Therapeutical progress in sepsis-induced cardiomyopathy

Sepsis-induced cardiomyopathy (SCM) is a life-threatening complication of severe sepsis with a high mortality rate. This review comprehensively explores SCM. It details the multifaceted pathogenesis, including inflammatory storm, mitochondrial dysfunction, abnormal calcium handling, complement activation, and emerging mechanisms related to exosomes and non-coding RNAs. We propose an integrated mechanistic model centered on the "energy metabolism-calcium handling" axis to explain the unique reversibility of SCM. Conventional treatments like antibiotic therapy, fluid management, and the use of vasopressors and inotropic agents are discussed, along with their limitations. Promising strategies such as repurposing old drugs, applying traditional Chinese medicine, and new approaches are presented. To bridge the gap between mechanistic understanding and clinical application, we categorize these emerging therapies according to the primary pathological pathway they target: inflammation, mitochondrial dysfunction, or calcium dysregulation. Furthermore, we introduce a framework for phenotype-guided treatment and critically evaluate the level of clinical evidence for each intervention. Small active molecules and nanomedicine also show potential in SCM treatment. Future research should focus on large-scale clinical trials to validate these therapies and integrate precision medicine strategies for better patient outcomes.