Abstract
BackgroundEchocardiographic 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.MethodsIn 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.ResultsThe 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.ConclusionsTransesophageal 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.
Highlights
Echocardiographic parameters have been poorly investigated for estimating cardiovascular risk in patients with sepsis and new-onset atrial fibrillation
New-onset atrial fibrillation (NOAF) was present during initial Transesophageal echocardiography (TEE) in 47% of patients
We found that left ventricular (LV) systolic dysfunction, severe aortic atheroma, and Left atrial (LA)/Left atrial appendage (LAA) dysfunction were common, and that the incidence of cardiovascular events was very high, including arterial thromboembolic event (7%), major bleeding event (19%), and all-cause death (29%)
Summary
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 echocardio‐ graphic abnormalities and their relationship with cardiovascular events in mechanically ventilated patients with sepsis and new-onset atrial fibrillation. New-onset atrial fibrillation (NOAF) is the commonest arrhythmia in the intensive care unit (ICU) occurring in one-third of critically ill patients with sepsis [1, 2]. In this setting, patients with NOAF are at greater risk. Transesophageal echocardiography (TEE) abnormalities, such as left ventricular (LV) systolic dysfunction, left atrial/left atrial appendage (LA/LAA) dysfunction, and severe aortic atheroma, are associated with an increased risk of arterial thromboembolic event in patients with atrial fibrillation [5]. Bedside echocardiography could be useful in critically ill patients with sepsis and NOAF for estimating their cardiovascular risk
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