Cardiac Dysfunction in Sepsis: Myth or Reality?

Abstract

Severe sepsis and septic shock systematically result in a cardiac impairment, which involves the systolic and diastolic function of both ventricles. Diagnosis mainly relies on doppler echocardiography. Parameters of cardiac function routinely used on clinical grounds are load-dependent and are particularly sensitive to afterload. Accordingly, serial hemodynamic assessments should be performed if necessary during the initial management of septic shock. The frequency of systolic dysfunction assessed using left ventricular (LV) ejection fraction ranges from 27 to 67% of patients. It does not appear to be associated with survival as initially suggested, such as LV dilatation, when the ventricular cavity size is indexed to body area. In contrast, LV hyperkinesia that reflects underlying profound vasoplegia could be a warning sign. Abnormal LV relaxation is observed in 37–62% of septic patients. Published studies suggest that it could be an independent predictor of death pending further external validation confirmation. Right ventricular dysfunction is also observed in patients with septic shock, irrespective of the presence of associated acute respiratory failure. Severe presentation may be encountered especially in patients with sepsis-associated acute respiratory distress syndrome who are under positive-pressure ventilation. Further large-scale studies including large cohorts of patients are required to establish or confirm the prognostic role of septic cardiomyopathy, and to tailor the acute management of septic shock patients according to their hemodynamic profile.