Despite advances in therapy, sepsis causes > 200,000 deaths per year in the United States, thus equaling the number of patients dying from myocardial infarction. Myocardial dysfunction is a common complication in patients with severe sepsis, and early recognition and aggressive supportive therapy are mandatory as mortality in patients with septic shock is still high. The value of the use of pulmonary artery catheters (PACs) has come under scrutiny after studies have failed to prove a survival benefit for patients treated with PAC-guided therapy compared to those in whom PACs were not used, Nevertheless, information about cardiac performance is needed for the selection of the most appropriate catecholamine regimen after adequate fluid resuscitation. In the past few years, the following two groups of biomarkers have emerged as potential candidates for the evaluation and quantification of cardiac dysfunction in patients with sepsis: cardiac troponins; and natriuretic peptides. so
These biomarkers were initially introduced for use in diagnosis and risk stratification in patients with acute coronary syndrome (ACS) and congestive heart failure (CHF) respectively,- but their spectrum of application is widening. The aim of the present review is to provide clinicians with a summary of the current evidence about the prognostic and diagnostic impact of cardiac troponins and natriuretic peptides in patients with sepsis-associated myocardial dysfunction. The available data on cardiac troponins and natriuretic peptides and the possible underlying pathophysiologic mechanisms are discussed in the light of studies on these biomarkers in patients without sepsis. Sepsis has been defined as the presence of the systemic inflammatory response syndrome (SIRS) in response to a culture-proven infection. However, SIRS can result not only from infection, but also from a variety of conditions such as autoimmune disorders, vasculitis, thromboembolism, and burns, or after surgery. The severity of sepsis is graded according to the associated organ dysfunction and hemodynamic compromise. The original definitions have been revisited by a group of experts, but, apart from expanding the list of signs and symptoms of sepsis, no relevant changes have been made. In a recently published review, Annane and coworkers2 propose a very practical modification of the definitions including exact hemodynamic definitions of septic shock.