Résumé
Ascites is a frequent complication of cirrhosis and a factor of poorprognosis. There are no recommendations for a systematic evaluation of thehemodynamic state assessed by echocardiography at the initial phase of thedecompensation. The aim of our study is to evaluate the concordance of theechocardiographic assessment made at the initial phase of the decompensated cirrhosiswith edema and ascites by intensivists considered as experts and non-expertgastroenterologists after a short training.Patients and methods: all patients admitted to the gastroenterology unit fordecompensated cirrhosis defined by edema of the lower limbs, and/or ascites, havebeen prospectively included. Patient admitted for another type of cirrhosis worseningthat may affect the hemodynamic state were not included. We performed 2echocardiography exams for each patient, one by a gastroenterologist and one by anintensivist. The gastroenterologists participating in the study were all trained in thesame way: 2 hours of training course and 2 days of hands-on training in intensive careunit. The primary endpoint is the agreement between gastroenterologist and ICUphysicians for 3 echocardiography parameters: visual LVEF (Left Ventricular EjectionFraction (%)), 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 agewas 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. Themedian MELD score was 13.3. All Patients had an estimated LVEF > 40% , estimated byboth intensivist and gastroenterologists (perfect agreement). The median VTI measuredby intensivists was 18.8 versus 17 cm by gastroenterologists (ICC (Intraclass CorrelationCoefficient) = 0.89, good agreement). The median E wave velocity was 0.68 byintensivists 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 LVEFand cardiac output in patient with decompensated cirrhosis. Evaluation of left ventriclefiling pressure appears more difficult. Further studies are necessary to precise the roleof echocardiography to improve prognosis.