Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: A review of the literature

Robert R. Ehrman, Ashley N. Sullivan, Mark J. Favot, Robert L. Sherwin, Christian A. Reynolds, Aiden Abidov, Phillip D. Levy

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Background: Sepsis is a common condition encountered by emergency and critical care physicians, with significant costs, both economic and human. Myocardial dysfunction in sepsis is a well-recognized but poorly understood phenomenon. There is an extensive body of literature on this subject, yet results are conflicting and no objective definition of septic cardiomyopathy exists, representing a critical knowledge gap. Objectives: In this article, we review the pathophysiology of septic cardiomyopathy, covering the effects of key inflammatory mediators on both the heart and the peripheral vasculature, highlighting the interconnectedness of these two systems. We focus on the extant literature on echocardiographic and laboratory assessment of the heart in sepsis, highlighting gaps therein and suggesting avenues for future research. Implications for treatment are briefly discussed. Conclusions: As a result of conflicting data, echocardiographic measures of left ventricular (systolic or diastolic) or right ventricular function cannot currently provide reliable prognostic information in patients with sepsis. Natriuretic peptides and cardiac troponins are of similarly unclear utility. Heterogeneous classification of illness, treatment variability, and lack of formal diagnostic criteria for septic cardiomyopathy contribute to the conflicting results. Development of formal diagnostic criteria, and use thereof in future studies, may help elucidate the link between cardiac performance and outcomes in patients with sepsis.

Original languageEnglish (US)
Article number112
JournalCritical Care
Volume22
Issue number1
DOIs
StatePublished - May 4 2018
Externally publishedYes

Fingerprint

Cardiomyopathies
Sepsis
Biomarkers
Right Ventricular Function
Natriuretic Peptides
Troponin
Emergency Medical Services
Critical Care
Economics
Physicians
Costs and Cost Analysis
Therapeutics

Keywords

  • B-type natriuretic peptide
  • Echocardiography
  • Sepsis
  • Troponin
  • Ultrasound

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy : A review of the literature. / Ehrman, Robert R.; Sullivan, Ashley N.; Favot, Mark J.; Sherwin, Robert L.; Reynolds, Christian A.; Abidov, Aiden; Levy, Phillip D.

In: Critical Care, Vol. 22, No. 1, 112, 04.05.2018.

Research output: Contribution to journalReview article

Ehrman, Robert R. ; Sullivan, Ashley N. ; Favot, Mark J. ; Sherwin, Robert L. ; Reynolds, Christian A. ; Abidov, Aiden ; Levy, Phillip D. / Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy : A review of the literature. In: Critical Care. 2018 ; Vol. 22, No. 1.
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