Septic Cardiomyopathy: Difficult Definition, Challenging Diagnosis, Unclear Treatment

Area of Science:

• Critical Care Medicine
• Cardiology
• Pathophysiology

Background:

• Sepsis frequently leads to multiorgan failure, including cardiac dysfunction, termed septic cardiomyopathy (SCM).
• SCM is an underdiagnosed complication of sepsis, lacking a formal definition and representing a significant knowledge gap.
• It is characterized by transient myocardial dysfunction not caused by ischemia or pre-existing heart disease.

Purpose of the Study:

• To define septic cardiomyopathy (SCM) and its diagnostic challenges.
• To explore the multifactorial pathogenesis of SCM.
• To review current diagnostic modalities and treatment strategies for SCM.

Main Methods:

• Echocardiography, including tissue Doppler imaging (TDI) and global longitudinal strain (GLS), is the primary diagnostic tool.
• Assessment of right ventricular (RV) dysfunction is critical, influenced by factors like mechanical ventilation and ARDS.
• Cardiac biomarkers have uncertain prognostic value for SCM specificity.

Main Results:

• SCM diagnosis is complicated by the fact that traditional measures like ejection fraction may reflect vasoplegia rather than intrinsic myocardial dysfunction.
• RV dysfunction is a significant component of SCM, exacerbated by sepsis and supportive therapies.
• Current treatment focuses on sepsis management and hemodynamic optimization, with no specific SCM therapies.

Conclusions:

• Standardized diagnostic criteria for SCM are lacking, hindering effective management.
• Future research should focus on classification systems integrating biomarkers and echocardiographic data for tailored therapies.
• Emerging treatments like levosimendan and VA-ECMO show promise for severe SCM but require further validation.