Effect of volume infusion on left atrial strain in acute circulatory failure.

Autor: Cicetti M; Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France.; Università Cattolica del Sacro Cuore, Roma, Italy., Bagate F; Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France. francois.bagate@aphp.fr.; Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France. francois.bagate@aphp.fr., Lapenta C; Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France., Gendreau S; Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France.; Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France., Masi P; Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France.; Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France., Mekontso Dessap A; Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France.; Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France.; INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, F-94010, France.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2024 Apr 09; Vol. 14 (1), pp. 53. Date of Electronic Publication: 2024 Apr 09.
DOI: 10.1186/s13613-024-01274-6
Abstrakt: Background: Left atrial strain (LAS) is a measure of atrial wall deformation during cardiac cycle and reflects atrial contribution to cardiovascular performance. Pathophysiological significance of LAS in critically ill patients with hemodynamic instability has never been explored. This study aimed at describing LAS and its variation during volume expansion and to assess the relationship between LAS components and fluid responsiveness.
Methods: This prospective observational study was performed in a French ICU and included patients with acute circulatory failure, for whom the treating physician decided to proceed to volume expansion (rapid infusion of 500 mL of crystalloid solution). Trans-thoracic echocardiography was performed before and after the fluid infusion. LAS analysis was performed offline. Fluid responsiveness was defined as an increase in velocity-time integral (VTI) of left ventricular outflow tract ≥ 10%.
Results: Thirty-eight patients were included in the final analysis. Seventeen (45%) patients were fluid responders. LAS analysis had a good feasibility and reproducibility. Overall, LAS was markedly reduced in all its components, with values of 19 [15 - 32], -9 [-19 - -7] and - 9 [-13 - -5] % for LAS reservoir (LASr), conduit (LAScd) and contraction (LASct), respectively. LASr, LAScd and LASct significantly increased during volume expansion in the entire population. Baseline value of LAS did not predict fluid responsiveness and the changes in LAS and VTI during volume expansion were not significantly correlated.
Conclusions: LAS is severely altered during acute circulatory failure. LAS components significantly increase during fluid administration, but cannot be used to predict or assess fluid responsiveness.
(© 2024. The Author(s).)
Databáze: MEDLINE
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