A review of current landscape and definition of septic cardiomyopathy

Abstract

Abstract Background Septic cardiomyopathy (SCM) is a reversible myocardial dysfunction that is increasingly recognised in critically-ill septic patients. SCM and sepsis cause significant morbidity and mortality. However, the lack of consensus on the diagnostic criteria for SCM makes it difficult to understand how sepsis can impact cardiac function. Purpose To review the current literature regarding SCM and compare the various proposed diagnostic criteria and imaging parameters utilised. Method This literature review comprised of a three-part research method: patient population, imaging modality, and outcomes. Our patient population included critically ill patients diagnosed with sepsis or septic shock. We analysed all cardiac imaging modalities, including TTE, TOE, CT, and CMR. Our outcome was mortality or any related terms. We conducted a comprehensive search of PubMed, EMBASE, and SCOPUS and manually searched for past reviews on the subject. We excluded conference abstracts, review articles, and duplicates using Covidence. Only English-language, adult-audience articles were considered, and the last search update was in November 2022. Result This study analysed 77 papers on SCM, of which 55 were prospective and 18 were retrospective (figure 1). The majority of research was conducted in the ICU, and 61 studies used TTE as the primary imaging modality for assessing SCM. Approximately 44% of the studies evaluated cardiac dysfunction in septic patients using systolic function as the primary metric. About half of the research lacked a clear definition of SCM, and 49% did not provide a definitive LVEF cut-off point (figure 2). 78% of the studies determined the reversibility period to be between 7 and 10 days. The majority of studies required that SCM be diagnosed within 24 hours. However, 66% of the studies did not include any type of imaging follow-up for septic patients with cardiac dysfunction. Conclusion The heterogeneity inherent among these studies points toward the lack of standardisation in measurements and use of various parameters to assesses cardiac dysfunction in septic patients. There is a need for a new definition of SCM that may be better suited to describing the spectrum of cardiac dysfunction in patients with severe sepsis. Further work is required to establish a consensus definition of SCM and a standardised diagnostic approach.Figure 1Figure 2