Sepsis-Induced Cardiomyopathy: Mechanism, Prevalence, Assessment, Prognosis, and Management.

Abstract

Sepsis-induced cardiomyopathy (SICM) is a heterogeneous cardiovascular dysfunction associated with sepsis and septic shock. Although traditionally defined by reversible left ventricular (LV) systolic dysfunction, recent evidence has revealed a broader spectrum, including LV diastolic dysfunction, hyperdynamic LV systolic states, and right ventricular (RV) injury, occurring independently or in combination. Despite their prognostic significance, these phenotypes remain underrecognized and understudied. The pathophysiology of SICM involves inflammatory cytokines, mitochondrial dysfunction, altered coronary microcirculation, and dynamic changes in loading conditions. Echocardiography, because it is widely available, noninvasive, and capable of comprehensive hemodynamic evaluation, has become the primary modality for assessing cardiac function in sepsis. Emerging measures, including longitudinal LV function and ventriculo-arterial coupling, supplement the LV ejection fraction or other conventional parameters. The inherent differences in sensitivity and specificity in diagnosing myocardial dysfunction along with inconsistent definitions have led to wide variability in reported prevalence. New-onset LV systolic dysfunction occurs in approximately 5% to 32% of patients with sepsis, whereas LV diastolic dysfunction and RV injury are reported in 20% to 57% and 18% to 79%, respectively. All these cardiac phenotypes are associated with significantly increased mortality. Management requires phenotype-guided, individualized approaches rather than standardized resuscitation strategies. SICM comprises a spectrum of cardiac abnormalities, including LV systolic dysfunction, hyperdynamic LV function, diastolic dysfunction, and RV injury. Although no targeted therapies have shown survival benefit, recognition of SICM phenotypes is crucial. A tailored, phenotype-guided approach may optimize management.