Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study
In: ISSN: 2110-5820 ; Annals of Intensive Care ; https://hal.sorbonne-universite.fr/hal-03981516 ; Annals of Intensive Care, 2021, 2021
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Zugriff:
International audience ; Background: Echocardiographic parameters have been poorly investigated for estimating cardiovascular risk in patients with sepsis and new-onset atrial fibrillation. We aim to assess the prevalence of transesophageal echocardiographic abnormalities and their relationship with cardiovascular events in mechanically ventilated patients with sepsis and new-onset atrial fibrillation. Methods: In this prospective multicenter pilot study, left atrial/left atrial appendage (LA/LAA) dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were assessed using an initial transesophageal echocardiographic study, which was repeated after 48-72 h to detect LA/LAA thrombus formation. The study outcome was a composite of cardiovascular events at day 28, including arterial thromboembolic events (ischemic stroke, non-cerebrovascular arterial thromboembolism, LA/LAA thrombus), major bleeding, and all-cause death. Results: The study population comprised 94 patients (septic shock 63%; 35% women; median age 69 years). LA/LAA dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were detected in 17 (19%), 22 (24%), and 27 (29%) patients, respectively. At day 28, the incidence of cardiovascular events was 46% (95% confidence interval [CI]: 35 to 56). Arterial thromboembolic events and major bleeding occurred in 7 (7%) patients (5 ischemic strokes, 1 non-cerebrovascular arterial thromboembolism, 2 left atrial appendage thrombi) and 18 (19%) patients, respectively. At day 28, 27 patients (29%) died. Septic shock (hazard ratio [HR]: 2.36; 95% CI 1.06 to 5.29) and left ventricular systolic dysfunction (HR: 2.06; 95% CI 1.05 to 4.05) were independently associated with cardiovascular events. Conclusions: Transesophageal echocardiographic abnormalities are common in mechanically ventilated patients with sepsis and new-onset atrial fibrillation, but only left ventricular systolic dysfunction was associated with cardiovascular events at day 28.
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Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study
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| Autor/in / Beteiligte Person: | Labbé, Vincent ; Ederhy, Stephane ; Lapidus, Nathanael ; Joffre, Jérémie ; Razazi, Keyvan ; Laine, Laurent ; Sy, Oumar ; Voicu, Sebastian ; Chemouni, Frank ; Aissaoui, Nadia ; Smonig, Roland ; Doyen, Denis ; Carrat, Fabrice ; Voiriot, Guillaume ; Mekontso-Dessap, Armand ; Cohen, Ariel ; Fartoukh, Muriel ; CHU Tenon AP-HP ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) ; Sorbonne Université (SU) ; Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS) ; Institut Mondor de Recherche Biomédicale (IMRB) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor Créteil ; Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12) ; CHU Saint-Antoine AP-HP ; Thrombose, atherothrombose et pharmacologie appliquée ; Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU) ; Groupe Henri Mondor-Albert Chenevier ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Hôpital Albert Chenevier ; Centre Hospitalier de Saint-Denis Ile-de-France ; Centre Hospitalier de Melun (CHM) ; Service de Réanimation Médicale et Toxicologique Hôpital Lariboisière ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal, APHP ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) ; Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité) ; Institut Gustave Roussy (IGR) ; Hôpital Européen Georges Pompidou APHP (HEGP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO) ; Université Paris Descartes - Paris 5 (UPD5) ; AP-HP - Hôpital Bichat - Claude Bernard Paris ; Centre Hospitalier Universitaire de Nice (CHU Nice) ; Unité de Recherche Clinique de la Côte d’Azur (URRIS UR2CA) ; Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA) ; Sorbonne Université - Faculté de Médecine (SU FM) ; FAST Study Group: Bertrand Guidet, Hafid Ait-Oufella, Simon Bourcier, Daniel Da Silva, Sebastien Jochmans, Jean Dellamonica, Jean-François Timsit, Bruno Megarbane, Jean-Luc Diehl, Sophie Rushton-Smith |
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| Zeitschrift: | ISSN: 2110-5820 ; Annals of Intensive Care ; https://hal.sorbonne-universite.fr/hal-03981516 ; Annals of Intensive Care, 2021, 2021 |
| Veröffentlichung: | HAL CCSD ; SpringerOpen, 2021 |
| Medientyp: | academicJournal |
| DOI: | 10.1186/s13613-021-00934-1 |
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