Sepsis-Induced Myocardial Dysfunction

We read with great interest the study by Lanspa et al1Lanspa M.J. Cirulis M.M. Wiley B.M. al.Right ventricular dysfunction in early sepsis and septic shock.Chest. 2021; 159: 1055-1063Abstract Full Text PDF PubMed Scopus (12) Google Scholar CHEST (March 2021) which authors report a very high incidence of right (RV) patients severe or shock its association 28-day mortality rates. Although this seems plausible, we have some reservations about interpretation results. First, included all who had “RV dysfunction” (per criteria), yielded 180 RV out whom 145 form left (LV) (inclusive LV systolic/diastolic dysfunction) as well (Fig 1 article). Hence, it appears that majority group “biventricular” dysfunction, is unclear whether primary led to vice versa? Second, end point rates may potentially be within “early-phase” sepsis, when biventricular failure more likely prevail.2Cecconi M. Evans L. Levy Rhodes A. Sepsis shock.Lancet. 2018; 392: 75-87Abstract (436) Third, since echocardiographic parameters are dynamic change continuously both contradictory3Cirulis Huston J.H. Sardar P. al.Right-to-left diastolic diameter ratio shock.J Crit Care. 48: 307-310Crossref (11) similar findings4Innocenti F. Palmieri V. Stefanone V.T. al.Epidemiology systolic emergency department.Intern Emerg Med. 2020; 15: 1281-1289Crossref (8) been published. Fourth, rate associated was due initial presentation persistence despite treatment. A follow-up echocardiogram assess transient resolved after treatment would helped clarify recovery leads better outcomes present dysfunction. Fifth, has established animal models seen endothelial damage cytokine release rather than isolated pulmonary artery hypertension.5Pischke S.E. Hestenes S. Johansen H.T. al.Sepsis causes myocardial inflammation independent hypertension porcine model.PLoS One. 2019; 14e0218624Crossref (6) incorporation other biomarkers along help delineate sepsis-induced cardiomyopathy. believe future integrated precision medicine-based approach incorporate echocardiography, clinical parameters, biomarkers, cardiac enzymes, epigenetics, genomics not only differentiate an epiphenomenon but also identify various subphenotypes need distinct therapeutic approaches. Right Ventricular Dysfunction Early Septic ShockCHESTVol. 159Issue 3PreviewRight nearly half studied over threefold higher mortality. Full-Text ResponseCHESTVol. 4PreviewWe thank Pal al for raising several important questions regarding They note most concomitant challenge determining if one preceded other. observed substantial overlap among consistent previous comparable reports cardiomypoathy.