measured. Hematoxylin and eosin staining was used for all histological analyses. Results indicated upregulation of miR-181b, but negligible levels of FSTL1, p-p38MAPK, TLR4, TRAF6, p-Akt, IRAK1, TREM1, p-NF-κBp65, and p-IκB-α, as well as negligible DNA-bound levels of NF-KB65 and TLR4. We also observed lower levels of IL-8, IL-6, ACAM-1, TNF-α, MPO, and IL-12 in the Panax notoginseng saponin–treated group when compared with controls. In addition, Panax notoginseng saponin–treated rats had significantly reduced serum levels of lipase and amylase. Histological analyses confirmed that Panax notoginseng saponin treatment significantly reduced taurocholate-induced pancreatic inflammation. Collectively, our results suggest that Panax notoginseng saponin treatment attenuated acute pancreatitis and pancreatic inflammation by increasing miR-181b signaling. These findings suggest that Panax notoginseng saponins have therapeutic potential in the treatment of taurocholate-induced SAP.

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Section: Introductionmentioning

confidence: 99%

Protective effects of Panax notoginseng saponins in a rat model of severe acute pancreatitis occur through regulation of inflammatory pathway signaling by upregulation of miR-181b

Liu

Huang

et al. 2018

Int J Immunopathol Pharmacol

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“…Mild acute pancreatitis (with low morbidity and no mortality). 6 There is no local complications or organ failure. There are certain uncommon complications which are being reported recently and those are transient hypotension, ARDS and transient myocardial ischemia.…”

Section: Managementmentioning

confidence: 97%

Observation on Uncommon Complications of Acute Pancreatitis

Singh¹,

Mudang²,

Kumar³

2020

jemds

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A B S T R A C T BACKGROUNDAcute pancreatitis is a sudden inflammation of pancreas that lasts for a short time. It may range from mild discomfort to a severe, life threatening illness. Abdominal pain which is the major symptom of acute pancreatitis may be accompanied by nausea, vomiting and abdominal distension. 1 There may be low grade fever with features of shock which is not unusual. 2 Most people with acute pancreatitis recover completely after getting the right treatment. About 80% of cases of acute attack are self-limited and recover spontaneously within a week after the treatment. But in severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection and cyst formation. Severe pancreatitis can also harm other vital organs such as heart, lungs and kidneys. Transient hypotension, transient myocardial ischemia reflected by ST-T changes in ECG and associated with diastolic dysfunction and ARDS are uncommon complications of acute pancreatitis. This study was conducted to evaluate their incidence and prognostic significance in acute pancreatitis. METHODSThis study was conducted in Patna Medical College Hospital, Patna, on admitted cases during the period august 2018 -august 2019. A total of 30 cases were included in this study who were diagnosed as acute pancreatitis and gave written consent for the same. Patients with association or history of stroke, head injury, CNS infection, features of demyelination, acute coronary syndrome, cardiogenic pulmonary oedema and established liver disease were excluded. RESULTSThe incidence of transient hypotension, transient myocardial ischemia and ARDS in this study was found to be 13.3%, 6.6% and 6.6% respectively and they were all associated with high mortality. CONCLUSIONSThe commonest risk factor of acute pancreatitis was seen to be Gall Stone followed by Alcoholism, hyperlipidaemia and smoking in this study also. The overall mortality (13.3%) in this study was slightly lower than other studies. and this may be due to small sample size and variation of mortality with time of admission. Transient hypotension, transient myocardial ischemia reflected by ST-T changes in ECG, associated with diastolic dysfunction and ARDS were observed as uncommon complications of acute pancreatitis. Their incidence in this study were 13.3%, 6.6% and 6.6% respectively and they were all associated with high mortality. The clinical significance of their early detection is that the early mortality can be reduced with intensive medical and surgical management.

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“…Группой исследователей предположено, что действие цитокинов на миокард должно приводить к диастолической дисфункции сердца [18]. Профиль нарушений функции миокарда при ОП подтверждает высказанное предположение [18,19]. Таким образом, последствия выделения в системный кровоток цитокинов на миокард требуют дальнейшего изучения.…”

Section: цитокины и бактериальные эндотоксины: острый панкреатит и сеunclassified

“…Так, причиной КД при ОП может являться повреждение ионных насосов, ответственных за выведение ионов кальция из саркоплазматического ретикулума, и, таким образом, расслабление миокарда [19]. Следствием этого должно быть нарушение диастолического расслабления миокарда, что подтверждается как в эксперименте, так и клинически [18,19,43].…”

Section: электролитные нарушенияunclassified

“…Гиповолемия при ОП связана с секвестрацией жидкости «в третье пространство», внешними потерями (рвота и диарея) и повышением капиллярной проницаемости на фоне системного воспаления [59][60][61]. Одним из ключевых факторов, вызывающих депрессию миокарда при ОП, может быть гипотензия, связанная c гиповолемией, следствием чего является ишемия миокарда [10,18,42]. Объем и состав используемых инфузионных сред при тяжелом ОП -одна из самых дискутабельных тем, касающихся лечения этого заболевания [3,60,[62][63][64].…”

Section: миокардиальная депрессия в условиях целостного организмаunclassified

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Cardiac depression in severe acute pancreatitis: development mechanisms and possible treatment approaches. Review

Ershov

Андреенков

Манасова

2021

Annals of Critical Care

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Cardiac depression, also known as myocardial depression, is one of the typical complications of severe acute pancreatitis. The review describes modern views on the mechanism of development of this phenomenon; the place of the term myocardial depression factor at the current stage of study of the problem was discussed; pathogenetic factors of myocardial depression requiring further study have been identified. An attempt to consider cardiac depression as a phenomenon involving the whole cardiovascular system, rather than the heart along, was made. Each pathophysiological factor is examined in terms of the possibility of clinical use.

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Characterization of Cardiac Dysfunction by Echocardiography in Early Severe Acute Pancreatitis

Abstract: Two thirds of patients with early SAP and hypotension had cardiac dysfunction, which was most commonly diastolic dysfunction. A better understanding of the nature of cardiac dysfunction in this setting may allow more accurate diagnosis, prognostication, and management.

Cited by 15 publications

References 28 publications

Protective effects of Panax notoginseng saponins in a rat model of severe acute pancreatitis occur through regulation of inflammatory pathway signaling by upregulation of miR-181b

Protective effects of Panax notoginseng saponins in a rat model of severe acute pancreatitis occur through regulation of inflammatory pathway signaling by upregulation of miR-181b

Observation on Uncommon Complications of Acute Pancreatitis

Cardiac depression in severe acute pancreatitis: development mechanisms and possible treatment approaches. Review

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