Sepsis-induced myocardial dysfunction
Abstract
Purpose of review: Sepsis leads to a complex intramyocardial inflammatory response that results in sepsis-induced myocardial dysfunction. Here, recent findings are reviewed in a physiologic context. Recent findings: Decreased systolic contractility during sepsis limits ventricular ejection and stroke volume. Initially, this effect is compensated for by increased diastolic filling during volume resuscitation. Reduced afterload due to arterial vasodilation also compensates so that cardiac output can be maintained or increased. Recent results recognize the importance of diastolic dysfunction, reduced ventricular diastolic compliance that impedes ventricular filling. Diastolic dysfunction becomes increasingly important as severity of septic shock increases. When impaired ventricular ejection is coupled with limited diastolic filling, stroke volume must decrease. Accordingly, diastolic dysfunction is more closely related to mortality than systolic dysfunction. Recent trials of beta-adrenergic agonists and levosimendan have been disappointing, while approaches to modulating the intramyocardial inflammatory response show promise. Summary: Sepsis-induced myocardial dysfunction is increasingly recognized as a major contributor to outcome of septic shock. Significant strides have been made in understanding the intramyocardial inflammatory response that causes myocardial dysfunction. A number of novel approaches show promise by modulating the intramyocardial inflammatory response.
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Sepsis-induced myocardial dysfunction is recognized as a major contributor to haemodynamic instability and is associated with worse outcomes in septic shock.
“Sepsis-induced myocardial dysfunction is recognised as a major contributor to the haemodynamic instability and is associated with worse outcomes of patients with septic shock [368].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [368]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
- Authors
- Walley, K. R.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Walley, Keith R.
- ORCID
- Walley, Keith R.
- Venue
- Current Opinion in Critical Care
- Published
- 2018-08
- Volume
- 24
- Issue
- 4
- Pages
- 292-299
- ISSN
- 1070-5295 (ISSN-L)
- 1531-7072
- OpenAlex
- W2804721740
- Cited by
- 165
- References
- 75
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 19 · 2023: 41 · 2022: 19 · 2021: 34 · 2020: 18 · 2019: 10 · 2018: 2
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (FDN154311)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- septic cardiomyopathy, septic shock, diastolic dysfunction, systolic dysfunction, ventricular ejection, stroke volume, diastolic filling, fluid resuscitation, arterial vasodilation, afterload, beta-adrenergic agonists, levosimendan, mortality
- MeSH terms
- Critical Care, Echocardiography, Humans, Shock, Septic, Stroke Volume, Survival Analysis, Ventricular Function, Left, Ventricular Dysfunction, Left, Sepsis
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