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Master Thesis

Concordance between echocardiographic assessment performed in the initial phase of decompensated cirrhosis with edema and ascites by an expert intensive care physician and a non-expert gastroenterologist: the echocirrho study

Abstract : Ascites is a frequent complication of cirrhosis and a factor of poor prognosis. There are no recommendations for a systematic evaluation of the hemodynamic state assessed by echocardiography at the initial phase of the decompensation. The aim of our study is to evaluate the concordance of the echocardiographic assessment made at the initial phase of the decompensated cirrhosis with edema and ascites by intensivists considered as experts and non-expert gastroenterologists after a short training. Patients and methods: all patients admitted to the gastroenterology unit for decompensated cirrhosis defined by edema of the lower limbs, and/or ascites, have been prospectively included. Patient admitted for another type of cirrhosis worsening that may affect the hemodynamic state were not included. We performed 2 echocardiography exams for each patient, one by a gastroenterologist and one by an intensivist. The gastroenterologists participating in the study were all trained in the same way: 2 hours of training course and 2 days of hands-on training in intensive care unit. The primary endpoint is the agreement between gastroenterologist and ICU physicians for 3 echocardiography parameters: visual LVEF (Left Ventricular Ejection Fraction (%)), sub aortic VTI (velocity time integral, cm) and E wave velocity (m.s-1). Results: from march 2018 to august 2018, 27 patients were included. The median age was 62 years, 81,5% were men. Alcohol was the main etiology of cirrhosis (21 patients, 78%). There was mostly advanced liver disease with 40.7% Child C, 55.6% Child B. The median MELD score was 13.3. All Patients had an estimated LVEF > 40% , estimated by both intensivist and gastroenterologists (perfect agreement). The median VTI measured by intensivists was 18.8 versus 17 cm by gastroenterologists (ICC (Intraclass Correlation Coefficient) = 0.89, good agreement). The median E wave velocity was 0.68 by intensivists versus 0.8 m/s by gastroenterologists (ICC = 0.30, poor agreement). Conclusion: this preliminary study shows that, after a short training period, echocardiography can be performed by gastroenterologists in order to assess both LVEF and cardiac output in patient with decompensated cirrhosis. Evaluation of left ventricle filing pressure appears more difficult. Further studies are necessary to precise the role of echocardiography to improve prognosis.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03211444
Contributor : Scd Université de Montpellier <>
Submitted on : Wednesday, April 28, 2021 - 5:03:02 PM
Last modification on : Tuesday, June 22, 2021 - 11:36:02 AM

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  • HAL Id : dumas-03211444, version 1

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Adrien Ardavan Prost. Concordance between echocardiographic assessment performed in the initial phase of decompensated cirrhosis with edema and ascites by an expert intensive care physician and a non-expert gastroenterologist: the echocirrho study. Human health and pathology. 2018. ⟨dumas-03211444⟩

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