Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature.
Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature.
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DOI：
10.1186/s13054-018-2043-8
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发表时间：
2018-05-04
期刊：
影响因子：
--
通讯作者：
Levy PD
中科院分区：
文献类型：
--
作者：
Ehrman RR;Sullivan AN;Favot MJ;Sherwin RL;Reynolds CA;Abidov A;Levy PD
脓毒症是急诊和重症监护医生遇到的一种常见疾病，具有巨大的经济和人力成本。脓毒症中的心肌功能障碍是一种众所周知但知之甚少的现象。在这个主题上有大量的文献，但结果是相互矛盾的，并且没有对感染性心肌病的客观定义，这代表了一个关键的知识缺口。在这篇文章中，我们回顾了感染性心肌病的病理生理学，包括关键炎症介质对心脏和外周血管系统的影响，强调了这两个系统的相互联系。我们集中在现有的文献中，超声心动图和实验室评估败血症的心脏，强调其中的差距，并建议未来的研究途径。对治疗的意义进行了简要讨论。由于相互矛盾的数据，超声心动图测量左室(收缩或舒张期)或右室功能目前不能提供脓毒症患者可靠的预后信息。利钠肽和心肌肌钙蛋白的作用同样不清楚。疾病分类的异质性、治疗的可变性以及缺乏感染性心肌病的正式诊断标准导致了相互矛盾的结果。制定正式的诊断标准，并在未来的研究中使用，可能有助于阐明脓毒症患者的心功能和预后之间的联系。
Sepsis is a common condition encountered by emergency and critical care physicians, with significant costs, both economic and human. Myocardial dysfunction in sepsis is a well-recognized but poorly understood phenomenon. There is an extensive body of literature on this subject, yet results are conflicting and no objective definition of septic cardiomyopathy exists, representing a critical knowledge gap. In this article, we review the pathophysiology of septic cardiomyopathy, covering the effects of key inflammatory mediators on both the heart and the peripheral vasculature, highlighting the interconnectedness of these two systems. We focus on the extant literature on echocardiographic and laboratory assessment of the heart in sepsis, highlighting gaps therein and suggesting avenues for future research. Implications for treatment are briefly discussed. As a result of conflicting data, echocardiographic measures of left ventricular (systolic or diastolic) or right ventricular function cannot currently provide reliable prognostic information in patients with sepsis. Natriuretic peptides and cardiac troponins are of similarly unclear utility. Heterogeneous classification of illness, treatment variability, and lack of formal diagnostic criteria for septic cardiomyopathy contribute to the conflicting results. Development of formal diagnostic criteria, and use thereof in future studies, may help elucidate the link between cardiac performance and outcomes in patients with sepsis.
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