Skip to Main content Skip to Navigation
Journal articles

Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study

Vincent Labbé 1, 2, 3 Stephane Ederhy 4, 5 Nathanael Lapidus 6, 7 Jérémie Joffre 8 Keyvan Razazi 9, 2 Laurent Laine 10 Oumar Sy 11 Sebastian Voicu 12 Frank Chemouni 13, 14 Nadia Aissaoui 15 Roland Smonig 16 Denis Doyen 17 Fabrice Carrat 6, 7 Guillaume Voiriot 1, 2, 3 Armand Mekontso-Dessap 2, 9 Ariel Cohen 4, 5, 18 Muriel Fartoukh 1, 2, 3 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
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
Document type :
Journal articles
Complete list of metadata

https://hal.sorbonne-universite.fr/hal-03385504
Contributor : Gestionnaire Hal-Su Connect in order to contact the contributor
Submitted on : Tuesday, October 19, 2021 - 3:08:07 PM
Last modification on : Friday, December 3, 2021 - 12:14:04 PM

File

s13613-021-00934-1.pdf
Publication funded by an institution

Identifiers

Citation

Vincent Labbé, Stephane Ederhy, Nathanael Lapidus, Jérémie Joffre, Keyvan Razazi, et al.. Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study. Annals of Intensive Care, SpringerOpen, 2021, 11 (1), ⟨10.1186/s13613-021-00934-1⟩. ⟨hal-03385504⟩

Share

Metrics

Record views

33

Files downloads

23