用于预测重症 COVID-19 肺炎患者房颤的自动左心房应变分析：一项前瞻性研究
Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study.
作者信息
Beyls Christophe, Hermida Alexis, Bohbot Yohann, Martin Nicolas, Viart Christophe, Boisgard Solenne, Daumin Camille, Huette Pierre, Dupont Hervé, Abou-Arab Osama, Mahjoub Yazine
机构信息
Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France.
UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, Amiens, France.
出版信息
Ann Intensive Care. 2021 Dec 7;11(1):168. doi: 10.1186/s13613-021-00955-w.
BACKGROUND
Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain (LAS) analysis, a marker of LA contractility, have been associated with the development of AF in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict AF in patients with severe hypoxemic COVID-19 pneumonia. We conducted a prospective single center study in Amiens University Hospital intensive care unit (ICU) (France). Adult patients with severe or critical COVID-19 pneumonia according to the World Health Organization definition and in sinus rhythm were included. Transthoracic echocardiography was performed within 48 h of ICU admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of AF during ICU stay.
RESULTS
From March 2020 to February of 2021, 79 patients were included. Sixteen patients (20%) developed AF in ICU. Patients of the AF group were significantly older with a higher SAPS II score than those without AF. LAScd and LASr were significantly more impaired in the AF group compared to the other group (- 8.1 [- 6.3; - 10.9] vs. - 17.2 [- 5.0; - 10.2] %; P < 0.001 and 20.2 [12.3;27.3] % vs. 30.5 [23.8;36.2] %; P = 0.002, respectively), while LASct did not significantly differ between groups (p = 0.31). In a multivariate model, LAScd and SOFA cv were significantly associated with the occurrence of AF. A LAScd cutoff value of - 11% had a sensitivity of 76% and a specificity of 75% to identify patients with AF. The 30-day cumulative risk of AF was 42 ± 9% with LAScd > - 11% and 8 ± 4% with LAScd ≤ - 11% (log rank test P value < 0.0001).
CONCLUSION
For patients with severe COVID-19 pneumonia, development of AF during ICU stay is common (20%). LAS parameters seem useful in predicting AF within the first 48 h of ICU admission.
TRIAL REGISTRATION
NCT04354558.
背景
心房颤动（AF）是新冠肺炎肺炎中记录最多的心律失常。左心房（LA）应变（LAS）分析是LA收缩性的一个指标，在几种临床情况下与AF的发生有关。我们旨在评估LA应变参数对严重低氧血症新冠肺炎肺炎患者AF的诊断能力。我们在法国亚眠大学医院重症监护病房（ICU）进行了一项前瞻性单中心研究。纳入根据世界卫生组织定义患有严重或危重型新冠肺炎肺炎且处于窦性心律的成年患者。在入住ICU后48小时内进行经胸超声心动图检查。通过自动化软件进行LA应变分析。记录以下LA应变参数：储存期LA应变（LASr）、管道期LA应变（LAScd）和收缩期LA应变（LASct）。主要终点是ICU住院期间AF的发生。
结果
从2020年3月至2021年2月，共纳入79例患者。16例患者（20%）在ICU发生AF。AF组患者年龄显著更大，急性生理与慢性健康状况评分系统II（SAPS II）评分更高。与非AF组相比，AF组的LAScd和LASr受损更严重（分别为-8.1[-6.3；-10.9]%对-17.2[-5.0；-10.2]%；P<0.001和20.2[12.3；27.3]%对30.5[23.8；36.2]%；P = 0.002），而LASct在两组之间无显著差异（P = 0.31）。在多变量模型中，LAScd和序贯器官衰竭评估（SOFA）cv与AF的发生显著相关。LAScd临界值为-11%时，识别AF患者的敏感性为76%，特异性为75%。LAScd>-11%时AF的30天累积风险为42±9%，LAScd≤-11%时为8±4%（对数秩检验P值<0.0001）。
结论
对于严重新冠肺炎肺炎患者，ICU住院期间发生AF很常见（20%）。LAS参数似乎有助于预测入住ICU后48小时内的AF。
试验注册号
NCT04354558。
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