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Published in: Cardiovascular Toxicology 4/2016

01-10-2016

Various Echocardiographic Patterns of Left Ventricular Systolic Dysfunction Induced by Carbon Monoxide Intoxication

Authors: Jin-Sun Park, Kyoung-Woo Seo, Byoung-Joo Choi, So-Yeon Choi, Myeong-Ho Yoon, Gyo-Seung Hwang, Seung-Jea Tahk, Sang-Cheon Choi, Young-Gi Min, Joon-Han Shin

Published in: Cardiovascular Toxicology | Issue 4/2016

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Abstract

Carbon monoxide (CO) intoxication could cause significant cardiac injury. Although cardiac dysfunction after CO intoxication can be presented, the echocardiographic findings after CO intoxication are poorly defined. The purpose of this study was to evaluate the clinical patterns of left ventricular (LV) systolic dysfunction using echocardiography. A total of 132 CO-intoxicated patients were enrolled. Clinical, demographic and laboratory data and echocardiographic findings were analyzed. The LV dysfunction group (29 patients) showed higher lactate level (5.8 ± 3.3 vs. 4.1 ± 3.5 mmol/L, p = 0.024) and lower base excess (BE) (−8.2 ± 6.0 vs. −4.8 ± 4.7 mEq/L, p = 0.001) compared with normal LV function group. Among the LV dysfunction group, three different echocardiographic patterns were presented. Regional wall motion abnormality was presented in 14 patients. Apical ballooning, typical finding of stress-induced cardiomyopathy, was presented in eight patients. Global hypokinesia of LV was presented in seven patients. Laboratory findings indicating the severity of CO intoxication, such as lactate level, pH value, BE and aspartate aminotransferase, showed statistical significance according to the patterns of LV dysfunction (p = 0.033, 0.022, 0.02 and 0.006, respectively). Our results demonstrate that CO intoxication could induce various patterns of LV dysfunction. The patterns of LV dysfunction might affect subsequent clinical outcomes.
Literature
1.
go back to reference Henry, C. R., Satran, D., Lindgren, B., Adkinson, C., Nicholson, C. I., & Henry, T. D. (2006). Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA, 295, 398–402.CrossRefPubMed Henry, C. R., Satran, D., Lindgren, B., Adkinson, C., Nicholson, C. I., & Henry, T. D. (2006). Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA, 295, 398–402.CrossRefPubMed
2.
go back to reference Satran, D., Henry, C. R., Adkinson, C., Nicholson, C. I., Bracha, Y., & Henry, T. D. (2005). Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. Journal of the American College of Cardiology, 45, 1513–1516.CrossRefPubMed Satran, D., Henry, C. R., Adkinson, C., Nicholson, C. I., Bracha, Y., & Henry, T. D. (2005). Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. Journal of the American College of Cardiology, 45, 1513–1516.CrossRefPubMed
4.
go back to reference Jang, W. I., & Park, J. H. (2010). Transient left ventricular systolic dysfunction associated with carbon monoxide toxicity. Journal of Cardiovascular Ultrasound, 18, 12–15.CrossRefPubMedPubMedCentral Jang, W. I., & Park, J. H. (2010). Transient left ventricular systolic dysfunction associated with carbon monoxide toxicity. Journal of Cardiovascular Ultrasound, 18, 12–15.CrossRefPubMedPubMedCentral
5.
go back to reference Kim, S., Lim, J. H., Kim, Y., Oh, S., & Choi, W. G. (2012). A case of acute carbon monoxide poisoning resulting in an ST elevation myocardial infarction. Korean Circulation Journal, 42, 133–135.CrossRefPubMedPubMedCentral Kim, S., Lim, J. H., Kim, Y., Oh, S., & Choi, W. G. (2012). A case of acute carbon monoxide poisoning resulting in an ST elevation myocardial infarction. Korean Circulation Journal, 42, 133–135.CrossRefPubMedPubMedCentral
6.
go back to reference Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2005). Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography, 18, 1440–1463.CrossRefPubMed Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2005). Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography, 18, 1440–1463.CrossRefPubMed
7.
go back to reference Lippi, G., Rastelli, G., Meschi, T., Borghi, L., & Cervellin, G. (2012). Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clinical Biochemistry, 45, 1278–1285.CrossRefPubMed Lippi, G., Rastelli, G., Meschi, T., Borghi, L., & Cervellin, G. (2012). Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clinical Biochemistry, 45, 1278–1285.CrossRefPubMed
9.
go back to reference Moon, J. M., Shin, M. H., & Chun, B. J. (2011). The value of initial lactate in patients with carbon monoxide intoxication: In the emergency department. Human and Experimental Toxicology, 30, 836–843.CrossRefPubMed Moon, J. M., Shin, M. H., & Chun, B. J. (2011). The value of initial lactate in patients with carbon monoxide intoxication: In the emergency department. Human and Experimental Toxicology, 30, 836–843.CrossRefPubMed
10.
go back to reference Sokal, J. A., & Kralkowska, E. (1985). The relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man. Archives of Toxicology, 57, 196–199.CrossRefPubMed Sokal, J. A., & Kralkowska, E. (1985). The relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man. Archives of Toxicology, 57, 196–199.CrossRefPubMed
11.
go back to reference Chen, K. C., & McGrath, J. J. (1985). Response of the isolated heart to carbon monoxide and nitrogen anoxia. Toxicology and Applied Pharmacology, 81, 363–370.CrossRefPubMed Chen, K. C., & McGrath, J. J. (1985). Response of the isolated heart to carbon monoxide and nitrogen anoxia. Toxicology and Applied Pharmacology, 81, 363–370.CrossRefPubMed
12.
go back to reference Suner, S., & Jay, G. (2008). Carbon monoxide has direct toxicity on the myocardium distinct from effects of hypoxia in an ex vivo rat heart model. Academic Emergency Medicine, 15, 59–65.CrossRefPubMed Suner, S., & Jay, G. (2008). Carbon monoxide has direct toxicity on the myocardium distinct from effects of hypoxia in an ex vivo rat heart model. Academic Emergency Medicine, 15, 59–65.CrossRefPubMed
13.
go back to reference Alonso, J. R., Cardellach, F., López, S., Casademont, J., & Miró, O. (2003). Carbon monoxide specifically inhibits cytochrome c oxidase of human mitochondrial respiratory chain. Pharmacology and Toxicology, 93, 142–146.CrossRefPubMed Alonso, J. R., Cardellach, F., López, S., Casademont, J., & Miró, O. (2003). Carbon monoxide specifically inhibits cytochrome c oxidase of human mitochondrial respiratory chain. Pharmacology and Toxicology, 93, 142–146.CrossRefPubMed
14.
go back to reference Taskiran, D., Nesil, T., & Alkan, K. (2007). Mitochondrial oxidative stress in female and male rat brain after ex vivo carbon monoxide treatment. Human and Experimental Toxicology, 26, 645–651.CrossRefPubMed Taskiran, D., Nesil, T., & Alkan, K. (2007). Mitochondrial oxidative stress in female and male rat brain after ex vivo carbon monoxide treatment. Human and Experimental Toxicology, 26, 645–651.CrossRefPubMed
15.
go back to reference Wattel, F., Favory, R., Lancel, S., Neviere, R., & Mathieu, D. (2006). Carbon monoxide and the heart: Unequivocal effects? Bulletin de l’Academie Nationale de Medecine, 190, 1961–1975.PubMed Wattel, F., Favory, R., Lancel, S., Neviere, R., & Mathieu, D. (2006). Carbon monoxide and the heart: Unequivocal effects? Bulletin de l’Academie Nationale de Medecine, 190, 1961–1975.PubMed
16.
go back to reference Henry, T. D., Lesser, J. R., & Satran, D. (2008). Myocardial fibrosis from severe carbon monoxide poisoning detected by cardiac magnetic resonance imaging. Circulation, 118, 792.CrossRefPubMed Henry, T. D., Lesser, J. R., & Satran, D. (2008). Myocardial fibrosis from severe carbon monoxide poisoning detected by cardiac magnetic resonance imaging. Circulation, 118, 792.CrossRefPubMed
17.
go back to reference Jung, Y. S., Lee, J. S., Min, Y. G., Park, J. S., Jeon, W. C., Park, E. J., et al. (2014). Carbon monoxide-induced cardiomyopathy. Circulation Journal, 78, 1437–1444.CrossRefPubMed Jung, Y. S., Lee, J. S., Min, Y. G., Park, J. S., Jeon, W. C., Park, E. J., et al. (2014). Carbon monoxide-induced cardiomyopathy. Circulation Journal, 78, 1437–1444.CrossRefPubMed
18.
go back to reference Ishikawa, T., Quan, L., Michiue, T., Kawamoto, O., Wang, Q., Chen, J. H., et al. (2013). Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Science International, 228, 52–60.CrossRefPubMed Ishikawa, T., Quan, L., Michiue, T., Kawamoto, O., Wang, Q., Chen, J. H., et al. (2013). Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Science International, 228, 52–60.CrossRefPubMed
19.
go back to reference Wittstein, I. S., Thiemann, D. R., Lima, J. A., Baughman, K. L., Schulman, S. P., Gerstenblith, G., et al. (2005). Neurohumoral features of myocardial stunning due to sudden emotional stress. New England Journal of Medicine, 352, 539–548.CrossRefPubMed Wittstein, I. S., Thiemann, D. R., Lima, J. A., Baughman, K. L., Schulman, S. P., Gerstenblith, G., et al. (2005). Neurohumoral features of myocardial stunning due to sudden emotional stress. New England Journal of Medicine, 352, 539–548.CrossRefPubMed
20.
go back to reference Paur, H., Wright, P. T., Sikkel, M. B., Tranter, M. H., Mansfield, C., O’Gara, P., et al. (2012). High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: A new model of Takotsubo cardiomyopathy. Circulation, 126, 697–706.CrossRefPubMedPubMedCentral Paur, H., Wright, P. T., Sikkel, M. B., Tranter, M. H., Mansfield, C., O’Gara, P., et al. (2012). High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: A new model of Takotsubo cardiomyopathy. Circulation, 126, 697–706.CrossRefPubMedPubMedCentral
21.
go back to reference Akashi, Y. J., Sakakibara, M., & Miyake, F. (2002). Reversible left ventricular dysfunction “Takotsubo” cardiomyopathy associated with pneumothorax. Heart, 87, E1.CrossRefPubMedPubMedCentral Akashi, Y. J., Sakakibara, M., & Miyake, F. (2002). Reversible left ventricular dysfunction “Takotsubo” cardiomyopathy associated with pneumothorax. Heart, 87, E1.CrossRefPubMedPubMedCentral
22.
go back to reference Jin, U., Park, J. S., Min, Y. G., Yang, H. M., Lim, H. S., Choi, B. J., et al. (2015). Hanging-associated left ventricular systolic dysfunction. Resuscitation, 88, 1–5.CrossRefPubMed Jin, U., Park, J. S., Min, Y. G., Yang, H. M., Lim, H. S., Choi, B. J., et al. (2015). Hanging-associated left ventricular systolic dysfunction. Resuscitation, 88, 1–5.CrossRefPubMed
23.
go back to reference Kao, H. K., Lien, T. C., Kou, Y. R., & Wang, J. H. (2009). Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulmonary Pharmacology & Therapeutics, 22, 473–477.CrossRef Kao, H. K., Lien, T. C., Kou, Y. R., & Wang, J. H. (2009). Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulmonary Pharmacology & Therapeutics, 22, 473–477.CrossRef
24.
go back to reference Turner, M., Esaw, M., & Clark, R. J. (1999). Carbon monoxide poisoning treated with hyperbaric oxygen: Metabolic acidosis as a predictor of treatment requirements. Journal of Accident and Emergency Medicine, 16, 96–98.CrossRefPubMedPubMedCentral Turner, M., Esaw, M., & Clark, R. J. (1999). Carbon monoxide poisoning treated with hyperbaric oxygen: Metabolic acidosis as a predictor of treatment requirements. Journal of Accident and Emergency Medicine, 16, 96–98.CrossRefPubMedPubMedCentral
25.
go back to reference Gianni, M., Dentali, F., Grandi, A. M., Sumner, G., Hiralal, R., & Lonn, E. (2006). Apical ballooning syndrome or Takotsubo cardiomyopathy: A systematic review. European Heart Journal, 27, 1523–1529.CrossRefPubMed Gianni, M., Dentali, F., Grandi, A. M., Sumner, G., Hiralal, R., & Lonn, E. (2006). Apical ballooning syndrome or Takotsubo cardiomyopathy: A systematic review. European Heart Journal, 27, 1523–1529.CrossRefPubMed
Metadata
Title
Various Echocardiographic Patterns of Left Ventricular Systolic Dysfunction Induced by Carbon Monoxide Intoxication
Authors
Jin-Sun Park
Kyoung-Woo Seo
Byoung-Joo Choi
So-Yeon Choi
Myeong-Ho Yoon
Gyo-Seung Hwang
Seung-Jea Tahk
Sang-Cheon Choi
Young-Gi Min
Joon-Han Shin
Publication date
01-10-2016
Publisher
Springer US
Published in
Cardiovascular Toxicology / Issue 4/2016
Print ISSN: 1530-7905
Electronic ISSN: 1559-0259
DOI
https://doi.org/10.1007/s12012-015-9347-6

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