Systematic review of the current landscape and imaging-based definition of septic cardiomyopathy

Background: Septic cardiomyopathy (SCM) has no current unified definition, although it can be associated with significant mortality. It encompasses a wide spectrum of cardiac dysfunction ranging from mild to severe systolic and/or diastolic dysfunction of the left and/or right ventricle. The objective of this review is to evaluate the imaging modalities and parameters used to define SCM and the clinical outcomes. Methods: We conducted a systematic review of the literature, including studies up to August 2025, examining the impact of cardiac dysfunction, specifically related to the systolic and/or diastolic dysfunction of the left or right ventricle. We focussed on mortality and comparable phrases as the primary outcome. We considered all cardiac imaging methods. All relevant studies were identified in a search strategy including MEDLINE, Embase and Scopus. Results: About 2669 articles were identified, of which 142 full-text publications were evaluated. Final analysis included 87 publications. Forty five articles provided a definition of SCM. Seventy studies used TTE. Eighteen studies associated LV dysfunction to mortality. Thirteen studies found an association between diastolic dysfunction or RV dysfunction and mortality. About 64% of the studies assessed cardiac function within 24-h of admission. Twenty eight studies re-assessed reversibility of cardiac dysfunction. Interpretation: Cardiac dysfunction is commonly reported in the critically ill septic population. There was considerable heterogeneity with regards to the diagnostic criteria of SCM, parameters used to determine cardiac dysfunction, outcomes evaluated, timing of study or assessing reversibility. Given the high prevalence of cardiac dysfunction in sepsis, a unified assessment and definition of SCM is needed.