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To the Editor.—
We read with interest the editorial by Samuel Vaisrub, MD, in the April 22, 1974, issue of The Journal, entitled "Myocardial Depressant Factor (MDF) in Cardiogenic Shock" (228:500, 1974). Dr. Vaisrub stated that the most prominent humoral factor shown to play an important part in cardiogenic shock is MDF, a small peptide of molecular weight range between 800 and 1,000. While the hypothesis developed primarily by Drs. Lefer and Glenn is most attractive, we believe it must be interpreted with extreme caution at the present time. Since the turn of the century, toxic factors have been implicated in circulatory shock, but to date, none have had sustained importance as primary factors in the pathogenesis of shock. Using the cat papillary muscle assay system as described by Lefer, we have examined unprocessed plasma, ultrafiltered plasma, dialyzed plasma, column-eluted fractions of plasma, and desalted ultrafiltrates of plasma for MDF activity
Wangensteen SL, Crampton RS, Ferguson WW. Myocardial Depressant Factor in Cardiogenic Shock. JAMA. 1974;228(13):1638–1639. doi:10.1001/jama.1974.03230380016010
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