Cardiac dysfunction and circulating cardiac markers during sepsis

Among several alterations affecting the cardiovascular system during severe sepsis or septic shock, myocardial depression has been pointed out with increasing attention over the last 30 years as a frequent and often misdiagnosed clinical condition. As expected, patients with cardiac dysfunction during sepsis have a worse prognosis than those without. In the present review, we will first discuss the etiology, pathophysiology, monitoring and clinical manifestations of cardiac dysfunction in patients with severe sepsis or septic shock. Thereafter, we will briefly present the evidence on the role of circulating biomarkers of cardiac function in the management of sepsis. Circulating cardiac biomarkers are becoming increasingly popular in cardiovascular diseases, as they are a simple and cost-effective tool for triage, diagnosis and prognosis. Their importance during sepsis is related to the development of complications due to an aging population with frequent co-morbidities and a scarce functional reserve. We will focus on two specific markers of cardiac origin: troponins, which reveal cardiac myocytes injury, and natriuretic peptides, as indicators of cardiac chambers wall stress and fluid homeostasis. The bulk of evidences accumulated so far on cardiac markers support their role as prognostic indicators, with marginal improvement in terms of accuracy, as compared to widely employed clinical scores. Their potential to satisfy unmet needs in the daily care of septic patients is more appealing, in particular for monitoring the cardiovascular system during support therapy.