Chapter 9

Which Biomarkers Can I Use to Manage Septic Cardiomyopathy

Anaïs Caillard, Etienne Gayat, Dahdouh Souheila and Alexandre Mebazaa

Abstract

Alteration of myocardial performance, characterized by left ventricular systolic and diastolic dysfunction, is a common and early complication of septic shock and has a significant impact on patient's prognosis. Cardio-vascular biomarkers are commonly used for diagnosis and risk stratification in cardiac patients. In particular, troponins are included in the definition of acute coronary syndrome and natriuretic peptides are the gold standard biomarkers for the diagnosis and the risk stratification of acute heart failure. Interest has recently focused on the use of these biomarkers as tools to identified cardiac sepsis-induced dysfunction and prognosis. Although echocardiography would be needed to confirm the diagnosis of cardiac dysfunction, biomarkers can alert physician and lead to perform a cardiac ultrasound. Whereas many evidences suggest that cardiac troponins are useful in severe sepsis or septic shock to identify those patients requiring early and aggressive therapy more studies are needed before considering natriuretic peptides in this indication. Among the most recently described biomarker, few data suggest that mid-regional pro-adrenomedullin (MRproADM) could be useful for risk stratification of septic patients.

Total Pages: 154-163 (10)

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