Résumé
Objectif : L'objectif principal était de comparer la prévalence de la dysfonction ventriculaire gauche (VG) et/ ou droite (VD) des patients admis au service d'urgence (SU) avec une insuffisance respiratoire aiguë (IRA) secondaire ou non à une pneumopathie à Covid-19. Méthodes : Pendant un mois, nous avons inclus (24/7) de façon prospective les patients de l'unité de Covid-19 du SU qui présentaient une IRA. Pour chaque patient, un test RT-PCR, une tomodensitométrie thoracique et une échographie cardiaque de niveau 2 et pulmonaire étaient systématiquement réalisés avant toute intervention thérapeutique. Chaque patient était classé selon les phénotypes cardiovasculaires suivants : insuffisance VG, insuffisance VD, hypovolémie ± hyperkinésie et profil hémodynamique normal. Résultats : Parmi les 517 patients admis pendant la période d'étude, 78 présentaient une IRA (15 %) et 62 ont bénéficié d'une échocardiographie de niveau 2 (âge : 73 ± 14 ans ;SpO2 : 90 ± 4 % ;lactate : 2,1 ± 1,3 mmol/l). Le diagnostic de la Covid-19 a été établi pour 22 patients (35 %). L'insuffisance VG (15 [38 %] vs 2 [9 %] ;p = 0,016) et celle VD (12 [30 %] vs 1 [5 %] ;p = 0,018) étaient plus souvent observées dans le groupe témoin que chez les patients ayant une pneumopathie à Covid-19. Inversement, les patients Covid-19 avaient plus fréquemment un profil hémodynamique normal ou une hypovolémie associée ou non à une vasoplégie (20 [91 %] vs 21 [53 %] ;p = 0,002). La mortalité intrahospitalière était de 18 % ( n = 11). Tous les patients atteints de la Covid-19 présentant une insuffisance VG et/ou VD précoce sont décédés pendant leur hospitalisation. Conclusions : La dysfonction VG et celle VD étaient plus fréquentes chez les patients non atteints de la Covid-19, alors que les patients atteints de Covid-19 avaient un phénotype cardiovasculaire normal ou hypovolémique.Alternate : Objective: The main objective was to compare the prevalence of left ventricular (LV) and/or right ventricular (RV) dysfunction in patients admitted to the Emergency Department (ED) with an acute respiratory failure (ARF) related to Covid-19 or not. Methods: We prospectively enrolled consecutive adult patients (24/7) during one month in the Covid-19 unit of our ED who presented with ARF. In each patient, a RT-PCR test, chest CT scan, and level 2 echocardiography were systematically performed before any therapeutic intervention. Distinct cardiovascular phenotypes were distinguished: LVor RV failure, hypovolemia ± LV hyperkinesia, and normal hemodynamic profile. Results: Of the 517 patients admitted to the Covid-19 unit during the study period, 78 presented with ARF (15%), and echocardiography was performed in 62 of them (age: 73 ± 14 years;SpO2: 90 ± 4%;lactate: 2.1 ± 1.3 mmol/l). Twenty-two patients (35%) were diagnosed with Covid-19 pneumonia. LV failure was more frequently observed in the control group (15 [38%] vs. 2 [9%];P = 0.016), irrespective of LVejection fraction, as well as RV failure (12 [30%] vs. 1 [5%];P = 0.018). In contrast, Covid-19 patients exhibited more frequently a normal hemodynamic profile or hypovolemia associated or not with vasoplegia (20 [91%] vs. 21 [53%];P = 0.002). Hospital mortality reached 18% ( N = 11). All patients with Covid-19 pneumonia and early LV and/or RV failure died during their hospitalization. Conclusions: Non-Covid-19 ARF patients mainly exhibited LV/RV dysfunction, whereas patients with Covid-19 had a normal or hypovolemic cardiovascular phenotype.
Résumé
Objective: The main objective was to compare the prevalence of left ventricular (LV) and/or right ventricular (RV) dysfunction in patients admitted to the Emergency Department (ED) with an acute respiratory failure (ARF) related to Covid-19 or not. Methods: We prospectively enrolled consecutive adult patients (24/7) during one month in the Covid-19 unit of our ED who presented with ARF. In each patient, a RT-PCR test, chest CT scan, and level 2 echocardiography were systematically performed before any therapeutic intervention. Distinct cardiovascular phenotypes were distinguished: LV or RV failure, hypovolemia ± LV hyperkinesia, and normal hemodynamic profile. Results: Of the 517 patients admitted to the Covid-19 unit during the study period, 78 presented with ARF (15%), and echocardiography was performed in 62 of them (age: 73 ± 14 years;SpO2: 90 ± 4%;lactate: 2.1 ± 1.3 mmol/l). Twenty-two patients (35%) were diagnosed with Covid-19 pneumonia. LV failure was more frequently observed in the control group (15 [38%] vs. 2 [9%];P = 0.016), irrespective of LV ejection fraction, as well as RV failure (12 [30%] vs. 1 [5%];P = 0.018). In contrast, Covid-19 patients exhibited more frequently a normal hemodynamic profile or hypovolemia associated or not with vasoplegia (20 [91%] vs. 21 [53%];P = 0.002). Hospital mortality reached 18% (N = 11). All patients with Covid-19 pneumonia and early LV and/or RV failure died during their hospitalization. Conclusions: Non-Covid-19 ARF patients mainly exhibited LV/RV dysfunction, whereas patients with Covid-19 had a normal or hypovolemic cardiovascular phenotype. © SFMU et Lavoisier SAS 2022