Sepsis and the Heart: In the Quest for Noninvasive Pressure-Volume Loops at the Bedside.

Abstract

Background: Sepsis-induced cardiomyopathy (SICM) is prevalent yet remains difficult to diagnose using conventional echocardiography primarily due to its dependence on loading conditions, the dynamic nature of sepsis, and varied cardiovascular phenotypes. Recent advancements in noninvasive myocardial work (MW) analysis, particularly through left ventricle pressure-strain loop (LV PSL), offer a promising strategy for evaluating myocardial function by combining strain imaging with blood pressure data. This technique may address the limitations inherent in traditional measures such as ejection fraction, which can be influenced by fluctuating hemodynamics in sepsis and may not accurately reflect underlying myocardial function.

Case summary: This report presents three cases wherein patients exhibited either preserved or only mildly reduced left ventricular systolic function based on ejection fraction (LVEF), but were found to have diminished MW indices, including global work index, global constructive work, and global work efficiency along with low flow by left ventricle outflow-tract.

Conclusions: Relying solely on LVEF for diagnosing SICM is problematic due to numerous confounding variables. MW parameters constitute innovative, noninvasive echocardiographic indicators that have demonstrated value across a spectrum of cardiac disorders. Although these parameters appear promising as bedside assessment tools, their application within the context of sepsis warrants further investigation.