Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study - Université Paris-Est-Créteil-Val-de-Marne Access content directly
Journal Articles Journal of Intensive Care Year : 2021

Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study

François Bagate
  • Function : Author
Paul Masi
  • Function : Author
Thomas D’humières
  • Function : Author
Lara Al-Assaad
  • Function : Author
Laure Abou Chakra
  • Function : Author
Keyvan Razazi
  • Function : Author
Nicolas de Prost
Guillaume Carteaux
  • Function : Author
Armand Mekontso Dessap

Abstract

Abstract Background Sepsis is characterized by various hemodynamic alterations which could happen concomitantly in the heart, pulmonary and systemic circulations. A comprehensive demonstration of their interactions in the clinical setting of COVID-19 sepsis is lacking. This study aimed at evaluating the feasibility, clinical implications, and physiological coherence of the various indices of hemodynamic function and acute myocardial injury (AMI) in COVID-19 sepsis. Methods Hemodynamic and echocardiographic data of septic critically ill COVID-19 patients were prospectively recorded. A dozen hemodynamic indices exploring contractility and loading conditions were assessed. Several cardiac biomarkers were measured, and AMI was considered if serum concentration of high-sensitive troponin T (hs-TNT) was above the 99th percentile, upper reference. Results Sixty-seven patients were assessed (55 males), with a median age of 61 [50–70] years. Overall, the feasibility of echocardiographic parameters was very good, ranging from 93 to 100%. Hierarchical clustering method identified four coherent clusters involving cardiac preload, left ventricle (LV) contractility, LV afterload, and right ventricle (RV) function. LV contractility indices were not associated with preload indices, but some of them were positively correlated with RV function parameters and negatively correlated with a single LV afterload parameter. In most cases ( n = 36, 54%), echocardiography results prompted therapeutic changes. Mortality was not influenced by the echocardiographic variables in multivariable analysis. Cardiac biomarkers’ concentrations were most often increased with high incidence of AMI reaching 72%. hs-TNT was associated with mortality and inversely correlated with most of LV and RV contractility indices. Conclusions In this comprehensive hemodynamic evaluation in critically ill COVID-19 septic patients, we identified four homogeneous and coherent clusters with a good feasibility. AMI was common and associated with alteration of LV and RV functions. Echocardiographic assessment had a clinical impact on patient management in most cases.

Dates and versions

hal-04391550 , version 1 (12-01-2024)

Identifiers

Cite

François Bagate, Paul Masi, Thomas D’humières, Lara Al-Assaad, Laure Abou Chakra, et al.. Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study. Journal of Intensive Care, 2021, 9 (1), pp.12. ⟨10.1186/s40560-020-00516-6⟩. ⟨hal-04391550⟩

Collections

IMRB UPEC
5 View
0 Download

Altmetric

Share

Gmail Facebook X LinkedIn More