Prevalence and clinical outcomes of left ventricular systolic dysfunction after carbon monoxide exposure

Ahn, Kye Taek; Park, Jae‐Hyeong; Kim, Min Su; Park, Yun Seon; Kim, Yeon Ju; Lee, In Suk; Kim, Jun Hyung; Lee, Jae‐Hwan; Choi, Si Wan; Jeong, Jin‐Ok; Seong, In Whan

doi:10.1016/j.ijcard.2011.09.024

Cited by 3 publications

(4 citation statements)

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“…With prompt treatment, LVSD can be normalized within several days. 6) 13) Therefore, regardless of the level of CO-Hb, the evaluation of cardiac function is essential for prevention of cardiac complication or mortality at the ED. Moreover, patients with coronary artery disease are more susceptible to CO-induced cardiotoxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, several studies reported that myocardial injury after CO exposure can be identified by using electrocardiography and elevation of cardiac biomarker. 3) 7) 13) 15) However, electrocardiographic changes suggesting myocardial injury can include sinus tachycardia, and ST or T wave changes. Electrocardiographic changes were not prominent in our study.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Clinical Course of Left Ventricular Systolic Dysfunction in Patients with Carbon Monoxide Poisoning

et al. 2016

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Background and ObjectivesCarbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD.Subjects and MethodsWe included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF <50% assessed by echocardiography. We compared their clinical, chemical, radiological and electrocardiographic patterns according to the presence of LVSD.ResultsFrom May 2009 to June 2015, we included a total of 81 patients (48 men, 47±19 years old) with CO exposure in this cohort. LVSD was found in about 25 patients (31%). Nine had regional wall motion abnormality. Follow up echocardiographic examinations were available in 21 patients. Of them, 18 patients showed complete recovery in about 3 days (mean 2.8±1.7 days). Of 3 patients without recovery, 2 had significant coronary artery stenosis. LVSD was significantly associated with initial heart rate (>100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ≥8, area under the curve=0.952, p<0.001)ConclusionAbout 31% showed LVSD in patients with CO poisoning, and most of them (86%, 18 of 21 patients) recovered within 3 days. Patients with a higher clinical score (≥8) might have LVSD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Course of Left Ventricular Systolic Dysfunction in Patients with Carbon Monoxide Poisoning

et al. 2016

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“…A prospective study of transthoracic echocardiography on 40 patients with CO exposure found that 50% had left ventricular systolic dysfunction. On repeat testing in 3 days, the majority (80%) had completely recovered [41]. These changes are not usually simply uncovering pre-existing coronary artery disease.…”

Section: Toxicity Assessmentmentioning

confidence: 99%

Carbon monoxide poisoning in the 21st century

Chiew

Buckley

2014

Crit Care

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The world has experienced some very large shifts in the epidemiology of carbon monoxide poisoning, but it remains one of the most important toxicological global causes of morbidity and mortality. The diagnosis can be quickly confirmed with blood gases (pulse oximeters lack both sensitivity and specificity). Several strong predictors for serious neurological sequelae (prolonged loss of consciousness and elevated S100B) and reduced life expectancy (elevated troponin) are now reasonably well established. Despite this clearly defined high-risk group and extensive research into the pathophysiology, there has been little translation into better treatment. Much of the pathophysiological research has focused on hyperbaric oxygen. Yet it is apparent that clinical trials show little evidence for benefit from hyperbaric oxygen, and the most recent even raises the possibility of harm for repeated courses. More logical and promising potential antidotes have been under-researched, although recently both animal and small human studies suggest that erythropoietin may reduce S100B and prevent neurological sequelae. Major breakthroughs are likely to require further research on this and other treatments that may inhibit post-hypoxic inflammatory responses and apoptosis.

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“…In addition to diffuse hypokinesia and LV systolic dysfunction with regional wall motion abnormalities, an apical ballooning pattern of LV systolic dysfunction can occur. LV systolic dysfunction is and generally normalizes with conventional treatment within 3 days 91). Carbon monoxide poisoning can also result in myocardial fibrosis (detectable with DHE by CMR).…”

Section: Reversible Cardiomyopathiesmentioning

confidence: 99%

Role of Imaging in the Detection of Reversible Cardiomyopathy

Park

Kwon

Starling

et al. 2013

J Cardiovasc Ultrasound

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Heart failure is a major clinical problem in developed countries with about half of heart failure patients exhibiting decreased left ventricular systolic function. The correct identification and prompt treatment of some specific etiologies can reverse heart failure, and recognition of myocardial recovery may avoid long-term therapy. However, the echocardiographic patterns of patients with a variety of etiologies of heart failure are similar, so the selective use of other imaging techniques is necessary for identification of specific etiologies. The role of repeat imaging in monitoring the therapeutic response is controversial, as is the cessation of medical therapy in patients demonstrating recovery.

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Prevalence and clinical outcomes of left ventricular systolic dysfunction after carbon monoxide exposure

Cited by 3 publications

References 11 publications

Incidence and Clinical Course of Left Ventricular Systolic Dysfunction in Patients with Carbon Monoxide Poisoning

Incidence and Clinical Course of Left Ventricular Systolic Dysfunction in Patients with Carbon Monoxide Poisoning

Carbon monoxide poisoning in the 21st century

Role of Imaging in the Detection of Reversible Cardiomyopathy

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