Septic cardiomyopathy: Fact or fiction?

Septic cardiomyopathy (SCM) represents a dynamic form of myocardial dysfunction occurring in the setting of sepsis. Unlike chronic ischemic or structural heart disease, SCM arises acutely due to a complex interplay of inflammatory, metabolic, endothelial, and microvascular mechanisms and often, though not always, demonstrates reversibility within days.⁶'⁸'⁹ Despite increasing recognition, SCM remains poorly defined due to the absence of standardized diagnostic criteria and substantial overlap with other acute cardiomyopathies, including Takotsubo cardiomyopathy and myocarditis.¹⁰ Current diagnostic approaches rely primarily on echocardiography, strain imaging, biomarkers, and clinical trajectory, while emerging modalities such as cardiac magnetic resonance imaging may provide additional insight into myocardial inflammation, edema, and fibrosis. Management remains largely supportive and centered on treatment of the underlying septic process, with ongoing uncertainty regarding targeted heart failure therapies and adjunctive interventions. This review summarizes current understanding of SCM pathophysiology, diagnosis, imaging findings, and management while critically examining whether SCM represents a distinct disease entity or part of a broader stress-inflammatory cardiomyopathy spectrum.

The objectives include: proposing a broad definition and description of septic cardiomyopathy, providing a comprehensive literature review on current diagnostic and management options available for septic cardiomyopathy, and describing the limitations and gaps in this diagnosis and possible direction of future studies.