From Echocardiographic Evaluation to Biomarkers Measurement: The Role of Myocardial Dysfunction in Mortality Associated with Sepsis

Abstract Sepsis remains the leading cause of mortality and critical illness worldwide. Myocardial dysfunction is one of the most clinically relevant manifestations of sepsis and results from a complex interaction among genetic, molecular, metabolic, and structural changes. Despite the prominence given to the occurrence of systolic dysfunction during sepsis, the association between diastolic dysfunction and mortality is controversial, while diastolic dysfunction and right ventricular dysfunction are identified as independent predictors of mortality in the most recent studies. Elevation of biomarkers during sepsis may result from several mechanisms, and although the role of the B-type natriuretic peptide (BNP) and the N-terminal portion of its prohormone (NT-proBNP) as independent predictors of mortality is well defined, the same cannot be said about cardiac troponins due to conflicting results among currently available studies. The objective of the present review is to discuss the pathophysiological mechanisms of myocardial dysfunction induced by sepsis in adults and the role of echocardiography and cardiac biomarkers as tools for prognostic evaluation in this clinical setting.

摘要 脓毒症仍是全球范围内致死与危重症的首要病因。心肌功能障碍是脓毒症最具临床相关性的表现之一，其发生源于遗传、分子、代谢与结构改变之间的复杂相互作用。尽管学界对脓毒症期间收缩功能障碍的发生已给予广泛关注，但舒张功能障碍与死亡率的关联仍存在争议；而近期研究证实，舒张功能障碍与右心室功能障碍均为死亡率的独立预测因子。脓毒症期间生物标志物水平升高可由多种机制介导；尽管B型利钠肽（B-type natriuretic peptide, BNP）及其前体的N末端片段（N-terminal portion of its prohormone, NT-proBNP）作为死亡率独立预测因子的作用已明确，但目前现有研究结果存在矛盾，故心肌肌钙蛋白的同类作用尚未得到一致证实。本综述旨在探讨成人脓毒症相关性心肌功能障碍的病理生理机制，以及超声心动图与心脏生物标志物在该临床场景中作为预后评估工具的应用价值。