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Minerva Anestesiologica 2022 March;88(3):137-44

DOI: 10.23736/S0375-9393.21.15708-6


lingua: Inglese

Echocardiography is a good way to diagnose and monitor type 1 cardiorenal syndrome in ICU

Mario GENEIX 1 , Sebastien MOSCHIETTO 2, Antoine FROUIN 2, Fanny DEPEYRE 2, Thibault DUPONT 3, Florent MONTINI 2

1 Unit of Medical intensive Care, La Timone Hospital, Assistance Publique des Hopitaux de Marseille (APHM), University of Aix-Marseille, Marseille, France; 2 Medical Intensive Care Unit, Henry Duffaut Hospital, Avignon, France; 3 Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique des Hopitaux de Paris (APHP), University of Paris, Paris, France

BACKGROUND: Type-one cardiorenal syndrome (CRS) is defined by acute decompensated heart failure leading to secondary acute kidney injury. No study evaluates the reliability of transthoracic echocardiography as a help tool for diagnosis and optimization of CRS. Therefore, the aim of this study was to assess echocardiographic parameters in patients with CRS in the Intensive Care Unit.
METHODS: We conducted an observational, prospective, single-center study in the ICU department of a general hospital. Patients admitted in the ICU and presenting with type 1 CRS were included. Transthoracic echocardiography was performed at baseline and at day end after treatment by the same trained operator for the same patients. We report various echocardiographic indices at these two timepoints.
RESULTS: Twenty-seven patients were included. At baseline 96.3% of patients had signs of congestion (IVC dilation >2 cm), 76% had an altered S-wave (<11.5 cm/s), 72.73% had an altered TAPSE (<17 mm), 85.19% had an elevated RV/LV diameter ratio (>0.6). Between baseline and D end, IVC size and, the number of patients with an elevated RV/LV diameter ratio significantly decreased. Weight decreased, whereas natriuresis significantly increased, and the amount of vasopressors support decreased. Diuresis, and S-wave velocity showed non-significant changes.
CONCLUSIONS: Main echocardiographic findings at baseline in patients with type 1 CRS consist of a right ventricular dysfunction associated an IVC dilation. We report that weight, RV/LV diameter ratio, and IVC diameter might constitute good follow-up parameters to monitor treatment response.

KEY WORDS: Echocardiography; Cardio-renal syndrome; Diagnosis

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