Author:
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,Guidet Bertrand,Ait-Oufella Hafid,Bourcier Simon,Da Silva Daniel,Jochmans Sebastien,Dellamonica Jean,Timsit Jean-François,Megarbane Bruno,Diehl Jean-Luc,Rushton-Smith Sophie,
Abstract
Abstract
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.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine