Plasma Histone H4 and Its Implications in the Setting of Sepsis-related Myocardial Dysfunction

摘要

In clinical practice, septic cardiomyopathy (S-CMP) has been regarded as a poorly understood phenomenon with a variety of underlying mechanisms-including detrimental impacts of cytokines and nitric oxide on the myocardium-and generally presents with emerging systolic and/or diastolic dysfunction on transthoracic echocardiogram (TTE) in septic patients ( , , ). Within this context, the association of inflammation markers, in particular, with left ventricular systolic dysfunction might also be substantiated by previous reports in diverse clinical scenarios other than sepsis ( ). Interestingly, S-CMP, though renowned for its reversible nature ( ), might not fully recover in certain settings, potentially suggesting some degree of permanent myocardial injury ( ). In their recently published elegant article ( ), Lu et al. ( ) suggested plasma histone H4 as an important predictor of S-CMP evolution, along with vasopressor use, in a mixed population of sepsis and septic shock patients. Of note, the authors particularly focused on histone H4 both as a consequence and trigger of myocardial injury/dysfunction in the setting of S-CMP. However, though we fully agree on the important findings of the study ( ), we would like to make a few comments regarding further implications of plasma histone H4 in the setting of sepsis-related myocardial dysfunction.