Sepsis-Induced Cardiomyopathy: a Comprehensive Review

Abstract

Purpose of review: To briefly review epidemiology and pathophysiology of SICM and provide a more extensive review of the data on diagnostic and management strategies.

Recent findings: SICM is likely underdiagnosed and that has mortality implications. Current evidence supports speckle tracking echocardiography to identify decreased contractility irrespective of left ventricular ejection fraction for the diagnosis of SICM. There continues to be a dearth of large clinical trials evaluating the treatment of SICM and current consensus focuses on supportive measures such as vasopressors and inotropes. Sepsis is a significant cause of mortality, and sepsis-induced cardiomyopathy has both prognostic and management implications for these patients. Individualized work-up and management of these patients is crucial to improving outcomes.

Keywords: Echocardiography; Inotrope; Sepsis; Sepsis-induced cardiomyopathy; Sepsis-induced myocardial dysfunction; Septic cardiomyopathy.

Fig. 1

Proposed diagnostic criteria for sepsis-induced cardiomyopathy

Fig. 2

Summary of basic pathophysiology and proposed diagnosis and management of sepsis-induced cardiomyopathy. Risk factors include a history of congestive heart failure. Biomarkers while sensitive, are not specific, but do portent a poorer prognosis. Echocardiography should include global longitudinal strain which is the most sensitive and specific (although there are no agreed upon cutoff values). Judicious fluids should include dynamic measures (such as pulse pressure variation) to judge fluid responsiveness. Norepinephrine is considered the standard vasopressor and dobutamine is considered the standard inotrope. There is limited evidence for other vasopressors or inotropes. Adjuncts can include mechanical support (i.e. ECMO). PAMPs, pathogen-associated molecular patterns; DAMPs, damage-associated molecular patterns; NO, nitric oxide; TTE, transthoracic echocardiogram; ECMO, extracorporeal membrane oxygenation