Sepsis-associated myocardial dysfunction: from bedside to bench

Although the hemodynamic profile of sepsis is characterized by a high cardiac output state, there is clear evidence of myocardial dysfunction in patients with severe sepsis and septic shock. Cardiac abnormalities in sepsis include various degrees of left ventricular systolic dysfunction, left ventricular diastolic dysfunction, and right ventricular dysfunction. Possible underlying mechanisms include direct negative inotropic effects of circulating depressant substances, altered G-protein coupling, myocardial β1-receptor desensitization, and cytopathic hypoxia due to microcirculatory and metabolic abnormalities of the cardiomyocytes. We discuss herein the conflicting findings of the heterogeneous studies conducted in this field and, based on clinical data and findings from experimental work, hypothesize on the underlying pathophysiology and the mechanisms of established and innovative therapies.