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

Critical Care

卷:22

Christian A. Reynolds¹  Phillip D. Levy²  Robert R. Ehrman³  Mark J. Favot³  Robert L. Sherwin³  Ashley N. Sullivan⁴  Aiden Abidov⁵ 

[1] Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University School of Medicine;

[2] Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Detroit Receiving Hospital;

[3] Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital;

[4] Department of Emergency Medicine, Wayne State University School of Medicine, St. John Hospital and Medical Center;

[5] Division of Cardiology, Wayne State University School of Medicine, John D. Dingell VA Medical Center;

关键词: Echocardiography;    Sepsis;    Troponin;    B-type natriuretic peptide;    Ultrasound;   

DOI  :  10.1186/s13054-018-2043-8

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown