| 1. |
- Cavefors, Oscar, et al.
(författare)
-
Isolated diastolic dysfunction is associated with increased mortality in critically ill patients.
- 2023
-
Ingår i: Journal of critical care. - : Elsevier BV. - 1557-8615 .- 0883-9441. ; 76
-
Tidskriftsartikel (refereegranskat)abstract
- Left ventricular (LV) diastolic dysfunction is important in critically ill patients, but prevalence and impact on mortality is not well studied. We classified intensive care patients with normal left ventricular function according to current diastolic guidelines and explored associations with mortality.Echocardiography was performed within 24h of intensive care admission. Patients with reduced LV ejection fraction, regional wall motion abnormality, or a history of cardiac disease were excluded. Patients were classified according to the 2016 EACVI guidelines, Recommendations for the Evaluation of LV Diastolic Function by Echocardiography.Out of 218 patients, 162 (74%) had normal diastolic function, 21 (10%) had diastolic dysfunction, and 35 (17%) had indeterminate diastolic function. Diastolic dysfunction were more common in female patients, older patients and associated with sepsis, respiratory and cardiovascular comorbidity as well as higher SAPS Score. In a risk-adjusted logistic regression model, patients with indeterminate diastolic dysfunction (OR 4.3 [1.6-11.4], p=0.004) or diastolic dysfunction (OR 5.1 [1.6-16.5], p=0.006) had an increased risk of death at 90days compared to patients with normal diastolic function.Isolated diastolic dysfunction, assessed by a multi-parameter approach, is common in critically ill patients and is associated with mortality.Secondary analysis of data from a single-center prospective observational study focused on systolic dysfunction in intensive care unit patients (Clinical Trials ID: NCT03787810.
|
|
| 2. |
- Cavefors, Oscar
(författare)
-
Left ventricular dysfunction in critically ill patients
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT Background: Cardiac dysfunction is common in Intensive Care Unit (ICU) patients and can contribute to multiorgan failure and death. Despite this, few studies have been performed on pathogenies, prevalence, diagnosis and impact on mortality in unselected ICU patients. Aim: The thesis aimed to assess the prevalence, significance, and etiologies behind systolic and diastolic LV dysfunction in critically ill patients, as well as explore the use of cardiac biomarkers. Methods: Paper I was a prospective observational trial focusing on cardiac left ventricular (LV) systolic dysfunction in ICU patients. Patients underwent transthoracic echocardiography (TTE) within 24 hours of admission. A secondary analysis of the first cohort was performed in Paper II. Patients with normal systolic function and no cardiac disease were classified according to the European Association of Cardiovascular Imaging (EACVI) guidelines for diastolic dysfunction. In Paper III, a retrospective analysis focusing on cardiac biomarkers was performed using data from Paper I. Paper IV was a register study in which coronary angiography and cardiac magnetic resonance (CMR) results were systematically explored in ICU patients with Regional Wall Motion Abnormalities (RWMA). Results: The prevalence of systolic dysfunction, defined as ejection fraction (EF)<50% or RWMA, was 25 % in unselected ICU patients. Half of the patients had systolic dysfunction unrelated to primary cardiac disease. No mortality increase was seen at 30 days (primary outcome), but the 90-day mortality was increased. (Paper I) In total, 218 patients were included in Paper II. Of these, 21(10%) had diastolic dysfunction, and in 35(17%) diastolic function was indeterminate. A risk-adjusted model showed increased 90-day mortality in these patient groups. (Paper II) NT-proBNP and hsTNT were associated with cardiac dysfunction but were not sensitive enough to use for screening of cardiac dysfunction in unselected ICU patients. However, biomarkers were linked to increased mortality even after adjustments for cardiac dysfunction, disease severity, age, and independently associated factors. (Paper III) In the retrospective register study, 257 patients with RWMA were identified, and 53 of these had non-obstructed coronary arteries. The majority of patients with non-obstructed coronary arteries had reversible LV dysfunction. CMR showed Takotsubo or myocardial stunning as the most common reason for the RWMA in these patients. (Paper IV) Conclusions: Systolic and diastolic dysfunction is common and associated with increased mortality in ICU patients. Biomarkers are useful as risk markers but are not advisable for screening for cardiac dysfunction. A substantial part of ICU-associated cardiac dysfunction is not caused by coronary artery disease; those patients often have reversible cardiac dysfunction.
|
|
| 3. |
- Cavefors, Oscar, et al.
(författare)
-
Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome
- 2021
-
Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 8:6, s. 5415-5423
-
Tidskriftsartikel (refereegranskat)abstract
- Aims Left ventricular (LV) dysfunction can be triggered by non-cardiac disease, such as sepsis, hypoxia, major haemorrhage, or severe stress (Takotsubo syndrome), but its clinical importance is not established. In this study, we evaluate the incidence and impact on mortality of LV dysfunction associated with critical illness. Methods and results In this single-centre, observational study, consecutive patients underwent an echocardiographic examination within 24 h of intensive care unit (ICU) admission. LV systolic dysfunction was defined as an ejection fraction (EF) < 50% and/or regional wall motion abnormalities (RWMA). A cardiologist assessed patients with LV dysfunction for the presence of an acute or chronic cardiac disease, and coronary angiography was performed in high-risk patients. Of the 411 patients included, 100 patients (24%) had LV dysfunction and in 52 (13%) of these patients, LV dysfunction was not attributed to a cardiac disease. Patients with LV dysfunction and non-cardiac disease had higher mortality risk score (Simplified Acute Physiologic Score 3 score), heart rate, noradrenaline doses, and lactate levels as well as decreased EF, stroke volume, and cardiac output compared with patients with normal LV function. Diagnoses most commonly associated with LV dysfunction and non-cardiac disease were sepsis, respiratory insufficiency, major haemorrhage, and neurological disorders. RWMA (n = 40) with or without low EF was more common than global hypokinesia (n = 12) and was reversible in the majority of cases. Twelve patients had a circumferential pattern of RWMA in concordance with Takotsubo syndrome. Crude 30 day mortality was higher in patients with LV dysfunction and non-cardiac disease compared with patients with normal LV function (33% vs. 18%, P = 0.023), but not after risk adjustment (primary outcome) {odds ratio [OR] 1.56 [confidence interval (CI) 0.75-3.39], P = 0.225}. At 90 days, crude mortality was 44% and 22% (P = 0.002), respectively, in these groups. This difference was also significant after risk adjustment [OR 2.40 (CI 1.18-4.88), P = 0.016]. Conclusions Left ventricular systolic dysfunction is commonly triggered by critical illness, is frequently seen as regional hypokinesia, and is linked to an increased risk of death. The prognostic importance of LV dysfunction in critical illness might be underestimated.
|
|
| 4. |
|
|
| 5. |
- Holmqvist, Jacob, et al.
(författare)
-
Cardiac dysfunction and mortality in critically ill patients with COVID-19: A Swedish multicentre observational study
- 2022
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 66:5, s. 606-614
-
Tidskriftsartikel (refereegranskat)abstract
- Background The prevalence and importance of cardiac dysfunction in critically ill patients with COVID-19 in Sweden is not yet established. The aim of the study was to assess the prevalence of cardiac dysfunction and elevated pulmonary artery pressure (PAP), and its influence on mortality in patients with COVID-19 in intensive care in Sweden. Methods This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 h from admission and again after 4 to 7 days. Cardiac dysfunction was defined as left ventricular (LV) dysfunction (ejection fraction <50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (defined as TAPSE <17 mm or visually assessed moderate/severe RV dysfunction). Results We included 132 patients, of whom 127 (96%) were intubated. Cardiac dysfunction was found in 42 (32%) patients. Most patients had cardiac dysfunction at the first assessment (n = 35) while a few developed cardiac dysfunction later (n = 7) and some changed type of dysfunction (n = 3). LV dysfunction was found in 21 and RV dysfunction in 19 patients, while 5 patients had combined dysfunction. Elevated PAP was found in 34 patients (26%) and was more common in patients with RV dysfunction. RV dysfunction and elevated PAP were independently associated with an increased risk of death (OR 3.98, p = .013 and OR 3.88, p = .007, respectively). Conclusions Cardiac dysfunction occurs commonly in critically ill patients with COVID-19 in Sweden. RV dysfunction and elevated PAP are associated with an increased risk of death.
|
|
| 6. |
- Rosen-Wetterholm, Elin, et al.
(författare)
-
Regional wall motion abnormalities in critically ill patients with non-obstructed coronary arteries.
- 2023
-
Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 67:6, s. 746-754
-
Tidskriftsartikel (refereegranskat)abstract
- Left ventricular (LV) dysfunction is estimated to occur in 10 to 25% of the general ICU population and is frequently seen as regional wall motion abnormalities (RWMA). Although RWMA is mostly attributed to myocardial ischemia or infarction, some studies have suggested that non-ischemic RWMA might also be prevalent. We sought to establish that RWMA can be seen in critically ill patients with normal coronary arteries and to explore reasons for RWMA in this population.In this retrospective study, data from the hospital angiography register and the ICU register were collated between 2012 and 2019. Patients were identified who underwent angiography in conjunction with their ICU stay and had RWMA on echocardiography. Patients were divided into either those with non-obstructed or those with obstructed coronary arteries. Cardiac magnetic resonance imaging (cMRI) examinations were reviewed if they had been performed on patients with non-obstructed coronaries.We identified 53 patients with RWMA and non-obstructed coronary arteries and 204 patients with RWMA and obstructed coronary arteries. Patients with non-obstructed coronary arteries were more often female, younger, and had fewer cardiovascular risk factors. They less commonly had ST-elevation, but more frequently had T-wave inversion or serious arrhythmias. Troponin levels were higher in patients with obstructed coronary arteries, but NT-proBNP was similar between the groups. There were no differences in risk-adjusted 90-day mortality between patients with non-obstructed vs obstructed coronary arteries (OR 1.21, [95% CI 0.56-2.64], p=0.628). In those with non-obstructed coronary arteries, follow-up echocardiography was available for 38 patients, of whom 30 showed normalization of cardiac function. Of the 14 patients with non-obstructed coronary arteries on whom cMRI was performed, 7 had a tentative diagnosis of Takotsubo syndrome or myocardial stunning; 4 had a myocardial infarction (preexisting in 3 cases); 1 patient had acute myocarditis; 1 patient had post-myocarditis; and 1 patient was diagnosed with dilated cardiomyopathy.RWMA can be seen to occur in critically ill patients in the absence of coronary artery obstruction. Several conditions can cause regional hypokinesia and cMRI is useful to evaluate the underlying aetiology.
|
|
