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Table 3 Gaps and general limitations of the septic cardiomyopathy literature

From: Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature

  Limitations Potential Impact
Patient-related factors Observational study designs with generally small sample sizes High degree of confounding and bias; elucidation of true causal relationships not possible
Heterogeneous sepsis classification (SOFA, SIRS) and severity Difficult to make conclusions across varied populations; prognostic value of echocardiography findings confounded by collinearity between severity of disease and adverse outcomes
Pre-septic cardiac function largely unknown Acute versus chronic dysfunction may portend different prognosis
Variation in co-morbidities Complex interaction between pre-existing illnesses, acute infection, and treatment renders cross-patient comparisons difficult
Variation in treatments (mechanical ventilation, vasopressors, inotropes) Therapeutic interventions likely affect cardiac performance and echocardiographic measurements and may alter outcomes
Echocardiography-related factors Variable timing of initial echocardiogram Normal progression of disease (natural history) and treatment prior to initial exam may alter findings
Variability of timing and number of repeat echocardiograms Ongoing resuscitation may alter cardiac performance via intrinsic (e.g., increased contractility) or extrinsic (change in loading conditions) factors
Reference ranges derived in stable patients Unknown how/if normal values are applicable in the setting of sepsis
GLS values not standardized across ultrasound vendors Difficult to compare GLS values across US systems
  1. GLS global longitudinal strain, SIRS systemic inflammatory response syndrome, SOFA Sequential Organ Failure Assessment, US ultrasound