Sepsis-Associated Cardiomyopathy: Long-Term Prognosis, Management, and Guideline-Directed Medical Therapy

Abstract

Purpose of review: To explore the definitions of sepsis-induced cardiomyopathy and how that impacts interpretation of the available data and considerations of long-term prognosis and management.

Recent findings: The field of sepsis-induced cardiomyopathy has been hampered by lack of consensus about its proper definition, with a great deal of heterogeneity in clinical trial data in both individual studies and meta-analyses and consequent disparity of estimates of incidence, prognosis, and clinical significance. New diagnostic techniques, while potentially shedding light on pathophysiology, have only exacerbated these challenges. There are few persuasive data to suggest that decreased ejection fraction consequent to sepsis-induced cardiomyopathy merits a treatment strategy different from other causes, except that improvement may be more likely inasmuch as the classic description includes reversibility over 7 to 10 days. For persistent cardiac dysfunction after sepsis, whether pre-existing or newly diagnosed, institution and titration of guideline-directed medical therapy for HFrEF seems to be the most logical strategy. Armed with a clear understanding of what parameters of cardiac function are most important, clinicians can develop therapeutic strategies that make sense and calibrate them according to the clinical response.

Keywords: Cardiomyopathy; Guideline-directed medical therapy; HFrEF; Heart Failure; Management; Prognosis; Sepsis.