Echocardiographic Evidence of Cardiac Atrophy in the Critically Ill

Abirami Kumaresan, MD; Ameeka Pannu, MD; Ariel Mueller, MA; Andres De Lima, MD; Heba Naseem, MD; Sean P. O’Connor, BS; Juan Valencia, MD; Daniela Garcia, MD; Andre Fiche Gosling, MD; Daniel Talmor, MD; Shahzad Shaefi, MD

doi:10.1097/CCE.0000000000000804

Critical Care Explorations (Nov 2022)

Echocardiographic Evidence of Cardiac Atrophy in the Critically Ill

Abirami Kumaresan, MD,
Ameeka Pannu, MD,
Ariel Mueller, MA,
Andres De Lima, MD,
Heba Naseem, MD,
Sean P. O’Connor, BS,
Juan Valencia, MD,
Daniela Garcia, MD,
Andre Fiche Gosling, MD,
Daniel Talmor, MD,
Shahzad Shaefi, MD

Affiliations

Abirami Kumaresan, MD: 1 Department of Anesthesiology and Cardiac Surgery, Smidt Heart Institute Cedar-Sinai Medical Center, Los Angeles, CA.
Ameeka Pannu, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ariel Mueller, MA: 3 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Andres De Lima, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Heba Naseem, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Sean P. O’Connor, BS: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Juan Valencia, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Daniela Garcia, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Andre Fiche Gosling, MD: 4 Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL.
Daniel Talmor, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Shahzad Shaefi, MD: 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

DOI: https://doi.org/10.1097/CCE.0000000000000804
Journal volume & issue: Vol. 4, no. 11
p. e0804

Abstract

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OBJECTIVES:. The purpose of this explorative study is to determine if critically ill patients experience cardiac atrophy that can be quantified as a loss of left ventricular mass (LVM) and thus detected by echocardiography. DESIGN:. Retrospective single-center cohort study. SETTING:. Patients admitted to a tertiary medical center in Boston, MA. PATIENTS:. Adult critically ill patients with ICU length of stay greater than or equal to 5 days. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We conducted a retrospective cohort study of 68 patients, of which 42 were included in the final analysis (mean age 60.9 ± 19.2 yr; 47.6% male). The median length of ICU stay was 11.3 days (interquartile range, 6.8–20.1 d). A decrease in mean LVM over the course of admission for critical illness was observed (median 189.11 g [162.82–240.20 g] vs 176.69 g [142.37–226.26 g]; p = 0.01). After adjusting for sex, age, fluid balance, ICU type, dietary orders, time between echocardiograms, and vasopressor use, this decrease in LVM remained consistent (mean difference, –21.30 g; 95% CI, –41.85 to –0.74; p = 0.04). Relative wall thickness (RWT) did not change during admission. CONCLUSIONS:. These data reveal that a loss of LVM is present in patients over their ICU stay without a corresponding change in RWT, consistent with cardiac atrophy. Future prospective studies are needed to confirm these findings and identify possible sequelae of this finding.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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