Septic Cardiomyopathy: Occult Myocardial Depression Within a Hyperdynamic Circulatory State. A Narrative Review
DOI:
https://doi.org/10.61616/rvdc.v7i2.1834Palavras-chave:
septic shock, cardiomyopathy, echocardiography, biomarkersResumo
Septic cardiomyopathy is an acute and potentially reversible cardiovascular dysfunction associated with sepsis. It may remain clinically concealed by vasoplegia, which reduces afterload and may preserve a normal or hyperdynamic ejection fraction despite underlying depression of myocardial contractility. Its pathophysiology involves systemic inflammation, mitochondrial dysfunction, oxidative and nitrosative stress, endothelial and glycocalyx injury, disturbances in intracellular calcium handling, and β-adrenergic desensitisation. It may present as left ventricular hyperdynamic function, systolic or diastolic dysfunction, right ventricular injury, or biventricular involvement. Ejection fraction alone is insufficient for diagnosis. Assessment should integrate loading conditions, stroke volume, left ventricular outflow tract velocity–time integral, tissue Doppler imaging, global longitudinal strain, right ventricular function, and haemodynamic evolution. Cardiac troponins and natriuretic peptides provide prognostic information but lack diagnostic specificity. Septic cardiomyopathy therefore requires serial, multiparametric assessment. Management should be individualised according to the predominant cardiovascular phenotype, prioritising infection control, adequate tissue perfusion, and the judicious use of fluids, vasopressors, and inotropes.
Referências
1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287
2. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211. doi:10.1016/S0140-6736(19)32989-7
3. Parker MM, Shelhamer JH, Bacharach SL, et al. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med. 1984;100(4):483-490. doi:10.7326/0003-4819-100-4-483
4. Aissaoui N, Boissier F, Chew M, Singer M, Vignon P. Sepsis-induced cardiomyopathy. Eur Heart J. 2025;46(34):3339-3353. doi:10.1093/eurheartj/ehaf340
5. Sato R, Sanfilippo F, Lanspa M, Duggal A, Dugar S. Sepsis-induced cardiomyopathy: mechanism, prevalence, assessment, prognosis, and management. Chest. 2025;168(6):1383-1394. doi:10.1016/j.chest.2025.08.013
6. Boissier F, Aissaoui N. Septic cardiomyopathy: diagnosis and management. J Intensive Med. 2022;2(1):8-16. doi:10.1016/j.jointm.2021.11.004
7. Hasegawa D, Ishisaka Y, Maeda T, et al. Prevalence and prognosis of sepsis-induced cardiomyopathy: a systematic review and meta-analysis. J Intensive Care Med. 2023;38(9):797-808. doi:10.1177/08850666231180526
8. Torabi S, Omuro PK, Adam EH, Kammerer T. Septic cardiomyopathy in the ICU: echocardiographic phenotypes, global longitudinal strain, and right ventricular assessment. Diagnostics (Basel). 2026;16(11):1664. doi:10.3390/diagnostics16111664
9. Zakynthinos GE, Giamouzis G, Xanthopoulos A, et al. Septic cardiomyopathy: difficult definition, challenging diagnosis, unclear treatment. J Clin Med. 2025;14(3):986. doi:10.3390/jcm14030986
10. Sato R, Sanfilippo F, Hasegawa D, Prasitlumkum N, Duggal A, Dugar S. Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: a systematic review and meta-analysis. Ann Intensive Care. 2024;14(1):22. doi:10.1186/s13613-024-01255-9
11. Boissier F, Razazi K, Seemann A, et al. Left ventricular systolic dysfunction during septic shock: the role of loading conditions. Intensive Care Med. 2017;43(5):633-642. doi:10.1007/s00134-017-4698-z
12. Nasu M, Sato R, Takahashi K, Nakaizumi T, Maruyama A, Ueda S. The chronological demographics of ventricular-arterial decoupling in patients with sepsis and septic shock: a prospective observational study. J Intensive Care Med. 2023;38(4):340-348. doi:10.1177/08850666221120219
13. Hollenberg SM, Singer M. Pathophysiology of sepsis-induced cardiomyopathy. Nat Rev Cardiol. 2021;18(6):424-434. doi:10.1038/s41569-020-00492-2
14. Kuroshima T, Kawaguchi S, Okada M. Current perspectives of mitochondria in sepsis-induced cardiomyopathy. Int J Mol Sci. 2024;25(9):4710. doi:10.3390/ijms25094710
15. Jakobsson G, Papareddy P, Andersson H, et al. Therapeutic S100A8/A9 blockade inhibits myocardial and systemic inflammation and mitigates sepsis-induced myocardial dysfunction. Crit Care. 2023;27(1):374. doi:10.1186/s13054-023-04652-x
16. Zhang TN, Huang XM, Li L, et al. Lactylation of HADHA promotes sepsis-induced myocardial depression. Circ Res. 2025;137(4):e65-e87. doi:10.1161/CIRCRESAHA.124.325708
17. Muehlberg F, Blaszczyk E, Will K, Wilczek S, Brederlau J, Schulz-Menger J. Characterization of critically ill patients with septic shock and sepsis-associated cardiomyopathy using cardiovascular MRI. ESC Heart Fail. 2022;9(4):2147-2156. doi:10.1002/ehf2.13938
18. Kakino Y, Doi T, Okada H, et al. Recombinant thrombomodulin may protect cardiac capillary endothelial glycocalyx through promoting Glypican-1 expression under experimental endotoxemia. Heliyon. 2022;8(11):e11262. doi:10.1016/j.heliyon.2022.e11262
19. Razazi K, Labbe V, Laine L, et al. Hemodynamic effects and tolerance of dobutamine for myocardial dysfunction during septic shock: an observational multicenter prospective echocardiographic study. Front Cardiovasc Med. 2022;9:951016. doi:10.3389/fcvm.2022.951016
20. Ehrman RR, Bredell BX, Harrison NE, et al. Increasing illness severity is associated with global myocardial dysfunction in the first 24 hours of sepsis admission. Ultrasound J. 2022;14(1):32. doi:10.1186/s13089-022-00282-6
21. Jaffar R, Chaudhary AJ, Khan MN, et al. Hemodynamic patterns in septic cardiomyopathy: insights from echocardiographic parameters and biomarker analysis. Cureus. 2025;17(8):e91283. doi:10.7759/cureus.91283
22. Pruszczyk A, Zawadka M, Andruszkiewicz P, et al. Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: an updated systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2024;43(2):101339. doi:10.1016/j.accpm.2023.101339
23. Gonzalez FA, Bacariza J, Varudo AR, et al. Sepsis-induced myocardial dysfunction diagnosed with strain versus non-strain echocardiography parameters: incidence, evolution and association with prognosis. Ann Intensive Care. 2025;15(1):141. doi:10.1186/s13613-025-01561-w
24. Kim S, Seok H, Kim BK, et al. Seven-day and in-hospital mortality according to left and right ventricular dysfunction in patients with septic shock. Korean Circ J. 2023;53(12):813-825. doi:10.4070/kcj.2023.0050
25. Chawla S, Sato R, Duggal A, et al. Correlation between tissue Doppler-derived left ventricular systolic velocity (S') and left ventricle ejection fraction in sepsis and septic shock: a retrospective cohort study. J Intensive Care. 2023;11(1):28. doi:10.1186/s40560-023-00678-z
26. Vignon P, Charron C, Legras A, et al. Left ventricular diastolic dysfunction is prevalent but not associated with mortality in patients with septic shock. Intensive Care Med. 2025;51(1):94-105. doi:10.1007/s00134-024-07748-2
27. Zhang H, Zhang D, Wang X, et al. Prognostic implication of a novel right ventricular injury score in septic patients. ESC Heart Fail. 2023;10(2):1205-1213. doi:10.1002/ehf2.14289
28. Hirao Y, Hu J, Matsuda B, Sato R. Relationship between echocardiography-estimated right ventricular-pulmonary artery coupling and mortality in septic shock. J Crit Care. 2025;88:155072. doi:10.1016/j.jcrc.2025.155072
29. Slobod D, Assanangkornchai N, Alhazza M, Mettasittigorn P, Magder S. Right ventricular loading by lung inflation during controlled mechanical ventilation. Am J Respir Crit Care Med. 2022;205(11):1311-1319. doi:10.1164/rccm.202111-2483OC
30. Mukherjee M, Rudski LG, Addetia K, et al. Guidelines for the echocardiographic assessment of the right heart in adults and special considerations in pulmonary hypertension. J Am Soc Echocardiogr. 2025;38(3):141-186. doi:10.1016/j.echo.2025.01.006
31. Shvilkina T, Erion-Barner G, Downs TP, et al. Echocardiographic phenotypes in sepsis: identifying subgroups using latent profile analysis. J Intensive Care. 2026;14(1):37. doi:10.1186/s40560-026-00873-8
32. Chotalia M, Ali M, Chotalia R, Patel JM, Parekh D, Bangash MN. Cardiovascular subphenotypes in sepsis. Crit Care Med. Published online May 26, 2026. doi:10.1097/CCM.0000000000007159
33. Nagueh SF, Sanborn DY, Oh JK, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography and for heart failure with preserved ejection fraction diagnosis: an update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(6):537-569. doi:10.1016/j.echo.2025.03.011
34. Sato R, Hasegawa D, Guo S, Nuqali AE, Pino Moreno JE. Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management. J Intensive Care. 2025;13(1):1. doi:10.1186/s40560-024-00770-y
35. Sato R, Hasegawa D, Guo SC, Nishida K, Dugar S. Invasive hemodynamic monitoring with pulmonary artery catheter in sepsis-associated cardiogenic shock. Shock. 2024;61(5):712-717. doi:10.1097/SHK.0000000000002290
36. Malomo S, Oswald T, Stephenson E, et al. Characterisation of post-sepsis cardiomyopathy using cardiovascular magnetic resonance. Diagnostics (Basel). 2025;15(8):997. doi:10.3390/diagnostics15080997
37. Forner J, Schupp T, Weidner K, et al. Cardiac troponin I reveals diagnostic and prognostic superiority to aminoterminal pro-B-type natriuretic peptide in sepsis and septic shock. J Clin Med. 2022;11(21):6592. doi:10.3390/jcm11216592
38. Paraschiv C, Nicolaescu DO, Popescu RM, et al. NT-proBNP, echocardiography patterns and outcomes in sepsis-induced cardiac dysfunction. J Clin Med. 2025;14(24):8714. doi:10.3390/jcm14248714
39. Guarino M, et al. From cardiac injury to omics signatures: a narrative review on biomarkers in septic cardiomyopathy. Clin Exp Med. 2025;25:298. doi:10.1007/s10238-025-01842-5
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2026 Victoria Mickaela Coloma Morán , Daniela Alejandra Lozano Pazmiño, Estefanny Geovanna Dávila Cuenca , Maritza Elizabeth Quezada Ochoa, Robert Jefferson Martínez Panchana , Darwin Daniel Campos González
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
