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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Review

Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature

Authors: Robert R. Ehrman, Ashley N. Sullivan, Mark J. Favot, Robert L. Sherwin, Christian A. Reynolds, Aiden Abidov, Phillip D. Levy

Published in: Critical Care | Issue 1/2018

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Abstract

Background

Sepsis is a common condition encountered by emergency and critical care physicians, with significant costs, both economic and human. Myocardial dysfunction in sepsis is a well-recognized but poorly understood phenomenon. There is an extensive body of literature on this subject, yet results are conflicting and no objective definition of septic cardiomyopathy exists, representing a critical knowledge gap.

Objectives

In this article, we review the pathophysiology of septic cardiomyopathy, covering the effects of key inflammatory mediators on both the heart and the peripheral vasculature, highlighting the interconnectedness of these two systems. We focus on the extant literature on echocardiographic and laboratory assessment of the heart in sepsis, highlighting gaps therein and suggesting avenues for future research. Implications for treatment are briefly discussed.

Conclusions

As a result of conflicting data, echocardiographic measures of left ventricular (systolic or diastolic) or right ventricular function cannot currently provide reliable prognostic information in patients with sepsis. Natriuretic peptides and cardiac troponins are of similarly unclear utility. Heterogeneous classification of illness, treatment variability, and lack of formal diagnostic criteria for septic cardiomyopathy contribute to the conflicting results. Development of formal diagnostic criteria, and use thereof in future studies, may help elucidate the link between cardiac performance and outcomes in patients with sepsis.
Literature
1.
Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, Damske BA, Parrillo JE. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med. 1984;100(4):483–90.CrossRefPubMed
2.
Weisel RD, Vito L, Dennis RC, Valeri CR, Hechtman HB. Myocardial depression during sepsis. Am J Surg. 1977;133(4):512–21.CrossRefPubMed
3.
Charpentier J, Luyt CE, Fulla Y, Vinsonneau C, Cariou A, Grabar S, Dhainaut JF, Mira JP, Chiche JD. Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med. 2004;32(3):660–5.CrossRefPubMed
4.
Poelaert J, Declerck C, Vogelaers D, Colardyn F, Visser CA. Left ventricular systolic and diastolic function in septic shock. Intensive Care Med. 1997;23(5):553–60.CrossRefPubMed
5.
Kakihana Y, Ito T, Nakahara M, Yamaguchi K, Yasuda T. Sepsis-induced myocardial dysfunction: pathophysiology and management. J Intensive Care. 2016;4:22.CrossRefPubMedPubMedCentral
6.
Zanotti-Cavazzoni SL, Hollenberg SM. Cardiac dysfunction in severe sepsis and septic shock. Curr Opin Crit Care. 2009;15(5):392–7.CrossRefPubMed
7.
Murphy CV, Schramm GE, Doherty JA, Reichley RM, Gajic O, Afessa B, Micek ST, Kollef MH. The importance of fluid management in acute lung injury secondary to septic shock. Chest. 2009;136(1):102–9.CrossRefPubMed
8.
Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75.CrossRefPubMed
9.
Schneider AJ, Teule GJ, Groeneveld AB, Nauta J, Heidendal GA, Thijs LG. Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J. 1988;116(1 Pt 1):103–12.CrossRefPubMed
10.
Maeder M, Fehr T, Rickli H, Ammann P. Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest. 2006;129(5):1349–66.CrossRefPubMed
11.
Russell JA, Boyd J, Nakada T, Thair S, Walley KR. Molecular mechanisms of sepsis. Contrib Microbiol. 2011;17:48–85.CrossRefPubMed
12.
Conway-Morris A, Wilson J, Shankar-Hari M. Immune activation in sepsis. Crit Care Clin. 2018;34(1):29–42.CrossRefPubMed
13.
Anthonymuthu TS, Kim-Campbell N, Bayir H. Oxidative lipidomics: applications in critical care. Curr Opin Crit Care. 2017;23(4):251–6.CrossRefPubMed
14.
Bednarczyk JM, Fridfinnson JA, Kumar A, Blanchard L, Rabbani R, Bell D, Funk D, Turgeon AF, Abou-Setta AM, Zarychanski R. Incorporating dynamic assessment of fluid responsiveness into goal-directed therapy: a systematic review and meta-analysis. Crit Care Med. 2017;45(9):1538–45.CrossRefPubMedPubMedCentral
15.
Cherpanath TG, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, Groeneveld AB. Predicting fluid responsiveness by passive leg raising: a systematic review and meta-analysis of 23 clinical trials. Crit Care Med. 2016;44(5):981–91.CrossRefPubMed
16.
Ma IWY, Caplin JD, Azad A, Wilson C, Fifer MA, Bagchi A, Liteplo AS, Noble VE. Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements. Crit Ultrasound J. 2017;9(1):10.CrossRefPubMedPubMedCentral
17.
Boissier F, Razazi K, Seemann A, Bedet A, Thille AW, de Prost N, Lim P, Brun-Buisson C, Mekontso Dessap A. Left ventricular systolic dysfunction during septic shock: the role of loading conditions. Intensive Care Med. 2017;43(5):633–42.CrossRefPubMed
18.
Bruni FD, Komwatana P, Soulsby ME, Hess ML. Endotoxin and myocardial failure: role of the myofibril and venous return. Am J Phys. 1978;235(2):H150–6.
19.
Cunnion RE, Schaer GL, Parker MM, Natanson C, Parrillo JE. The coronary circulation in human septic shock. Circulation. 1986;73(4):637–44.CrossRefPubMed
20.
21.
Madorin WS, Rui T, Sugimoto N, Handa O, Cepinskas G, Kvietys PR. Cardiac myocytes activated by septic plasma promote neutrophil transendothelial migration: role of platelet-activating factor and the chemokines LIX and KC. Circ Res. 2004;94(7):944–51.CrossRefPubMed
22.
Rudiger A, Singer M. Mechanisms of sepsis-induced cardiac dysfunction. Crit Care Med. 2007;35(6):1599–608.CrossRefPubMed
23.
Celes MR, Torres-Duenas D, Malvestio LM, Blefari V, Campos EC, Ramos SG, Prado CM, Cunha FQ, Rossi MA. Disruption of sarcolemmal dystrophin and beta-dystroglycan may be a potential mechanism for myocardial dysfunction in severe sepsis. Lab Investig. 2010;90(4):531–42.CrossRefPubMed
24.
Jardin F, Fourme T, Page B, Loubieres Y, Vieillard-Baron A, Beauchet A, Bourdarias JP. Persistent preload defect in severe sepsis despite fluid loading: A longitudinal echocardiographic study in patients with septic shock. Chest. 1999;116(5):1354–9.CrossRefPubMed
25.
Siddiqui Y, Crouser ED, Raman SV. Nonischemic myocardial changes detected by cardiac magnetic resonance in critical care patients with sepsis. Am J Respir Crit Care Med. 2013;188(8):1037–9.CrossRefPubMedPubMedCentral
26.
Levy RJ, Piel DA, Acton PD, Zhou R, Ferrari VA, Karp JS, Deutschman CS. Evidence of myocardial hibernation in the septic heart. Crit Care Med. 2005;33(12):2752–6.CrossRefPubMed
27.
Budinger GR, Duranteau J, Chandel NS, Schumacker PT. Hibernation during hypoxia in cardiomyocytes. Role of mitochondria as the O2 sensor. J Biol Chem. 1998;273(6):3320–6.CrossRefPubMed
28.
Cappelletti S, Ciallella C, Aromatario M, Ashrafian H, Harding S, Athanasiou T. Takotsubo Cardiomyopathy and Sepsis. Angiology. 2017;68(4):288–303.CrossRefPubMed
29.
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.CrossRefPubMed
30.
McLean AS, Huang SJ, Hyams S, Poh G, Nalos M, Pandit R, Balik M, Tang B, Seppelt I. Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock. Crit Care Med. 2007;35(4):1019–26.CrossRefPubMed
31.
Pulido JN, Afessa B, Masaki M, Yuasa T, Gillespie S, Herasevich V, Brown DR, Oh JK. Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock. Mayo Clin Proc. 2012;87(7):620–8.CrossRefPubMedPubMedCentral
32.
Huang SJ, Nalos M, McLean AS. Is early ventricular dysfunction or dilatation associated with lower mortality rate in adult severe sepsis and septic shock? A meta-analysis. Crit Care. 2013;17(3):R96.CrossRefPubMedPubMedCentral
33.
Sevilla Berrios RA, O'Horo JC, Velagapudi V, Pulido JN. Correlation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: a systematic review and meta-analysis. J Crit Care. 2014;29(4):495–9.CrossRefPubMed
34.
Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016;37(15):1196–207.CrossRefPubMed
35.
Kaluzynski K, Chen X, Emelianov SY, Skovoroda AR, O'Donnell M. Strain rate imaging using two-dimensional speckle tracking. IEEE Trans Ultrason Ferroelectr Freq Control. 2001;48(4):1111–23.CrossRefPubMed
36.
Basu S, Frank LH, Fenton KE, Sable CA, Levy RJ, Berger JT. Two-dimensional speckle tracking imaging detects impaired myocardial performance in children with septic shock, not recognized by conventional echocardiography. Pediatr Crit Care Med. 2012;13(3):259–64.CrossRefPubMed
37.
Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100(21):1673–80.CrossRefPubMed
38.
Ng PY, Sin WC, Ng AK, Chan WM. Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS). Crit Care. 2016;20(1):145.CrossRefPubMedPubMedCentral
39.
Chang WT, Lee WH, Lee WT, Chen PS, Su YR, Liu PY, Liu YW, Tsai WC. Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients. Intensive Care Med. 2015;41(10):1791–9.CrossRefPubMed
40.
Palmieri V, Innocenti F, Guzzo A, Guerrini E, Vignaroli D, Pini R. Left ventricular systolic longitudinal function as predictor of outcome in patients with sepsis. Circ Cardiovasc Imaging. 2015;8(11):e003865. discussion e003865PubMed
41.
Innocenti F, Palmieri V, Guzzo A, Stefanone VT, Donnini C, Pini R. SOFA score and left ventricular systolic function as predictors of short-term outcome in patients with sepsis. Internal and emergency medicine. 2018;13(1):51–58.
42.
Orde SR, Pulido JN, Masaki M, Gillespie S, Spoon JN, Kane GC, Oh JK. Outcome prediction in sepsis: speckle tracking echocardiography based assessment of myocardial function. Crit Care. 2014;18(4):R149.CrossRefPubMedPubMedCentral
43.
De Geer L, Engvall J, Oscarsson A. Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome. Crit Care. 2015;19:122.CrossRefPubMedPubMedCentral
44.
Zaky A, Gill EA, Lin CP, Paul CP, Bendjelid K, Treggiari MM. Characteristics of sepsis-induced cardiac dysfunction using speckle-tracking echocardiography: a feasibility study. Anaesth Intensive Care. 2016;44(1):65–76.PubMedPubMedCentral
45.
Dalla K, Hallman C, Bech-Hanssen O, Haney M, Ricksten SE. Strain echocardiography identifies impaired longitudinal systolic function in patients with septic shock and preserved ejection fraction. Cardiovasc Ultrasound. 2015;13:30.CrossRefPubMedPubMedCentral
46.
De Geer L, Oscarsson A, Engvall J. Variability in echocardiographic measurements of left ventricular function in septic shock patients. Cardiovasc Ultrasound. 2015;13:19.CrossRefPubMedPubMedCentral
47.
Yu CM, Sanderson JE, Marwick TH, Oh JK. Tissue Doppler imaging a new prognosticator for cardiovascular diseases. J Am Coll Cardiol. 2007;49(19):1903–14.CrossRefPubMed
48.
Paraskevaidis IA, Kyrzopoulos S, Farmakis D, Parissis J, Tsiapras D, Iliodromitis EK, Kremastinos DT. Ventricular long-axis contraction as an earlier predictor of outcome in asymptomatic aortic regurgitation. Am J Cardiol. 2007;100(11):1677–82.CrossRefPubMed
49.
Weng L, Liu YT, Du B, Zhou JF, Guo XX, Peng JM, Hu XY, Zhang SY, Fang Q, Zhu WL. The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock. Crit Care. 2012;16(3):R71.CrossRefPubMedPubMedCentral
50.
Weng L, Liu Y, Zhou J, Guo X, Peng J, Hu X, Fang Q, Zhu W, Li H, Du B, et al. Left ventricular systolic function and systolic asynchrony in patients with septic shock and normal left ventricular ejection fraction. Shock (Augusta, GA). 2013;40(3):175–81.CrossRef
51.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–60.CrossRefPubMed
52.
Brown SM, Pittman JE, Hirshberg EL, Jones JP, Lanspa MJ, Kuttler KG, Litwin SE, Grissom CK. Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study. Crit Ultrasound J. 2012;4(1):8.CrossRefPubMedPubMedCentral
53.
Mahjoub Y, Benoit-Fallet H, Airapetian N, Lorne E, Levrard M, Seydi AA, Amennouche N, Slama M, Dupont H. Improvement of left ventricular relaxation as assessed by tissue Doppler imaging in fluid-responsive critically ill septic patients. Intensive Care Med. 2012;38(9):1461–70.CrossRefPubMed
54.
Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, Avidan A, Beeri R, Weissman C, Jaffe AS, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J. 2012;33(7):895–903.CrossRefPubMed
55.
Landesberg G, Jaffe AS, Gilon D, Levin PD, Goodman S, Abu-Baih A, Beeri R, Weissman C, Sprung CL, Landesberg A. Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Crit Care Med. 2014;42(4):790–800.CrossRefPubMed
56.
Sturgess DJ, Marwick TH, Joyce C, Jenkins C, Jones M, Masci P, Stewart D, Venkatesh B. Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers. Crit Care. 2010;14(2):R44.CrossRefPubMedPubMedCentral
57.
Rolando G, Espinoza ED, Avid E, Welsh S, Pozo JD, Vazquez AR, Arzani Y, Masevicius FD, Dubin A. Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock. Rev Bras Ter Intensiva. 2015;27(4):333–9.CrossRefPubMedPubMedCentral
58.
Sanfilippo F, Corredor C, Fletcher N, Landesberg G, Benedetto U, Foex P, Cecconi M. Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Intensive Care Med. 2015;41(6):1004–13.CrossRefPubMed
59.
Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M, Fletcher N. Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth. 2017;119(4):583–94.CrossRefPubMed
60.
Lanspa MJ, Gutsche AR, Wilson EL, Olsen TD, Hirshberg EL, Knox DB, Brown SM, Grissom CK. Application of a simplified definition of diastolic function in severe sepsis and septic shock. Crit Care. 2016;20(1):243.CrossRefPubMedPubMedCentral
61.
Damy T, Ghio S, Rigby AS, Hittinger L, Jacobs S, Leyva F, Delgado JF, Daubert JC, Gras D, Tavazzi L, et al. Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure). J Am Coll Cardiol. 2013;61(21):2153–60.CrossRefPubMed
62.
Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, Chamera E, Corretti MC, Champion HC, Abraham TP, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006;174(9):1034–41.CrossRefPubMed
63.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.CrossRefPubMed
64.
Gajanana D, Seetha Rammohan H, Alli O, Romero-Corral A, Purushottam B, Ponamgi S, Figueredo VM, Pressman GS. Tricuspid annular plane systolic excursion and its association with mortality in critically ill patients. Echocardiography (Mount Kisco, NY). 2015;32(8):1222–7.CrossRef
65.
Zhang HM, Wang XT, Zhang LN, He W, Zhang Q, Liu DW. Left ventricular longitudinal systolic function in septic shock patients with normal ejection fraction: a case-control study. Chin Med J. 2017;130(10):1169–74.CrossRefPubMedPubMedCentral
66.
Furian T, Aguiar C, Prado K, Ribeiro RV, Becker L, Martinelli N, Clausell N, Rohde LE, Biolo A. Ventricular dysfunction and dilation in severe sepsis and septic shock: relation to endothelial function and mortality. J Crit Care. 2012;27(3):319 e319–5.CrossRef
67.
Vallabhajosyula S, Kumar M, Pandompatam G, Sakhuja A, Kashyap R, Kashani K, Gajic O, Geske JB, Jentzer JC. Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study. Ann Intensive Care. 2017;7(1):94.CrossRefPubMedPubMedCentral
68.
Wu AH. Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med. 2001;27(6):959–61.CrossRefPubMed
69.
Cheng H, Fan WZ, Wang SC, Liu ZH, Zang HL, Wang LZ, Liu HJ, Shen XH, Liang SQ. N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A retrospective study. J Crit Care. 2015;30(3):654 e659–14.CrossRef
70.
Rosjo H, Varpula M, Hagve TA, Karlsson S, Ruokonen E, Pettila V, Omland T. Circulating high sensitivity troponin T in severe sepsis and septic shock: distribution, associated factors, and relation to outcome. Intensive Care Med. 2011;37(1):77–85.CrossRefPubMed
71.
Vallabhajosyula S, Sakhuja A, Geske JB, Kumar M, Poterucha JT, Kashyap R, Kashani K, Jaffe AS, Jentzer JC. Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock. J Am Heart Assoc. 2017;6(9) https://​doi.​org/​10.​1161/​JAHA.​117.​005930.
72.
Masson S, Caironi P, Fanizza C, Carrer S, Caricato A, Fassini P, Vago T, Romero M, Tognoni G, Gattinoni L, et al. Sequential N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin measurements during albumin replacement in patients with severe sepsis or septic shock. Crit Care Med. 2016;44(4):707–16.PubMed
73.
de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet (London, England). 2003;362(9380):316–22.CrossRef
74.
Richards AM, Crozier IG, Yandle TG, Espiner EA, Ikram H, Nicholls MG. Brain natriuretic factor: regional plasma concentrations and correlations with haemodynamic state in cardiac disease. Br Heart J. 1993;69(5):414–7.CrossRefPubMedPubMedCentral
75.
Varpula M, Pulkki K, Karlsson S, Ruokonen E, Pettila V. Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. Crit Care Med. 2007;35(5):1277–83.CrossRefPubMed
76.
Ikonomidis I, Nikolaou M, Dimopoulou I, Paraskevaidis I, Lekakis J, Mavrou I, Tzanela M, Kopterides P, Tsangaris I, Armaganidis A, et al. Association of left ventricular diastolic dysfunction with elevated NT-pro-BNP in general intensive care unit patients with preserved ejection fraction: a complementary role of tissue Doppler imaging parameters and NT-pro-BNP levels for adverse outcome. Shock (Augusta, Ga). 2010;33(2):141–8.CrossRef
77.
Ostermann M, Ayis S, Tuddenham E, Lo J, Lei K, Smith J, Sanderson B, Moran C, Collinson P, Peacock J, et al. Cardiac troponin release is associated with biomarkers of inflammation and ventricular dilatation during critical illness. Shock (Augusta, Ga). 2017;47(6):702–8.CrossRef
78.
Nizamuddin J, Mahmood F, Tung A, Mueller A, Brown SM, Shaefi S, O'Connor M, Talmor D, Shahul S. Interval changes in myocardial performance index predict outcome in severe sepsis. J Cardiothorac Vasc Anesth. 2017;31(3):957–64.CrossRefPubMed
79.
Velissaris D, Pierrakos C, Scolletta S, De Backer D, Vincent JL. High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients. Crit Care. 2011;15(4):R177.CrossRefPubMedPubMedCentral
80.
Sanfilippo F, Santonocito C, Morelli A, Foex P. Beta-blocker use in severe sepsis and septic shock: a systematic review. Curr Med Res Opin. 2015;31(10):1817–25.CrossRefPubMed
81.
Zangrillo A, Putzu A, Monaco F, Oriani A, Frau G, De Luca M, Di Tomasso N, Bignami E, Lomivorotov V, Likhvantsev V, et al. Levosimendan reduces mortality in patients with severe sepsis and septic shock: A meta-analysis of randomized trials. J Crit Care. 2015;30(5):908–13.CrossRefPubMed
82.
Gordon AC, Perkins GD, Singer M, McAuley DF, Orme RM, Santhakumaran S, Mason AJ, Cross M, Al-Beidh F, Best-Lane J, et al. Levosimendan for the prevention of acute organ dysfunction in sepsis. N Engl J Med. 2016;375(17):1638–48.CrossRefPubMed
Metadata
Title
Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature
Authors
Robert R. Ehrman
Ashley N. Sullivan
Mark J. Favot
Robert L. Sherwin
Christian A. Reynolds
Aiden Abidov
Phillip D. Levy
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2043-8

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