Sepsis-induced cardiomyopathy: mechanisms, epidemiology, diagnosis, and treatments

Sepsis-induced cardiomyopathy (SICM) is a life-threatening complication of sepsis characterized by reversible myocardial dysfunction. Its pathophysiology involves a complex interplay of inflammatory pathways, oxidative stress, mitochondrial dysfunction, and genetic factors, leading to impaired cardiac contractility, ventricular dilatation, and increased mortality. Epidemiologically, SICM exhibits demographic variations, with younger age, male sex, and pre-existing heart failure identified as key risk factors. Diagnostic approaches rely on a combination of biomarkers (e.g., troponins, NT-proBNP), advanced imaging techniques (e.g., speckle-tracking echocardiography), and clinical criteria, though standardized definitions remain elusive. Treatment strategies include pharmacological interventions (e.g., levosimendan, melatonin), mechanical circulatory support (e.g., VA-ECMO, Impella), and emerging therapies targeting ferroptosis or mitochondrial function. Historical perspectives highlight the evolution from recognizing SICM as a rare complication to its current status as a major contributor to sepsis mortality, while future directions emphasize personalized medicine, multi-omics integration, and targeted therapeutics. This review synthesizes current knowledge of SICM, identifies critical gaps, and proposes actionable research priorities to improve patient outcomes.