Sepsis-Induced myocardial dysfunction: heterogeneity of functional effects and clinical significance

Abstract

Sepsis is a life-threatening disease state characterized by organ dysfunction and a dysregulated response to infection. The heart is one of the many organs affected by sepsis, in an entity termed sepsis-induced cardiomyopathy. This was initially used to describe a reversible depression in ejection fraction with ventricular dilation but advances in echocardiography and introduction of new techniques such as speckle tracking have led to descriptions of other common abnormalities in cardiac function associated with sepsis. This includes not only depression of systolic function, but also supranormal ejection fraction, diastolic dysfunction, and right ventricular dysfunction. These reports have led to inconsistent definitions of sepsis-induced cardiomyopathy. Just as there is heterogeneity among patients with sepsis, there is heterogeneity in the cardiac response; thus resuscitating these patients with a single approach is likely suboptimal. Many factors affect the heart in sepsis including inflammatory mediators, catecholamine responsiveness, and pathogen related toxins. This review will discuss different functional effects characterized by echocardiographic changes in sepsis and their prognostic and management implications.

Therapeutic S100A8/A9 blockade inhibits myocardial and systemic inflammation and mitigates sepsis-induced myocardial dysfunction

“…Lastly, there are important differences in the patterns of cardiac dysfunction in experimental sepsis models and sepsis patients. While LVEF and stroke volumes are severely depressed in our mouse model, sepsis patients have highly heterogeneous patterns of LVEF and LV volumes [ 6 ]. In sepsis patients with depressed LVEF, cardiac dilation may also be present as a compensatory mechanism to preserve stroke volume [ 54 – 56 ].…”

“…Currently, there are no clear guidelines for echocardiographic evaluation of cardiac function in sepsis. Non-cardiac factors such as reduced afterload related to vasoplegia have a strong influence on LVEF and LV volumes, leading to high heterogeneity among sepsis patients [ 6 ]. LVEF alone is considered to have a poor diagnostic and prognostic value in SIMD [ 5 , 6 ].…”

“…Non-cardiac factors such as reduced afterload related to vasoplegia have a strong influence on LVEF and LV volumes, leading to high heterogeneity among sepsis patients [ 6 ]. LVEF alone is considered to have a poor diagnostic and prognostic value in SIMD [ 5 , 6 ]. We followed the American Society for Echocardiography recommendations for quantification of LV systolic function [ 29 ] and the PRICES consensus recommendations for reporting critical care echocardiography research studies.…”

“…SIMD is generally defined as an acute and reversible global cardiac dysfunction with reduced contractility, often associated with left ventricular (LV) dilation, diminished response to fluid resuscitation and catecholamines, and the absence of acute coronary syndrome as etiology [ 5 ]. Echocardiographically, there is high heterogeneity among sepsis patients, including subgroups with normal, depressed or elevated LV ejection fraction (LVEF) or LV volumes [ 6 ]. Depressed myocardial strain was found to be significantly associated with increased mortality in sepsis patients, suggesting that the presence of SICM might contribute to a poor prognosis [ 7 ].…”

A Brief Overview of Sepsis Induced Cardiomyopathy

“…Estimation of LVEF is a poor diagnostic tool for identifying SICM as LVEF estimation is influenced by afterload and preload conditions. LVEF estimation can change remarkably and quickly based on the volume status and mean arterial pressures that may be rapidly shifting in septic states [12,13]. As such, identification of reduced contractility with speckle tracking echocardiography (STE), irrespective of the LVEF is the diagnostic approach supported by evidence [8].…”