Septic Cardiomyopathy in the ICU: Echocardiographic Phenotypes, Global Longitudinal Strain, and Right Ventricular Assessment

Background/Objectives: Septic cardiomyopathy (SC) is a frequent and clinically relevant complication of sepsis, characterized by acute, typically reversible myocardial dysfunction in the absence of primary coronary artery disease. Its clinical presentation is highly heterogeneous, and conventional diagnostic parameters frequently fail to capture the full extent of cardiac impairment. This narrative review aims to synthesize current evidence on the echocardiographic assessment of SC, with a focused emphasis on global longitudinal strain (GLS), right ventricular (RV) dysfunction, and diastolic impairment, and to discuss their prognostic and therapeutic implications. Methods: A comprehensive literature search was performed in PubMed/MEDLINE for publications between 2010 and March 2026, supplemented by seminal historical studies. A second, structured literature search was performed in PubMed/MEDLINE for publications between 2010 and April 2026, supplemented by seminal historical studies. Eligible study types included original research articles, systematic reviews, meta-analyses, and clinical guidelines. The search and selection workflow followed the principles of PRISMA-ScR. A qualitative narrative synthesis was performed. Results: SC encompasses distinct echocardiographic phenotypes—global hypokinesia, hyperdynamic function, RV dysfunction, and diastolic impairment—each carrying specific pathophysiological and prognostic implications. Left ventricular ejection fraction (LVEF) is highly load-dependent and may be misleading in vasoplegic states. GLS derived from speckle-tracking echocardiography defects may detect subclinical myocardial dysfunction earlier than LVEF, and provides independent prognostic information in observational studies. RV dysfunction occurs in 20–50% of sepsis patients and represents a powerful robust independent predictor of mortality. Diastolic dysfunction Grade ≥ 2 is independently associated with adverse outcomes through elevated filling pressures and reduced cardiac reserve. Conclusions: A multiparametric echocardiographic approach integrating LVEF, GLS, RV function indices, and diastolic parameters is essential and may improve the accurate phenotyping and hemodynamic management of SC. Structured diagnostic algorithms, expert-based diagnostic frameworks incorporating these tools which may facilitate phenotype-guided therapy and improve clinical outcomes, are proposed to facilitate phenotype-guided therapy; their impact on patient outcomes warrants confirmation in prospective multicenter studies.