Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study.
Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study.
复制标题
DOI：
10.1186/s40560-020-00516-6
复制
发表时间：
2021-01-20
影响因子：
7.1
通讯作者：
Mekontso Dessap A
中科院分区：
文献类型：
--
作者：
Bagate F;Masi P;d'Humières T;Al-Assaad L;Chakra LA;Razazi K;de Prost N;Carteaux G;Derumeaux G;Mekontso Dessap A
脓毒症的特点是各种血流动力学改变，可同时发生在心脏、肺和全身循环。缺乏对它们在COVID-19败血症临床环境中的相互作用的全面论证。本研究旨在评价COVID-19败血症中血流动力学功能和急性心肌损伤（AMI）各项指标的可行性、临床意义和生理一致性。前瞻性记录感染性重症COVID-19患者的血流动力学和超声心动图资料。评估了十几项探讨收缩性和负荷条件的血流动力学指标。测量几种心脏生物标志物，如果血清高敏感肌钙蛋白T （hs-TNT）浓度高于99个百分位数，即上基准值，则考虑AMI。67例患者接受评估，其中男性55例，中位年龄61岁[50-70]。总的来说，超声心动图参数的可行性很好，范围从93%到100%。分层聚类方法确定了涉及心脏前负荷、左心室收缩力、左心室后负荷和右心室功能的四个相干聚类。左室收缩性指标与前载指标无相关性，但部分指标与左室功能参数呈正相关，与单个左室后载参数呈负相关。在大多数病例中（n = 36, 54%），超声心动图结果提示治疗改变。在多变量分析中，死亡率不受超声心动图变量的影响。心脏生物标志物的浓度通常升高，AMI的高发率达到72%。hs-TNT与死亡率相关，与大部分左室和右室收缩性指标呈负相关。在本次重症COVID-19脓毒症患者的血流动力学综合评估中，我们确定了4个均匀一致的集群，具有良好的可行性。AMI很常见，并与左、右心室功能改变有关。在大多数情况下，超声心动图评估对患者管理有临床影响。在线版本包含补充材料，可在10.1186/s40560-020-00516-6获得。
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. 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. 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. 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. The online version contains supplementary material available at 10.1186/s40560-020-00516-6.
登录
查看更多内容
影响因子：
38.9
作者：
Boissier, Florence;Katsahian, Sandrine;Dessap, Armand Mekontso
通讯作者：
Dessap, Armand Mekontso
影响因子：
158.5
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
通讯作者：
Jonigk, Danny
影响因子：
3.8
作者：
Lassen MCH;Skaarup KG;Lind JN;Alhakak AS;Sengeløv M;Nielsen AB;Espersen C;Ravnkilde K;Hauser R;Schöps LB;Holt E;Johansen ND;Modin D;Djernaes K;Graff C;Bundgaard H;Hassager C;Jabbari R;Carlsen J;Lebech AM;Kirk O;Bodtger U;Lindholm MG;Joseph G;Wiese L;Schiødt FV;Kristiansen OP;Walsted ES;Nielsen OW;Madsen BL;Tønder N;Benfield T;Jeschke KN;Ulrik CS;Knop FK;Lamberts M;Sivapalan P;Gislason G;Marott JL;Møgelvang R;Jensen G;Schnohr P;Søgaard P;Solomon SD;Iversen K;Jensen JUS;Schou M;Biering-Sørensen T
通讯作者：
Biering-Sørensen T
影响因子：
24
作者：
Giustino G;Croft LB;Stefanini GG;Bragato R;Silbiger JJ;Vicenzi M;Danilov T;Kukar N;Shaban N;Kini A;Camaj A;Bienstock SW;Rashed ER;Rahman K;Oates CP;Buckley S;Elbaum LS;Arkonac D;Fiter R;Singh R;Li E;Razuk V;Robinson SE;Miller M;Bier B;Donghi V;Pisaniello M;Mantovani R;Pinto G;Rota I;Baggio S;Chiarito M;Fazzari F;Cusmano I;Curzi M;Ro R;Malick W;Kamran M;Kohli-Seth R;Bassily-Marcus AM;Neibart E;Serrao G;Perk G;Mancini D;Reddy VY;Pinney SP;Dangas G;Blasi F;Sharma SK;Mehran R;Condorelli G;Stone GW;Fuster V;Lerakis S;Goldman ME
通讯作者：
Goldman ME
影响因子：
8.1
作者：
Nafati, C.;Gardette, M.;Zieleskiewicz, L.
通讯作者：
Zieleskiewicz, L.