Sepsis-Related Myocardial Dysfunction (SIMD) Severity Index Calculator
- Sepsis-Related Myocardial Dysfunction (SIMD) Severity Index
Enter values available at bedside/ICU admission or within the first 24 hours. Use absolute (positive) value for GLS (e.g., 18 = normal strain ~ −18%). Troponin input is expressed as multiple of your lab’s upper limit of normal (ULN). Norepinephrine dose is in µg/kg/min.
- Sepsis-Related Myocardial Dysfunction (SIMD): Explanation and Clinical Context
SIMD (often termed septic cardiomyopathy) describes acute, at least partially reversible systolic and/or diastolic ventricular dysfunction during sepsis in the absence of primary coronary occlusion. It may manifest as reduced LVEF, impaired LV global longitudinal strain (GLS), right ventricular dysfunction, and reduced cardiac index, and it often coexists with vasoplegia, hypoperfusion, and microcirculatory derangements. Echocardiography is central for diagnosis and for guiding hemodynamic therapy; strain imaging can unmask subclinical dysfunction even when LVEF is preserved. Elevated cardiac biomarkers (troponin, natriuretic peptides) are common and prognostically informative but not specific. Severity of shock (vasopressor dose) and tissue hypoperfusion (lactate) integrate the systemic burden and, when combined with cardiac dysfunction, mark higher risk. Because there is no universally accepted, validated SIMD severity score to date, this calculator implements a pragmatic composite: LVEF, GLS (absolute), cardiac index, norepinephrine dose, lactate, troponin (×ULN), and RV dysfunction. “SIMD present” is flagged by commonly used research cutoffs (LVEF <50%, GLS <16% absolute, or CI <2.2 L/min/m²). The summed point bands (Mild/Moderate/Severe/Critical) are intended for education, serial tracking, and research prototyping, not definitive management. Always correlate with the clinical picture, repeat echo after resuscitation, and consider alternative etiologies (AMI, myocarditis, PE).
Reference:
Kakihana Y, et al. J Intensive Care. 2016;4:22. doi:10.1186/s40560-016-0148-1.
L’Heureux M, et al. Curr Cardiol Rep. 2020;22:35. doi:10.1007/s11886-020-01277-2.
Ehrman RR, et al. Ultrasound J. 2022;14:24. doi:10.1186/s13089-022-00282-6.
Sun P, et al. ICU septic cardiomyopathy nomogram. Sci Rep. 2024;14:16753. doi:10.1038/s41598-024-64965-x.
González FA, et al. Strain-based SIMD characterization. Ann Intensive Care. 2025;15:XX. doi:10.1186/s13613-025-01561-w.
Zakynthinos GE, et al. J Clin Med. 2025;14:986. doi:10.3390/jcm14030986.
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