A Meta-Analytic Perspective on Echocardiographic Signs of Long-Term Cardiac Dysfunction After Burns, Sepsis, and Trauma

Severe burns, major trauma, and sepsis cause systemic inflammation and metabolic stress, often leading to acute cardiac dysfunction. How myocardial sequelae evolve over time remains unclear. This meta-analysis evaluated whether consistent echocardiographic patterns of long-term dysfunction exist across these conditions and whether current data permit longitudinal comparison. A systematic search of PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar (inception-July 2025) followed PRISMA guidelines. Eligible studies reported echocardiographic outcomes ≥72 h after injury or sepsis onset. Data on demographics, illness severity, and echocardiographic parameters were extracted. Subgroup and meta-analyses compared conditions and follow-up periods. In this meta-analysis of 47 studies (n = 3117; trauma: 282, sepsis: 959, burns: 1876) left ventricular ejection fraction (LVEF), heart rate (HR), and E/A ratio were the most common echocardiographic parameters. LVEF was reported in n = 35 (73%) studies: n = 9 (19%) trauma, n = 17 (35%) sepsis, and n = 9 (19%) burn studies, limited by substantial heterogeneity in patient severity and follow-up timing. The same applies to HR, reported in n = 11 (23%) studies (n = 3 (6.3%) trauma, n = 5 (10%) sepsis, and n = 3 (6.3%) burn studies), and E/A ratio reported in n = 14 (29%) studies (n = 4 (8.3%) trauma, n = 6 (13%) sepsis, and n = 4 (8.3%) burn studies). Marked heterogeneity in study design, patient selection, and echocardiographic assessment limited direct comparability across conditions. Despite signals of long-term alteration, analysis was restricted by short follow-up durations (median 9 days for sepsis, 10 for trauma, 447 for burns) and scarce longitudinal data, particularly in trauma and sepsis cohorts. This meta-analysis identifies long-term myocardial dysfunction after burns, sepsis, and trauma, most pronounced in burn survivors. Marked heterogeneity and limited longitudinal data hinder trajectory assessment. Prospective studies with standardized echocardiography are needed to define post-critical illness cardiac phenotypes.