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

Study Overview
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Brief Summary
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The investigators hypothesize that trans-thoracic ultrasound performed by non-specialist gastroenterologists with a standard training by intensive care doctors will give equivalent results to those achieved by experts for a simple evaluation of hemodynamic status.

Official Title
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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

Conditions
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Liver Cirrhoses

Intervention / Treatment
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* Other: Trans-thoracic ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient must be an adult at least 18 years old Patient has known or suspected cirrhosis (diagnosed by biopsy or based on recognized clinical/biological/radiological criteria) Admitted to the gastroenterology service for odematous-ascitic decompensation defined by edema of the lower limbs, and/or ascites, anasarca, associated or not with weight gain. Exclusion Criteria: The subject is participating in an interventional study, or is in a period of exclusion determined by a previous study The subject refuses to sign the consent It is impossible to give the subject informed information The patient is under safeguard of justice or state guardianship Patient is pregnant or breastfeeding Patient already participated in the study Patient with cirrhosis admitted for a different decompensation (active digestive hemorrhage or sepsis) Poorly echogenic patient Patient withdraws consent Patient with anasarca of cardiac origin Ultrasound diagnosis of a severe cardiac pathology requiring specialized treatment in intensive care or cardiology (severe cardiac insufficiency, acute pulmonary edema, endocarditis, severe valvulopathy, cardiac tamponade, intracardiac thrombus)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with liver cirrhosis<br> | Other: Trans-thoracic ultrasound<br>* Trans-thoracic ultrasound performed by an expert and a non-expert<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Concordance in Left Ventricular Ejection Fraction measurement on trans-thoracic ultrasound by expert versus a non-specialist gastroenterologist with standard training | Difference in measured Left Ventricular Ejection Fraction (%) | 48 hours | 
| Concordance in E' wave at the lateral mitral ring and mitral E wave measurement by expert versus a non-specialist gastroenterologist with standard training | Difference in measured E / E' ratio | 48 hours | 
| Concordance in stroke volume measurement by expert versus a non-specialist gastroenterologist with standard training | Difference in measured velocity-time integral (cm) | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Death rate |  | Day 28 | 
| Duration of hospitalization |  | End of follow-up (maximum 28 days) | 
| Number of admissions to intensive care |  | End of follow-up (maximum 28 days) | 
| Consummation of diuretics |  | Day 0 | 
| albumin infusion necessity |  | Day 0 | 
| Use of vasopressors |  | Day 0 | 
| auto ejection fraction measurement on trans-thoracic ultrasound by expert | Doppler | Day 0 | 
| lateral mitral annulus measurement on trans-thoracic ultrasound by expert | Doppler | Day 0 | 
| Mitral E wave measurement on trans-thoracic ultrasound by expert | Doppler | Day 0 | 
| Mitral A wave measurement on trans-thoracic ultrasound by expert | Doppler | Day 0 | 
| Inferior vena cava collapsibility index measurement on trans-thoracic ultrasound by expert | Doppler | Day 0 | 
| Presence of intrapulmonary shunt | Y/N | Day 0 | 
| Presence of aortic stenosis | Y/N | Day 0 | 
| Presence of mitral insufficiency | Y/N | Day 0 | 
| Presence of mitral stenosis | Y/N | Day 0 | 
| left atrium surface area | cm2 | Day 0 | 
| left ventricle diameter | mm | Day 0 | 
| Septal wall thickness | mm | Day 0 | 
| Posterior wall thickness | mm | Day 0 | 
| tricuspid annular plane systolic excursion | mm | Day 0 | 
| tricuspid annular plane systolic velocity | cm/s | Day 0 | 
| heart chamber dilation |  | Day 0 | 
| pulmonary arterial hypertension | mmHg | Day 0 | 
| Pericardial effusion |  | Day 0 |