Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study
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...
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doaj-137724f53e7141f59664f4c8fe9c37472021-01-24T12:09:29ZengBMCJournal of Intensive Care2052-04922021-01-019111010.1186/s40560-020-00516-6Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort studyFrançois Bagate0Paul Masi1Thomas d’Humières2Lara Al-Assaad3Laure Abou Chakra4Keyvan Razazi5Nicolas de Prost6Guillaume Carteaux7Genevieve Derumeaux8Armand Mekontso Dessap9AP-HP, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive RéanimationAP-HP, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive RéanimationAP-HP, Hôpitaux universitaires Henri Mondor, Service de PhysiologieAP-HP, Hôpitaux universitaires Henri Mondor, Service de PhysiologieAP-HP, Hôpitaux universitaires Henri Mondor, Service de PhysiologieAP-HP, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive RéanimationAP-HP, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive RéanimationAP-HP, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive RéanimationAP-HP, Hôpitaux universitaires Henri Mondor, Service de PhysiologieAP-HP, Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive RéanimationAbstract 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.https://doi.org/10.1186/s40560-020-00516-6COVID-19SepsisCardiac dysfunctionAfterload |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
François Bagate Paul Masi Thomas d’Humières Lara Al-Assaad Laure Abou Chakra Keyvan Razazi Nicolas de Prost Guillaume Carteaux Genevieve Derumeaux Armand Mekontso Dessap |
spellingShingle |
François Bagate Paul Masi Thomas d’Humières Lara Al-Assaad Laure Abou Chakra Keyvan Razazi Nicolas de Prost Guillaume Carteaux Genevieve Derumeaux Armand Mekontso Dessap Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study Journal of Intensive Care COVID-19 Sepsis Cardiac dysfunction Afterload |
author_facet |
François Bagate Paul Masi Thomas d’Humières Lara Al-Assaad Laure Abou Chakra Keyvan Razazi Nicolas de Prost Guillaume Carteaux Genevieve Derumeaux Armand Mekontso Dessap |
author_sort |
François Bagate |
title |
Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study |
title_short |
Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study |
title_full |
Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study |
title_fullStr |
Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study |
title_full_unstemmed |
Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study |
title_sort |
advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study |
publisher |
BMC |
series |
Journal of Intensive Care |
issn |
2052-0492 |
publishDate |
2021-01-01 |
description |
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. |
topic |
COVID-19 Sepsis Cardiac dysfunction Afterload |
url |
https://doi.org/10.1186/s40560-020-00516-6 |
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