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Wu L, Hou Q, Lu Y, Bai J, Sun L, Huang Y, Zhang M, Zheng J. Feasibility of lung ultrasound to assess pulmonary overflow in congenital heart disease children. Pediatr Pulmonol 2018; 53:1525-1532. [PMID: 30251402 DOI: 10.1002/ppul.24169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pulmonary overflow (PO) is one of the most common complications in congenital heart disease (CHD) children with an incidence of 48-60% approximately. This study explored the feasibility of using lung ultrasound (LUS) to assess pulmonary overcirculation in CHD children and compare the diagnostic performance of LUS and chest radiography (CXR) for the detection of pulmonary overcirculation. METHOD The upper anterior area, lower anterior area, upper lateral area, and lower posterior area, in each hemithorax were scanned in 59 children in the supine position. A-lines, B-lines in each scanned region were recorded, and the worst LUS abnormality in the video clip was considered to characterize the examined region. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LUS and CXR were compared using computed tomography (CT) as a standard criterion. RESULTS PO was diagnosed in 53% (31/59), 63% (37/59), and 51% (30/59) children with CT, CXR, and LUS, respectively. The sensitivity, specificity, and diagnostic accuracy of PO were 96%, 94%, and 95% for LUS and 74%, 50%, and 63% for CXR. The percentage of mild, moderate, and severe PO diagnosed via LUS were 31% (18/59), 19% (11/59), and 2% (1/59), respectively. Furthermore, the PO incidence diagnosed by LUS in CHD children less than 1 year old were significantly higher than those beyond 1 year old. CONCLUSION LUS is a noninvasive and useful tool for the detection and assessment of PO in CHD children at the operating room, and is better than CXR in sensitivity and specificity, comparable to CT.
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Affiliation(s)
- Lei Wu
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiaoru Hou
- Diagnostic imaging Center, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Lu
- Department of Radiology, Renji Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Huang
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mazhong Zhang
- Department of Anesthesiology and Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology and Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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202
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Schmid M, Dodt C. [Emergency lung ultrasound]. Med Klin Intensivmed Notfmed 2018; 113:616-624. [PMID: 30306189 DOI: 10.1007/s00063-018-0485-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
Acute and emergency physicians need to make rapid and far-reaching decisions on the basis of little diagnostic information. In patients with symptoms suggestive of a cardiopulmonary diagnosis, point-of-care lung ultrasound (LUS) is becoming increasingly used. In patients with acute dyspnea, chest pain and shock, LUS increases the diagnostic reliability. The BLUE protocol helps to differentiate important diagnoses of acute dyspnea (pulmonary edema, pneumonia, acute respiratory distress syndrome, pulmonary embolism, pleural effusions or pneumothorax). LUS is also used for treatment follow-up. It is clearly superior to other diagnostic measures (auscultation, chest X‑ray). With ever smaller "handheld" ultrasound devices, the use of ultrasound is also being increasingly used in preclinical situations.
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Affiliation(s)
- M Schmid
- Notfallzentrum, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - C Dodt
- Notfallzentrum, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland
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203
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Via G, Tavazzi G. Diagnosis of diastolic dysfunction in the emergency department: really at reach for minimally trained sonologists? A call for a wise approach to heart failure with preserved ejection fraction diagnosis in the ER. Crit Ultrasound J 2018; 10:26. [PMID: 30294760 PMCID: PMC6174119 DOI: 10.1186/s13089-018-0107-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/08/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland.
| | - Guido Tavazzi
- Emergency Department, Anaesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Anaesthesia, Intensive Care and Pain Therapy Unit, University of Pavia, Pavia, Italy
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204
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Seidowsky A, Vilaine È, Mansencal N, Ébel A, Villain C, Cheddani L, Massy ZA. [Pulmonary ultrasound and dialysis]. Nephrol Ther 2018; 14 Suppl 1:S73-S81. [PMID: 29606266 DOI: 10.1016/j.nephro.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/09/2018] [Indexed: 01/08/2023]
Abstract
Profound deficit of the body fluid composition regulation system is present at the end stage kidney disease, leading to the increase the risk of acute or chronic volume overload, which impacts the morbidity and mortality in these patients. Pulmonary ultrasound by its ability to estimate extrapulmonary water at an infraclinical stage has helped to make progress in this area. Line B is the element of fundamental semiology that reflects the presence of water in the pulmonary alveoli. The alteration of left ventricular function and the increase of pulmonary capillary permeability are the determining factors in the genesis of subclinical pulmonary congestion and are positively correlated with B-lines. Because of its non-invasive nature, its ease of use, its intra- and interoperability reproducibility and its ease of learning, nephrologists can be efficiently and quickly trained to use it to measure pulmonary congestion. Recent data have shown an epidemiological association between B-lines and mortality in end stage kidney disease patients. The causal role of subclinical pulmonary congestion assessed by these B lines in the genesis of detrimental events is being evaluated by a randomized, multicentre, open-label European clinical trial (Lung water by ultra-sound guided treatment [LUST] trial). The clinical usefulness of pulmonary ultrasound in the management of subclinical pulmonary congestion in patients with end stage kidney disease remains to be determined, but it could be considered from now as an additional tool to improve the management of this congestion, possibly by complementing bioimpedancemetry data.
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Affiliation(s)
- Alexandre Seidowsky
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Service de néphrologie-hémodialyse, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - Ève Vilaine
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Nicolas Mansencal
- Service de cardiologie, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Alexandre Ébel
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Cédric Villain
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Lynda Cheddani
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Ziad A Massy
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
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Picano E, Ciampi Q, Wierzbowska-Drabik K, Urluescu ML, Morrone D, Carpeggiani C. The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol. Cardiovasc Ultrasound 2018; 16:22. [PMID: 30285774 PMCID: PMC6167852 DOI: 10.1186/s12947-018-0141-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations. INTEGRATED-QUADRUPLE STRESS-ECHO Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In "ABCD" protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo. CONCLUSION Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous "ABCD" protocol.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology, National Council Research, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Quirino Ciampi
- Fatebenefratelli Hospital of Benevento, Viale Principe di Napoli, 12, 82100 Benevento, Italy
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Ul Kniaziewicza 1/5, 91-347 Lodz, Poland
| | | | - Doralisa Morrone
- Cardiothoracic department, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Clara Carpeggiani
- Institute of Clinical Physiology, National Council Research, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
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206
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Scali MC, Ciampi Q, Picano E, Bossone E, Ferrara F, Citro R, Colonna P, Costantino MF, Cortigiani L, Andrea AD, Severino S, Dodi C, Gaibazzi N, Galderisi M, Barbieri A, Monte I, Mori F, Reisenhofer B, Re F, Rigo F, Trambaiolo P, Amor M, Lowenstein J, Merlo PM, Daros CB, de Castro e Silva Pretto JL, Miglioranza MH, Torres MAR, de Azevedo Bellagamba CC, Chaves DQ, Simova I, Varga A, Čelutkienė J, Kasprzak JD, Wierzbowska-Drabik K, Lipiec P, Weiner-Mik P, Szymczyk E, Wdowiak-Okrojek K, Djordjevic-Dikic A, Dekleva M, Stankovic I, Neskovic AN, Zagatina A, Di Salvo G, Perez JE, Camarozano AC, Corciu AI, Boshchenko A, Lattanzi F, Cotrim C, Fazendas P, Haberka M, Sobkowic B, Kosmala W, Witkowski T, Gosciniak P, Salustri A, Rodriguez-Zanella H, Leal LIM, Nikolic A, Gligorova S, Urluescu ML, Fiorino M, Novo G, Preradovic-Kovacevic T, Ostojic M, Beleslin B, Villari B, De Nes M, Paterni M, Carpeggiani C. Quality control of B-lines analysis in stress Echo 2020. Cardiovasc Ultrasound 2018; 16:20. [PMID: 30249305 PMCID: PMC6154410 DOI: 10.1186/s12947-018-0138-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/03/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. PURPOSE To provide web-based upstream quality control and harmonization of B-lines reading criteria. METHODS 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. RESULTS All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). CONCLUSIONS Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.
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Affiliation(s)
- Maria Chiara Scali
- Cardiology Department, Nottola Hospital, Siena, Italy
- Cardiothoracic Department, University of Pisa, Pisa, Italy
| | - Quirino Ciampi
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Eduardo Bossone
- Cardiology Department, Ospedale santa Maria Incoronata dell’Olmo, cava de’ Tirreni, Salerno, Italy
| | - Francesco Ferrara
- Cardiology Department, Ospedale santa Maria Incoronata dell’Olmo, cava de’ Tirreni, Salerno, Italy
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico of Bari, Bari, Italy
| | | | | | - Antonello D’. Andrea
- Cardiology Department, Echocardiography Lab, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Sergio Severino
- Cardiology Department, Echocardiography Lab, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Claudio Dodi
- Casa di Cura Figlie di San Camillo, Cremona, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Andrea Barbieri
- Cardiology Department, Modena University Hospital, Modena, Italy
| | - Ines Monte
- Cardio-Thorax-Vascular Department, Echocardiography lab, Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Fabio Mori
- Cardiology Department, Careggi Hospital, Florence, Italy
| | - Barbara Reisenhofer
- Cardiology Division, Pontedera-Volterra Hospital, ASL Toscana 3 Nord-Ovest, Florence, Italy
| | - Federica Re
- Cardiology Department, San Camillo-Forlanini Hospital, Rome, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale dell’Angelo Mestre-Venice, Venice, Italy
| | | | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | | | | | | | | | - Marco A. R. Torres
- Hospital de Clinicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Iana Simova
- Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Jelena Čelutkienė
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, State Research Institute for Innovative Medicine, Vilnius, Lithuania
| | | | | | - Piotr Lipiec
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Paulina Weiner-Mik
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Eva Szymczyk
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | | | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | | | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar N. Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Angela Zagatina
- Cardiology Department, University Hospital, Saint Petersburg, Russian Federation
| | | | - Julio E. Perez
- Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO USA
| | - Ana Cristina Camarozano
- Hospital de Clinicas UFPR, Medicine Department, Federal University of Paranà, Curitiba, Brazil
| | - Anca Irina Corciu
- Department of Cardiology, IRCCS Policlinico San Donato Clinic, Milan, Italy
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Center of Russian Academy of Sciences, Tomsk, Russia
| | - Fabio Lattanzi
- Cardiothoracic Department, University of Pisa, Pisa, Italy
| | - Carlos Cotrim
- Heart Center, Hospital da Cruz Vermelha, Lisbon and Medical School of University of Algarve, Faro, Portugal
| | - Paula Fazendas
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Maciej Haberka
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Bozena Sobkowic
- Department of Cardiology, Medical University of Białystok, Białystok, Poland
| | - Wojciech Kosmala
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Witkowski
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Gosciniak
- Department of Cardiology, Provincial Hospital, Szczecin, Poland
| | | | | | | | | | | | - Madalina-Loredana Urluescu
- Cardiology Department, County Hospital Sibiu, Invasive and Non-Invasive Center for Cardiac and Vascular Pathology in Adults - CVASIC Sibiu, Faculty of Medicine, Sibiu, Romania
| | - Maria Fiorino
- Cardiology Division Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Miodrag Ostojic
- Institute for Cardiovascular Diseases, Dedinje, Belgrade, Italy
- University Clinical Center, Banja Luka, Republic of Srpska Bosnia and Herzegovina
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Michele De Nes
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Marco Paterni
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Clara Carpeggiani
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
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207
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Zhou B, Zhang X. Lung mass density analysis using deep neural network and lung ultrasound surface wave elastography. ULTRASONICS 2018; 89:173-177. [PMID: 29852466 PMCID: PMC6014933 DOI: 10.1016/j.ultras.2018.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/07/2018] [Accepted: 05/22/2018] [Indexed: 06/01/2023]
Abstract
Lung mass density is directly associated with lung pathology. Computed Tomography (CT) evaluates lung pathology using the Hounsfield unit (HU) but not lung density directly. We have developed a lung ultrasound surface wave elastography (LUSWE) technique to measure the surface wave speed of superficial lung tissue. The objective of this study was to develop a method for analyzing lung mass density of superficial lung tissue using a deep neural network (DNN) and synthetic data of wave speed measurements with LUSWE. The synthetic training dataset of surface wave speed, excitation frequency, lung mass density, and viscoelasticity from LUSWE (788,000 in total) was used to train the DNN model. The DNN was composed of 3 hidden layers of 1024 neurons for each layer and trained for 10 epochs with a batch size of 4096 and a learning rate of 0.001 with three types of optimizers. The test dataset (4000) of wave speeds at three excitation frequencies (100, 150, and 200 Hz) and shear elasticity of superficial lung tissue was used to predict the lung density and evaluate its accuracy compared with predefined lung mass densities. This technique was then validated on a sponge phantom experiment. The obtained results showed that predictions matched well with test dataset (validation accuracy is 0.992) and experimental data in the sponge phantom experiment. This method may be useful to analyze lung mass density by using the DNN model together with the surface wave speed and lung stiffness measurements.
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Affiliation(s)
- Boran Zhou
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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208
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Integrated Cardiac and Lung Ultrasound (ICLUS) in the Cardiac Intensive Care Unit. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9463-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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209
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Kasprzak JD, Huttin O, Wierzbowska-Drabik K, Selton-Suty C. Imaging the Right Heart-Pulmonary Circulation Unit. Heart Fail Clin 2018; 14:361-376. [DOI: 10.1016/j.hfc.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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210
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Simonovic D, Coiro S, Carluccio E, Girerd N, Deljanin-Ilic M, Cattadori G, Ambrosio G. Exercise elicits dynamic changes in extravascular lung water and haemodynamic congestion in heart failure patients with preserved ejection fraction. Eur J Heart Fail 2018; 20:1366-1369. [PMID: 29943885 DOI: 10.1002/ejhf.1228] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Dejan Simonovic
- Institute for Treatment and Rehabilitation 'Niska Banja', Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | - Stefano Coiro
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Erberto Carluccio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France, and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Marina Deljanin-Ilic
- Institute for Treatment and Rehabilitation 'Niska Banja', Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | | | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
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211
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Čerlinskaitė K, Javanainen T, Cinotti R, Mebazaa A. Acute Heart Failure Management. Korean Circ J 2018; 48:463-480. [PMID: 29856141 PMCID: PMC5986746 DOI: 10.4070/kcj.2018.0125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/02/2018] [Indexed: 01/06/2023] Open
Abstract
Acute heart failure (AHF) is a life-threatening medical condition, where urgent diagnostic and treatment methods are of key importance. However, there are few evidence-based treatment methods. Interestingly, despite relatively similar ways of management of AHF throughout the globe, mid-term outcome in East Asia, including South Korea is more favorable than in Europe. Yet, most of the treatment methods are symptomatic. The cornerstone of AHF management is identifying precipitating factors and specific phenotype. Multidisciplinary approach is important in AHF, which can be caused or aggravated by both cardiac and non-cardiac causes. The main pathophysiological mechanism in AHF is congestion, both systemic and inside the organs (lung, kidney, or liver). Cardiac output is often preserved in AHF except in a few cases of advanced heart failure. This paper provides guidance on AHF management in a time-based approach. Treatment strategies, criteria for triage, admission to hospital and discharge are described.
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Affiliation(s)
- Kamilė Čerlinskaitė
- Department of Anesthesiology and Reanimation, Hôpital Lariboisière, Paris, France
- Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tuija Javanainen
- Department of Anesthesiology and Reanimation, Hôpital Lariboisière, Paris, France
- Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France
- Department of Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Raphaël Cinotti
- Department of Anesthesiology and Reanimation, Hôpital Lariboisière, Paris, France
- Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France
- Department of Anesthesia and Critical Care, University Hospital of Nantes, Nantes Cedex, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Reanimation, Hôpital Lariboisière, Paris, France
- Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, Paris, France
- University Paris Diderot, Paris, France.
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212
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Villalba-Orero M, López-Olañeta MM, González-López E, Padrón-Barthe L, Gómez-Salinero JM, García-Prieto J, Wai T, García-Pavía P, Ibáñez B, Jiménez-Borreguero LJ, Lara-Pezzi E. Lung ultrasound as a translational approach for non-invasive assessment of heart failure with reduced or preserved ejection fraction in mice. Cardiovasc Res 2018; 113:1113-1123. [PMID: 28472392 DOI: 10.1093/cvr/cvx090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/03/2017] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) has become an epidemic and constitutes a major medical, social, and economic problem worldwide. Despite advances in medical treatment, HF prognosis remains poor. The development of efficient therapies is hampered by the lack of appropriate animal models in which HF can be reliably determined, particularly in mice. The development of HF in mice is often assumed based on the presence of cardiac dysfunction, but HF itself is seldom proved. Lung ultrasound (LUS) has become a helpful tool for lung congestion assessment in patients at all stages of HF. We aimed to apply this non-invasive imaging tool to evaluate HF in mouse models of both systolic and diastolic dysfunction. Methods and results We used LUS to study HF in a mouse model of systolic dysfunction, dilated cardiomyopathy, and in a mouse model of diastolic dysfunction, diabetic cardiomyopathy. LUS proved to be a reliable and reproducible tool to detect pulmonary congestion in mice. The combination of LUS and echocardiography allowed discriminating those mice that develop HF from those that do not, even in the presence of evident cardiac dysfunction. The study showed that LUS can be used to identify the onset of HF decompensation and to evaluate the efficacy of therapies for this syndrome. Conclusions This novel approach in mouse models of cardiac disease enables for the first time to adequately diagnose HF non-invasively in mice with preserved or reduced ejection fraction, and will pave the way to a better understanding of HF and to the development of new therapeutic approaches.
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Affiliation(s)
| | | | - Esther González-López
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Laura Padrón-Barthe
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | | | - Jaime García-Prieto
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Timothy Wai
- Institut Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red Para Cardiología (CIBERCV), Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red Para Cardiología (CIBERCV), Madrid, Spain.,Department of Cardiology, Instituto de Investigación Sanitaria (IIS), Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Luis J Jiménez-Borreguero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,Hospital de la Princesa, Madrid, Spain
| | - Enrique Lara-Pezzi
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red Para Cardiología (CIBERCV), Madrid, Spain.,National Heart & Lung Institute, Imperial College London, London, UK
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213
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Tavazzi G, Neskovic AN, Hussain A, Volpicelli G, Via G. A plea for an early ultrasound-clinical integrated approach in patients with acute heart failure. A proactive comment on the ESC Guidelines on Heart Failure 2016. Int J Cardiol 2018; 245:207-210. [PMID: 28874293 DOI: 10.1016/j.ijcard.2017.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The European Association of Cardiology (ESC) Guidelines on the diagnosis and treatment of acute heart failure (AHF) indicate prompt therapy initiation and performance of relevant investigations as paramount. Specifically, echocardiography prior to treatment is advocated only with hemodynamic instability, and the evaluation of clinical signs of peripheral perfusion and congestion is suggested as guidance for early interventions. Given the growing body of evidence on the diagnostic/monitoring capabilities of bedside ultrasound (including focused cardiac ultrasound, comprehensive echocardiography, lung ultrasound), we discuss the potential benefit of an integrated clinical/ultrasound approach at the very early stages of acute heart failure. METHODS AND RESULTS We proposed a narrative review of the current evidence on the clinical-ultrasound integrated approach to AHF, with special emphasis on the components of the early diagnostic-therapeutic workup where cardiac, inferior vena cava and lung ultrasound showed high diagnostic accuracy and the capability of substantially changing an exclusively clinically-oriented patient management. A proactive comment to the ESC guidelines is made, suggesting an integration of clinical and biochemical assessment, as defined by guidelines, with combined bedside ultrasound on may help in the definition of AHF pathophysiology and treatment. CONCLUSION A multi-organ integrated clinical-ultrasound approach should be advocated as part of the clinical-diagnostic workup at AHF very early phase. Whenever competence and technology available, bedside ultrasound, along with clinical and biochemical assessment, should target AHF profiling, identify the cause of AHF, and subsequently aid disease course and response to treatment monitoring.
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Affiliation(s)
- G Tavazzi
- Anesthesia, Intensive Care and Pain Therapy, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Anesthesia and Intensive Care, Emergency Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | - A N Neskovic
- Department of Cardiology, University Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade, Serbia.
| | - A Hussain
- Cardiac Critical Care, King Abdulaziz Medical City, Ministry of National Guard Health, Riyadh, Saudi Arabia.
| | - G Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, 10043, Orbassano, Torino, Italy.
| | - G Via
- Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland.
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214
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Mondritzki T, Boehme P, White J, Park JW, Hoffmann J, Vogel J, Kolkhof P, Walsh S, Sandner P, Bischoff E, Dinh W, Hüser J, Truebel H. Remote Left Ventricular Hemodynamic Monitoring Using a Novel Intracardiac Sensor. Circ Cardiovasc Interv 2018; 11:e006258. [PMID: 29748220 DOI: 10.1161/circinterventions.117.006258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) remains the most common reason for hospital admission in patients aged >65 years. Despite modern drug therapy, mortality and readmission rates for patients hospitalized with HF remain high. This necessitates further research to identify early patients at risk for readmission to limit hospitalization by timely adjustment of medical therapy. Implantable devices can monitor left ventricular (LV) hemodynamics and remotely and continuously detect the early signs of decompensation to trigger interventions and reduce the risk of hospitalization for HF. Here, we report the first preclinical study validating a new batteryless and easy to implant LV-microelectromechanical system to assess LV performance. METHODS AND RESULTS A miniaturized implantable wireless pressure sensor was adapted for implantation in the LV apex. The LV-microelectromechanical system sensor was tested in a canine model of HF. The wireless pressure sensor measurements were compared with invasive left heart catheter-derived measurements at several time points. During different pharmacological challenge studies with dobutamine or vasopressin, the device was equally sensitive compared with invasive standard procedures. No adverse events or any observable reaction related to the implantation and application of the device for a period of 35 days was observed. CONCLUSIONS Our miniaturized wireless pressure sensor placed in the LV (LV-microelectromechanical system) has the potential to become a new telemetric tool to earlier identify patients at risk for HF decompensation and to guide the treatment of patients with HF.
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Affiliation(s)
- Thomas Mondritzki
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.) .,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| | - Philip Boehme
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| | - Jason White
- St Jude Medical (now Abbott), Atlanta, GA (J.W., J.W.P.)
| | - Jin Woo Park
- St Jude Medical (now Abbott), Atlanta, GA (J.W., J.W.P.)
| | - Jessica Hoffmann
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Julia Vogel
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Peter Kolkhof
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Stuart Walsh
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Peter Sandner
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,Hannover Medical School, Germany (P.S.)
| | - Erwin Bischoff
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Wilfried Dinh
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,Department of Cardiology, HELIOS Clinic Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany (W.D.)
| | - Jörg Hüser
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Hubert Truebel
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
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215
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Picano E, Morrone D, Scali MC, Huqi A, Coviello K, Ciampi Q. Integrated quadruple stress echocardiography. Minerva Cardioangiol 2018; 67:330-339. [PMID: 29642694 DOI: 10.23736/s0026-4725.18.04691-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Stress echocardiography (SE) is an established diagnostic technique. For 40 years, the cornerstone of the technique has been the detection of regional wall motion abnormalities (RWMA), due to the underlying physiologically-relevant epicardial coronary artery stenosis. In the last decade, three new parameters (more objective than RWMA) have shown the potential to integrate and complement RWMA: 1) B-lines, also known as ultrasound lung comets, as a marker of extravascular lung water, measured using lung ultrasound with the 4-site simplified scan symmetrically of the antero-lateral thorax on the third intercostal space, from mid-axillary to anterior axillary and mid-clavicular line; 2) left ventricular contractile reserve (LVCR), assessed as the peak stress/rest ratio of left ventricular force, also known as elastance (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D echocardiography); 3) coronary flow velocity reserve (CFVR) on left anterior descending coronary artery, calculated as peak stress/rest ratio of diastolic peak flow velocity assessed using pulsed-wave Doppler. The 4 parameters (RWMA, B-lines, LVCR and CFVR) now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-SE. IQ-SE optimizes the versatility of SE to include in a one-stop shop the core "ABCD" (asynergy+B-lines+contractile reserve+Doppler flowmetry) protocol. It allows a synoptic assessment of parameters mirroring the epicardial artery stenosis (RWMA), interstitial lung water (B-lines), myocardial function (LVCR) and small coronary vessels (CFVR). Each variable has a clear clinical correlate, different and complementary to all others: RWMA identify an ischemic vs. non-ischemic heart; B-lines a wet vs. dry lung; LVCR a strong vs. weak heart; CFVR a warm vs. cold heart. IQ-SE is highly feasible, with minimal increase in the imaging and analysis time, and obvious diagnostic and prognostic impact also beyond coronary artery disease - especially in heart failure. Large scale effectiveness studies with IQ-SE are now under way with the Stress Echo 2020 Study, and will provide the necessary evidence base prior to large scale acceptance of the technique.
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Affiliation(s)
| | - Doralisa Morrone
- Section of Cardiovascular Disease, Department of Surgery, Medicine, Molecular and Critical Area, Pisa University, Pisa, Italy
| | | | - Alda Huqi
- Versilia Hospital, Viareggio, Lucca, Italy
| | - Katia Coviello
- Section of Cardiovascular Disease, Department of Surgery, Medicine, Molecular and Critical Area, Pisa University, Pisa, Italy
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216
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Rudski LG, Gargani L, Armstrong WF, Lancellotti P, Lester SJ, Grünig E, D'Alto M, Åström Aneq M, Ferrara F, Saggar R, Saggar R, Naeije R, Picano E, Schiller NB, Bossone E. Stressing the Cardiopulmonary Vascular System: The Role of Echocardiography. J Am Soc Echocardiogr 2018; 31:527-550.e11. [PMID: 29573927 DOI: 10.1016/j.echo.2018.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 01/06/2023]
Abstract
The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.
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Affiliation(s)
- Lawrence G Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - William F Armstrong
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA-Cardiovascular Sciences, Liège, Belgium
| | - Steven J Lester
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, University Hospital Heidelberg, Heidelberg, Germany
| | - Michele D'Alto
- Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy
| | - Meriam Åström Aneq
- Department of Clinical Physiology, Institution of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Rajeev Saggar
- Lung Institute, Banner University Medical Center-Phoenix, University of Arizona, Phoenix, Arizona
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nelson B Schiller
- Cardiovascular Research Institute, Health eHeart Study, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
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217
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Schwartz L, Lafitte O, da Veiga Moreira J. Toward a Reasoned Classification of Diseases Using Physico-Chemical Based Phenotypes. Front Physiol 2018. [PMID: 29541031 PMCID: PMC5835834 DOI: 10.3389/fphys.2018.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Diseases and health conditions have been classified according to anatomical site, etiological, and clinical criteria. Physico-chemical mechanisms underlying the biology of diseases, such as the flow of energy through cells and tissues, have been often overlooked in classification systems. Objective: We propose a conceptual framework toward the development of an energy-oriented classification of diseases, based on the principles of physical chemistry. Methods: A review of literature on the physical chemistry of biological interactions in a number of diseases is traced from the point of view of the fluid and solid mechanics, electricity, and chemistry. Results: We found consistent evidence in literature of decreased and/or increased physical and chemical forces intertwined with biological processes of numerous diseases, which allowed the identification of mechanical, electric and chemical phenotypes of diseases. Discussion: Biological mechanisms of diseases need to be evaluated and integrated into more comprehensive theories that should account with principles of physics and chemistry. A hypothetical model is proposed relating the natural history of diseases to mechanical stress, electric field, and chemical equilibria (ATP) changes. The present perspective toward an innovative disease classification may improve drug-repurposing strategies in the future.
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Affiliation(s)
| | - Olivier Lafitte
- LAGA, UMR 7539, Paris 13 University, Sorbonne Paris Cité, Villetaneuse, France
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218
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Carlino MV, Paladino F, Sforza A, Serra C, Liccardi F, de Simone G, Mancusi C. Assessment of left atrial size in addition to focused cardiopulmonary ultrasound improves diagnostic accuracy of acute heart failure in the Emergency Department. Echocardiography 2018. [PMID: 29522655 DOI: 10.1111/echo.13851] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute dyspnea is one of the main reasons for admission to Emergency Department (ED). Availability of ultraminiaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. The aim of this study was to identify an integrated ultrasound approach for diagnosis of acute heart failure (acute HF), using PUD and combining evaluation from lung, heart and inferior vena cava (IVC). METHODS We included 102 patients presenting to the ED of "Antonio Cardarelli" Hospital in Naples (Italy) for acute dyspnea (AD). All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The gold standard was the final diagnosis determined by two expert reviewers: acute heart failure (acute HF) or noncardiac dyspnea. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive and negative predictive value and accuracy of the three ultrasonic methods, and their combinations for the diagnosis of acute HF, comparing with the final, validated diagnosis. RESULTS Lung ultrasound (LUS) alone exhibited a good sensitivity (100%) and specificity (82%) and had the highest accuracy (89%) among single modalities (heart and IVC) for the diagnosis of acute HF. The highest accuracy among all methods (96%) was obtained by the combination of positive LUS and either dilated left atrium or EF ≤ 40% or both (all P < .01 vs single modalities). CONCLUSION In patients presenting to ED, IUE using PUD is a useful extension of clinical examination and has a reliable diagnostic discriminant ability in the immediate evaluation of acute dyspnea. The combination of positive LUS with focused cardiac ultrasonography (FoCUS), including also dilated left atrium, substantially extends the spectrum of recognizable acute HF.
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Affiliation(s)
- Maria Viviana Carlino
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy.,Emergency Department, Cardarelli Hospital, Naples, Italy
| | | | - Alfonso Sforza
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy.,Emergency Department, Cardarelli Hospital, Naples, Italy
| | - Claudia Serra
- Emergency Department, Cardarelli Hospital, Naples, Italy
| | | | - Giovanni de Simone
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, UOC Emergency Medicine, Federico II University Hospital, Naples, Italy
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219
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Covic A, Siriopol D, Voroneanu L. Use of Lung Ultrasound for the Assessment of Volume Status in CKD. Am J Kidney Dis 2018; 71:412-422. [DOI: 10.1053/j.ajkd.2017.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
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220
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Dwyer KH, Merz AA, Lewis EF, Claggett BL, Crousillat DR, Lau ES, Silverman MB, Peck J, Rivero J, Cheng S, Platz E. Pulmonary Congestion by Lung Ultrasound in Ambulatory Patients With Heart Failure With Reduced or Preserved Ejection Fraction and Hypertension. J Card Fail 2018; 24:219-226. [PMID: 29499322 DOI: 10.1016/j.cardfail.2018.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/11/2018] [Accepted: 02/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although pulmonary congestion can be quantified in heart failure (HF) by means of lung ultrasonography (LUS), little is known about LUS findings (B-lines) in different HF phenotypes. This prospective cohort study investigated the prevalence and clinical and echocardiographic correlates of B-lines in ambulatory HF patients with preserved (HFpEF) or reduced (HFrEF) ejection fraction compared with hypertensive patients. We related LUS findings to 12-month HF hospitalizations and all-cause mortality. METHODS AND RESULTS We used LUS to examine hypertensive (n = 111), HFpEF (n = 46), and HFrEF (n = 73) patients (median age 66 y, 56% male, 79% white, and median EF 55%) undergoing clinically indicated outpatient echocardiography. B-line number was quantified offline, across 8 chest zones, blinded to clinical and echocardiographic characteristics. The proportion of patients with ≥3 B-lines was lower in hypertensive patients (13.5%) compared with both HFrEF (45.2%, P < .001) and HFpEF (34.8%; P = .05). HF patients with ≥3 B-lines had a higher risk of the composite outcome (age- and sex-adjusted hazard ratio 2.62, 95% confidence interval 1.15-5.96; P = .022). CONCLUSIONS When performed at the time of outpatient echocardiography, LUS findings of pulmonary congestion differ between patients with known HF and those with hypertension, and may be associated with adverse outcomes.
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Affiliation(s)
- Kristin H Dwyer
- Department of Emergency Medicine, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
| | | | - Eldrin F Lewis
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian L Claggett
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julie Peck
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jose Rivero
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Cheng
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elke Platz
- Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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221
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Wang XT, Wang C, Zhang HM, Liu DW. Clarifications on Continuous Renal Replacement Therapy and Hemodynamics. Chin Med J (Engl) 2018; 130:1244-1248. [PMID: 28485326 PMCID: PMC5443032 DOI: 10.4103/0366-6999.205863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Continuous renal replacement therapy (CRRT) is a continuous process of bedside blood purification which is widely used in the treatment of acute kidney injury (AKI) and for fluid management. However, since AKI and fluid overload are often found to be associated with hemodynamic abnormalities, determining the relationship between CRRT and hemodynamics remains a challenge in the treatment of critically ill patients. The aim of this review was to summarize key points in the relationship between CRRT and hemodynamics and to understand and monitor renal hemodynamics in critically ill patients, especially those with AKI. Data Sources: This review was based on data in articles published in the PubMed databases up to January 30, 2017, with the following keywords: “continuous renal replacement therapy,” “Hemodynamics,” and “Acute kidney injury.” Study Selection: Original articles and critical reviews on CRRT were selected for this review. Results: CRRT might treat AKI by hemodynamic therapy, and it was an important form of hemodynamic therapy. The targets of hemodynamic therapy should be established when using CRRT. Therefore, hemodynamic management and stability were very important during CRRT. Most studies suggested that renal hemodynamics should be clearly identified. Conclusions: CRRT is not only a replacement for organ function, but an important form of hemodynamic therapy. Improved hemodynamic management of critically ill patients can be achieved by establishing specific therapeutic hemodynamic targets and maintaining circulatory stability during CRRT. Over the long term, observation of renal hemodynamics will provide greater opportunities for the progression of CRRT hemodynamic therapy.
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Affiliation(s)
- Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Cui Wang
- Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550001, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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222
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Niyyar VD, O'Neill WC. Point-of-care ultrasound in the practice of nephrology. Kidney Int 2018; 93:1052-1059. [PMID: 29477241 DOI: 10.1016/j.kint.2017.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/31/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022]
Abstract
Sonography is increasingly being performed by clinicians and has applications throughout the spectrum of nephrology, including acute and chronic renal failure, urinary obstruction, cystic disease, pain, hematuria, transplantation, kidney biopsy, temporary and permanent vascular access, and assessment of fluid status. The skill is relatively easily acquired, expedites patient care, and enhances the practice of nephrology. However, the lack of exposure in most training programs remains a major obstacle.
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Affiliation(s)
- Vandana Dua Niyyar
- Emory University, Department of Medicine, Renal Division, Atlanta, Georgia, USA
| | - W Charles O'Neill
- Emory University, Department of Medicine, Renal Division, Atlanta, Georgia, USA.
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223
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Hempel D, Pfister R, Michels G. Strukturierte bettseitige Sonographie in der Intensivmedizin. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-017-0201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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224
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Pirompanich P, Karakitsos D, Alharthy A, Gillman LM, Blaivas M, Buchanan BM, Brindley PG, Wattanathum A. Evaluating Extravascular Lung Water in Sepsis: Three Lung-Ultrasound Techniques Compared against Transpulmonary Thermodilution. Indian J Crit Care Med 2018; 22:650-655. [PMID: 30294131 PMCID: PMC6161581 DOI: 10.4103/ijccm.ijccm_256_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Excessive extravascular lung water (EVLW) is associated with increased morbidity and mortality. We compared three lung-ultrasound (L-US) techniques against the reference-standard transpulmonary thermodilution (TPTD) technique to access EVLW. Materials and Methods: This was a prospective, single-blind, cross-sectional study. Forty-four septic patients were enrolled. EVLW index was measured by the TPTD method, and an index of ≥10 mL/kg was considered diagnostic of pulmonary edema. EVLW index was then compared to three established bedside L-US protocols that evaluate sonographic B-lines: (1) a 28-zone protocol (total B-line score [TBS]) (2) a scanning 8-region examination, and (3) a 4-point examination. Results: Eighty-nine comparisons were obtained. A statistically significant positive correlation was found between L-US TBS and an EVLW index ≥10 mL/kg (r = 0.668,P < 0.001). The 28-zone protocol score ≥39 has a sensitivity of 81.6% and a specificity of 76.5% to define EVLW index ≥10 mL/kg. In contrast, the positive 4-point examination and scanning 8-regions showed low sensitivity (23.7% and 50.0%, respectively) but high specificity (96.1% and 88.2%, respectively). Ten patients with a total of 21 comparisons met criteria for acute respiratory distress syndrome (ARDS). In this subgroup, only the TBS had statistically significant positive correlation to EVLW (r = 0.488,P = 0.025). Conclusion: L-US is feasible in patients with severe sepsis. In addition, L-US 28-zone protocol demonstrated high specificity and better sensitivity than abbreviated 4- and 8-zone protocols. In ARDS, the L-US 28-zone protocol was more accurate than the 4- and 8-zone protocols in predicting EVLW. Consideration of limitations of the latter protocols may prevent clinicians from reaching premature conclusions regarding the prediction of EVLW. Trial Registration: ISRCTN11419081. Registered 4 February 2015 retrospectively.
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Affiliation(s)
- Pattarin Pirompanich
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Dimitrios Karakitsos
- Department of Medicine, University of South Carolina, School of Medicine, Columbia, SC, USA.,Department of ICU, King Saud Medical City, Riyadh, KSA.,Department of Critical Care Medicine, Keck Medical School, USC, CA, USA
| | | | | | - Michael Blaivas
- Department of Medicine, University of South Carolina, School of Medicine, Columbia, SC, USA
| | - Brian M Buchanan
- Department of Critical Care Medicine, University of Alberta, Alberta, Canada
| | - Peter G Brindley
- Department of Critical Care Medicine, University of Alberta, Alberta, Canada
| | - Anan Wattanathum
- Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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225
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Ramachandran P, Chaudhury A, Devaraj U, Maheshwari KU, D'Souza G. Monitoring whole-lung lavage using lung ultrasound: The changing phases of the lung. Lung India 2018; 35:350-353. [PMID: 29970780 PMCID: PMC6034381 DOI: 10.4103/lungindia.lungindia_344_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lung ultrasound (LUS) has been proven to yield valuable information for lung and pleural pathology. It is well validated for assessing extravascular lung water. It can also be used to monitor stages of controlled lung de-aeration in whole lung lavage (WLL) which is the treatment for Pulmonary Alveolar Protienosis (PAP),characterized by abnormal surfactant in the alveoli affecting gas exchange .LUS can help decide the point of termination of lung flooding. A 55 year old lady with biopsy proven pulmonary alveolar proteinosis presented with respiratory failure. WLL was planned. LUS was used to study the stages of lung flooding as previously described for ARDS model.6 areas screened based on six areas that are normally examined like upper zone, mid zone and lower zone showed alveolar interstitial pattern. One lung ventilation (OLV) was done and isolation of lavage lung was confirmed which was seen as lung collapse (lung pulse) on LUS. Saline infusion resulted in increase in B lines followed by tissue like pattern with fluid bronchogram on LUS(alveolar flooding) in all the areas. During the lavage of the second lung, appearance of alveolar flooding pattern resulted in termination of saline infusion. The use of LUS in monitoring WLL reduced amount of saline used for lavage, pick up complications like pleural effusion and spillage.
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Affiliation(s)
- Priya Ramachandran
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Alisha Chaudhury
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Uma Devaraj
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - K Uma Maheshwari
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - George D'Souza
- Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
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226
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Osni Leão Perin P, de Fátma Ferreira Santana Boin I, Oliveira da Silva AM, Chueiri Neto F, Martins LC. Lung Ultrasound and Pulmonary Function Test in Cirrhotic Patients. Transplant Proc 2017; 49:824-828. [PMID: 28457404 DOI: 10.1016/j.transproceed.2017.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lung ultrasound (LU) is useful in the diagnosis of pulmonary interstitial-alveolar syndrome (IAS) when B-lines are detected. Its prevalence and effect in lung function is not well studied in cirrhotic patients. The objective of this study was to detect the prevalence of interstitial-alveolar involvement with LU and correlate with pulmonary function test to distinguish the effect of ascites and B-lines in pulmonary function. This was an observational single-center study with 49 patients listed for liver transplantation submitted for LU and pulmonary function tests. Patients were divided into 4 groups: no ascites and no B-lines (n = 19), B-lines only (n = 19), ascites only (n = 6), and ascites and B-lines (n = 5). There was a worse forced vital capacity (FVC) in patients with B-lines only (76.1% ± 9.2; P = .0058) and ascites only (66.8% ± 10.2; P = .0010). 1-second forced expiratory volume (FEV1) also was lower in patients with B-lines only (78.5% ± 10.3; P = .0001), ascites only (71.3% ± 13.2; P = .0004), and B-lines and ascites (74.2% ± 7.6; P = .0035). Model for End-Stage Liver Disease score was worse in the group with ascites and B-lines (22.4 ± 10.1; P = .0229). B-Lines reduced FVC and FEV1 in our study and may be an independent factor in worsening pulmonary function in these patients.
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Affiliation(s)
- P Osni Leão Perin
- General Intensive Care Unit, Surgery Department, State University of Campinas, Campinas, Brazil.
| | | | | | - F Chueiri Neto
- General Intensive Care Unit, Surgery Department, State University of Campinas, Campinas, Brazil
| | - L C Martins
- Internal Medicine Department, State University of Campinas, Campinas, Brazil
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227
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Kimura K, Kajimoto K, Otsubo S, Akiba T, Nitta K. Associations between fluid removal and number of B-lines, peak early mitral inflow wave velocity, and inferior vena cava dimensions in hemodialysis patients. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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228
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Sriram KB, Singh M. Lung ultrasound B-lines in exacerbations of chronic obstructive pulmonary disease. Intern Med J 2017; 47:324-327. [PMID: 28260256 DOI: 10.1111/imj.13370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022]
Abstract
We report on preliminary observations on performing lung ultrasound (LUS) in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD). We found that LUS had high specificity and moderate sensitivity in identifying patients with elevated B-type natriuretic peptide. Thus, we hypothesise that LUS may have utility in screening COPD patients with an exacerbation to identify the sub-group with elevated natriuretic peptides and are at risk of increased cardiovascular mortality. The use of LUS in patients with acute and chronic respiratory disorders is increasing and its role in COPD patients is an interesting subject for future research.
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Affiliation(s)
- Krishna B Sriram
- Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Maninder Singh
- Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia
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229
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Scali MC, Zagatina A, Simova I, Zhuravskaya N, Ciampi Q, Paterni M, Marzilli M, Carpeggiani C, Picano E. B-lines with Lung Ultrasound: The Optimal Scan Technique at Rest and During Stress. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2558-2566. [PMID: 28865726 DOI: 10.1016/j.ultrasmedbio.2017.07.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/16/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets, which are an important indication of extravascular lung water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution (comet map) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd-5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R2 = 0.9478), 8-S (R2 = 0.9478) and 4-S scan (R2 = 0.9146) was excellent, but only good with 1-S (R2 = 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.
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Affiliation(s)
- Maria Chiara Scali
- Cardiology Division, Nottola Hospital, Siena, Italy; Cardiothoracic Department, Cisanello, Pisa, Italy
| | - Angela Zagatina
- Cardiology Department, Medika Cardiocenter, Saint Petersburg, Russian Federation
| | - Iana Simova
- Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | - Nadezhda Zhuravskaya
- Cardiology Department, Medika Cardiocenter, Saint Petersburg, Russian Federation
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Marco Paterni
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | | | - Clara Carpeggiani
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy.
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230
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Abstract
Heart failure is common in adults, accounting for substantial morbidity and mortality worldwide. Its prevalence is increasing because of ageing of the population and improved treatment of acute cardiovascular events, despite the efficacy of many therapies for patients with heart failure with reduced ejection fraction, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β blockers, and mineralocorticoid receptor antagonists, and advanced device therapies. Combined angiotensin receptor blocker neprilysin inhibitors (ARNIs) have been associated with improvements in hospital admissions and mortality from heart failure compared with enalapril, and guidelines now recommend substitution of ACE inhibitors or ARBs with ARNIs in appropriate patients. Improved safety of left ventricular assist devices means that these are becoming more commonly used in patients with severe symptoms. Antidiabetic therapies might further improve outcomes in patients with heart failure. New drugs with novel mechanisms of action, such as cardiac myosin activators, are under investigation for patients with heart failure with reduced left ventricular ejection fraction. Heart failure with preserved ejection fraction is a heterogeneous disorder that remains incompletely understood and will continue to increase in prevalence with the ageing population. Although some data suggest that spironolactone might improve outcomes in these patients, no therapy has conclusively shown a significant effect. Hopefully, future studies will address these unmet needs for patients with heart failure. Admissions for acute heart failure continue to increase but, to date, no new therapies have improved clinical outcomes.
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Affiliation(s)
- Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - John R Teerlink
- School of Medicine, University of California, San Francisco, CA, USA; Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
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231
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[Structured bedside-ultrasound in intensive care medicine]. Med Klin Intensivmed Notfmed 2017; 112:741-758. [PMID: 29063125 DOI: 10.1007/s00063-017-0366-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 12/27/2022]
Abstract
The so-called point-of-care ultrasound (POCUS) is of increasing importance for diagnostics and therapy control in intensive care medicine. Based on focused thorax sonography, echocardiography, and abdominal sonography, the most important working and differential diagnoses can be demonstrated or excluded depending on the leading symptom. Sonographic-based algorithms allow a structured evaluation especially of patients with the common leading symptoms dyspnea and thoracic pain.
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232
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Cortigiani L, Carpeggiani C, Sicari R, Michelassi C, Bovenzi F, Picano E. Simple six-item clinical score improves risk prediction capability of stress echocardiography. Heart 2017; 104:760-766. [DOI: 10.1136/heartjnl-2017-312122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo assess the value of a simple score integrating non-ischaemia-related variables in expanding the wall motion abnormalities risk power during stress echocardiography (SE).MethodsStudy includes 14 279 patients who underwent SE for evaluation of coronary artery disease. All-cause death was the end point. Patients were randomly divided into the modelling and validation group of equal size. In the modelling group, multivariate analysis was conducted using clinical, rest and SE data, and a score was obtained from the number of non-ischaemia-related independent prognostic predictors. The score prognostic capability was compared in both groups.ResultsDuring a median follow-up of 31 months, 1230 patients died: 622 (9%) in the modelling and 608 (9%) in the validation group (p=0.68). Independent predictors of mortality were ischaemia at SE (HR 1.77, 95% CI 1.49 to 2.12; p<0.0001) and six other parameters: age>65 years, wall motion at rest, diabetes, left bundle branch block, anti-ischaemic therapy and male sex. Risk score resulted prognostically effective in the modelling and validation groups, both with and without inducible ischaemia subset. When risk score was included in the multivariate analysis, besides ischaemia at SE it was the only independent predictor of mortality in the modelling (HR 1.70, 95% CI 1.60 to 1.82; p<0.0001), in the validation (HR 1.77, 95% CI 1.65 to 1.90; p<0.0001) and in the overall group (HR 1.73, 95% CI 1.66 to 1.82; p<0.0001).ConclusionsSimple clinical variables may be able to optimise SE risk stratification.
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233
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Lüscher TF. Special issues in heart failure: pulmonary hypertension, deranged potassium levels, and haemodynamic profiles. Eur Heart J 2017; 38:2857-2859. [DOI: 10.1093/eurheartj/ehx563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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234
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Voroneanu L, Gavrilovici C, Covic A. Overhydration, underhydration, and total body sodium: A tricky “ménage a trois” in dialysis patients. Semin Dial 2017; 31:21-25. [DOI: 10.1111/sdi.12649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luminita Voroneanu
- Nephrology Department; Dialysis and Renal Transplant Center; “Dr. C.I. Parhon” University Hospital; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Cristina Gavrilovici
- Center for Health Policy and Ethics; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Adrian Covic
- Nephrology Department; Dialysis and Renal Transplant Center; “Dr. C.I. Parhon” University Hospital; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
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235
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Abstract
In heart failure patients, we hypothesize the occurrence of the "lung water cascade," with the various markers hierarchically ranked in a well-defined time sequence: (1) early, proximal hemodynamic event with increase in pulmonary capillary wedge pressure; (2) intermediate, direct imaging sign of pulmonary edema (easily detectable at bedside by lung ultrasound as B-lines); (3) late, distal clinical symptoms and signs such as dyspnea and pulmonary crackles. Completion of the cascade (from hemodynamic to pulmonary to clinical congestion) can require minutes (as with exercise), hours or even weeks (as with impending acute heart failure). Backward rewind of the downhill cascade can be achieved with timely pulmonary decongestion therapy, such as diuretics or dialysis, restoring a relatively dry lung. Any therapeutic intervention is more likely to succeed in the early steps of the cascade, at the imaging stage of asymptomatic pulmonary congestion, rather than downstream near to the end of the cascade, when clinical instability occurred.
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Affiliation(s)
| | - Maria C Scali
- Nottola Hospital, Siena, and Cardiothoracic Department, Pisa University Hospital, Pisa, Italy
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236
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Assaad S, Kratzert WB, Shelley B, Friedman MB, Perrino A. Assessment of Pulmonary Edema: Principles and Practice. J Cardiothorac Vasc Anesth 2017; 32:901-914. [PMID: 29174750 DOI: 10.1053/j.jvca.2017.08.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Indexed: 12/24/2022]
Abstract
Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. Consequently, over the past 2 centuries a concentrated effort to develop clinical tools to rapidly diagnose pulmonary edema and track response to treatment has occurred. The ideal properties of such a tool would include high sensitivity and specificity, easy availability, and the ability to diagnose early accumulation of lung water before the development of the full clinical presentation. In addition, clinicians highly value the ability to precisely quantify extravascular lung water accumulation and differentiate hydrostatic from high permeability etiologies of pulmonary edema. In this review, advances in understanding the physiology of extravascular lung water accumulation in health and in disease and the various mechanisms that protect against the development of pulmonary edema under physiologic conditions are discussed. In addition, the various bedside modalities available to diagnose early accumulation of extravascular lung water and pulmonary edema, including chest auscultation, chest roentgenography, lung ultrasonography, and transpulmonary thermodilution, are examined. Furthermore, advantages and limitations of these methods for the operating room and intensive care unit that are critical for proper modality selection in each individual case are explored.
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Affiliation(s)
- Sherif Assaad
- Cardiothoracic Anesthesia Service, VA Connecticut Healthcare System, Yale University School of Medicine, New Haven, CT.
| | - Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Benjamin Shelley
- Golden Jubilee National Hospital /West of Scotland Heart and Lung Centre, University of Glasgow, Glasgow, Scotland
| | - Malcolm B Friedman
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, VA Connecticut Healthcare System, New Haven, CT
| | - Albert Perrino
- Cardiothoracic Anesthesia Service, VA Connecticut Healthcare System, Yale University School of Medicine, New Haven, CT
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237
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Pulmonary congestion evaluated by lung ultrasound predicts decompensation in heart failure outpatients. Int J Cardiol 2017; 240:271-278. [DOI: 10.1016/j.ijcard.2017.02.150] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 12/26/2022]
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238
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Bianco F, Bucciarelli V, Ricci F, De Caterina R, Gallina S. Lung ultrasonography. J Cardiovasc Med (Hagerstown) 2017; 18:501-509. [DOI: 10.2459/jcm.0000000000000515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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239
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Sforza A, Mancusi C, Carlino MV, Buonauro A, Barozzi M, Romano G, Serra S, de Simone G. Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea. Cardiovasc Ultrasound 2017. [PMID: 28629375 PMCID: PMC5477143 DOI: 10.1186/s12947-017-0105-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The availability of ultra-miniaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. Information on accuracy of ultrasound with handheld units in immediate differential diagnosis in emergency department (ED) is poor. The aim of this study is to test the usefulness and accuracy of lung ultrasound (LUS) alone or combined with ultrasound of the heart and inferior vena cava (IVC) using a PUD for the differential diagnosis of acute dyspnea (AD). METHODS We included 68 patients presenting to the ED of "Maurizio Bufalini" Hospital in Cesena (Italy) for AD. All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The series was divided into patients with dyspnea of cardiac or non-cardiac origin. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive value and negative predictive value of the three ultrasonic methods and their various combinations for the diagnosis of cardiogenic dyspnea (CD), comparing with the final diagnosis made by an independent emergency physician. RESULTS LUS alone exhibited a good sensitivity (92.6%) and specificity (80.5%). The highest accuracy (90%) for the diagnosis of CD was obtained with the combination of LUS and one of the other two methods (heart or IVC). CONCLUSIONS The IUE with PUD is a useful extension of the clinical examination, can be readily available at the bedside or in ambulance, requires few minutes and has a reliable diagnostic discriminant ability in the setting of AD.
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Affiliation(s)
- Alfonso Sforza
- Hypertension Research Center, Federico II University Hospital of Naples, Via Pansini 5, bld #1, 80131, Naples, Italy.,Emergency Department, Bufalini Hospital, Cesena, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital of Naples, Via Pansini 5, bld #1, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Maria Viviana Carlino
- Hypertension Research Center, Federico II University Hospital of Naples, Via Pansini 5, bld #1, 80131, Naples, Italy.,Department of Traslational Medical Science. Federico II University Hospital, Naples, Italy
| | - Agostino Buonauro
- Hypertension Research Center, Federico II University Hospital of Naples, Via Pansini 5, bld #1, 80131, Naples, Italy
| | - Marco Barozzi
- Emergency Department, Bufalini Hospital, Cesena, Italy
| | | | - Sossio Serra
- Emergency Department, Bufalini Hospital, Cesena, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital of Naples, Via Pansini 5, bld #1, 80131, Naples, Italy. .,Department of Traslational Medical Science. Federico II University Hospital, Naples, Italy.
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240
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Lassus J. Evaluating pulmonary congestion with lung ultrasound and the need to take the next steps in heart failure. Eur J Heart Fail 2017; 19:1164-1165. [DOI: 10.1002/ejhf.891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Johan Lassus
- Cardiology, Heart and Lung Centre; Helsinki University and Helsinki University Hospital; Helsinki Finland
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241
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242
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Platz E, Merz AA, Jhund PS, Vazir A, Campbell R, McMurray JJ. Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. Eur J Heart Fail 2017; 19:1154-1163. [PMID: 28557302 DOI: 10.1002/ejhf.839] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/12/2017] [Accepted: 03/16/2017] [Indexed: 12/23/2022] Open
Abstract
AIMS Pulmonary congestion is an important finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS). We conducted a systematic review to describe dynamic changes in LUS findings of pulmonary congestion (B-lines) in HF and to examine the prognostic utility of B-lines in HF. METHODS AND RESULTS We searched online databases for studies conducted in patients with chronic or acute HF that used LUS to assess dynamic changes or the prognostic value of pulmonary congestion. We included studies in adult populations, published in English, and conducted in ≥25 patients. Of 1327 identified studies, 13 (25-290 patients) met the inclusion criteria: six reported on dynamic changes in LUS findings (438 patients) and seven on the prognostic value of B-lines in HF (953 patients). In acute HF, B-line number changed within as few as 3 h of HF treatment. In acute HF, ≥15 B-lines on 28-zone LUS at discharge identified patients at a more than five-fold risk for HF readmission or death. Similarly, in ambulatory patients with chronic HF, ≥3 B-lines on five- or eight-zone LUS marked those at a nearly four-fold risk for 6-month HF hospitalization or death. CONCLUSIONS Lung ultrasound findings change rapidly in response to HF therapy. This technique may represent a useful and non-invasive method to track dynamic changes in pulmonary congestion. Furthermore, residual congestion at the time of discharge in acute HF or in ambulatory patients with chronic HF may identify those at high risk for adverse events.
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Affiliation(s)
- Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Pardeep S Jhund
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ali Vazir
- Department of Cardiology and Critical Care, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Ross Campbell
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John J McMurray
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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243
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Taylor BJ, Stewart GM, Marck JW, Summerfield DT, Issa AN, Johnson BD. Interstitial lung fluid balance in healthy lowlanders exposed to high-altitude. Respir Physiol Neurobiol 2017; 243:77-85. [PMID: 28554819 DOI: 10.1016/j.resp.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 11/27/2022]
Abstract
We aimed to assess lung fluid balance before and after gradual ascent to 5150m. Lung diffusion capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (DmCO) and ultrasound lung comets (ULCs) were assessed in 12 healthy lowlanders at sea-level, and on Day 1, Day 5 and Day 9 after arrival at Mount Everest Base Camp (EBC). EBC was reached following an 8-day hike at progressively increasing altitudes starting at 2860m. DLCO was unchanged from sea-level to Day 1 at EBC, but increased on Day 5 (11±10%) and Day 9 (10±9%) vs. sea-level (P≤0.047). DmCO increased from sea-level to Day 1 (9±6%), Day 5 (12±8%), and Day 9 (17±11%) (all P≤0.001) at EBC. There was no change in ULCs from sea-level to Day 1, Day 5 and Day 9 at EBC. These data provide evidence that interstitial lung fluid remains stable or may even decrease relative to at sea-level following 8days of gradual exposure to high-altitude in healthy humans.
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Affiliation(s)
- Bryan J Taylor
- Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, UK; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA.
| | - Glenn M Stewart
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Jan W Marck
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Douglas T Summerfield
- Critical Care Medicine, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Amine N Issa
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
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244
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Correlation of B-Lines on Ultrasonography With Interstitial Lung Disease on Chest Radiography and CT Imaging. Chest 2017; 152:990-998. [PMID: 28522112 DOI: 10.1016/j.chest.2017.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/06/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We prospectively identified B-lines in patients undergoing ultrasonographic (US) examinations following liver transplantation who also had chest radiography (CXR) or chest CT imaging, or both, on the same day to determine if an association between the presence of B-lines from the thorax on US images correlates with the presence of lung abnormalities on CXR. METHODS Following institutional review board (IRB) approval, patients who received liver transplants and underwent routine US examinations and chest radiography or CT imaging, or both, on the same day between January 1, 2015 through July 1, 2016 were prospectively identified. Two readers who were blinded to chest films and CT images and reports independently reviewed the US interreader agreement for the presence or absence of B-lines and performed an evaluation for the presence or absence of diffuse parenchymal lung disease (DPLD) on chest films and CT images as well as from clinical evaluation. Receiver operating characteristic (ROC) curves were constructed. RESULTS There was good agreement between the two readers on the presence of absence of B-lines (kappa = 0.94). The area under the ROC curve for discriminating between positive DPLD and negative DPLD for both readers was 0.79 (95% CI, 0.71-0.87). CONCLUSIONS There is an association between the presence of extensive B-lines to the point of confluence and "dirty shadowing" on US examinations of the chest and associated findings on chest radiographs and CT scans of DPLD. Conversely, isolated B-lines do not always correlate with abnormalities on chest films and in fact sometimes appear to be a normal variant.
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245
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Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0101-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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246
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Soldati G, Demi M. The use of lung ultrasound images for the differential diagnosis of pulmonary and cardiac interstitial pathology. J Ultrasound 2017; 20:91-96. [PMID: 28592998 DOI: 10.1007/s40477-017-0244-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/09/2017] [Indexed: 12/24/2022] Open
Abstract
In recent years, great advances have been made in the use of lung ultrasound to detect pulmonary edema and interstitial changes in the lung. However, it is clear that B-lines oversimplify the description of the physical phenomena associated with their presence. The artifactual images that ultrasounds provide in interstitial pulmonary pathology are merely the ultimate outcome of the complex interaction of a specific acoustic wave with a specific three-dimensional biological structure. This interaction lacks a solid physical interpretation of the acoustic signs to support it. The aim of this paper was to describe the differences between the sonographic interstitial syndrome related to lung diseases and that related to cardiogenic edema in the light of current knowledge regarding the pleural plane's response to ultrasound waves.
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Affiliation(s)
- Gino Soldati
- UO Pronto Soccorso e Medicina d'Urgenza, Valle del Serchio General Hospital, Lucca, Italy
| | - Marcello Demi
- Department of Medical Image Processing, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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247
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Involvement of systemic venous congestion in heart failure. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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248
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Kimura BJ. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart 2017; 103:987-994. [PMID: 28259843 DOI: 10.1136/heartjnl-2016-309915] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/02/2017] [Indexed: 12/19/2022] Open
Abstract
The development of hand-carried, battery-powered ultrasound devices has created a new practice in ultrasound diagnostic imaging, called 'point-of-care' ultrasound (POCUS). Capitalising on device portability, POCUS is marked by brief and limited ultrasound imaging performed by the physician at the bedside to increase diagnostic accuracy and expediency. The natural evolution of POCUS techniques in general medicine, particularly with pocket-sized devices, may be in the development of a basic ultrasound examination similar to the use of the binaural stethoscope. This paper will specifically review how POCUS improves the limited sensitivity of the current practice of traditional cardiac physical examination by both cardiologists and non-cardiologists. Signs of left ventricular systolic dysfunction, left atrial enlargement, lung congestion and elevated central venous pressures are often missed by physical techniques but can be easily detected by POCUS and have prognostic and treatment implications. Creating a general set of repetitive imaging skills for these entities for application on all patients during routine examination will standardise and reduce heterogeneity in cardiac bedside ultrasound applications, simplify teaching curricula, enhance learning and recollection, and unify competency thresholds and practice. The addition of POCUS to standard physical examination techniques in cardiovascular medicine will result in an ultrasound-augmented cardiac physical examination that reaffirms the value of bedside diagnosis.
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Affiliation(s)
- Bruce J Kimura
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA.,Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, California, USA
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249
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Scali MC, Cortigiani L, Simionuc A, Gregori D, Marzilli M, Picano E. Exercise-induced B-lines identify worse functional and prognostic stage in heart failure patients with depressed left ventricular ejection fraction. Eur J Heart Fail 2017; 19:1468-1478. [PMID: 28198075 DOI: 10.1002/ejhf.776] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 12/22/2022] Open
Abstract
AIMS Exercise stress echocardiography (ESE) is recommended by the European Society of Cardiology guidelines for the evaluation of heart failure (HF) patients. Recently, lung ultrasound (LUS) has been proposed for the assessment of extravascular lung water through B-lines. The aim of this study was to assess B-lines during ESE in HF. METHODS AND RESULTS Standard transthoracic and LUS evaluation was performed during semi-supine ESE in 103 NYHA class I-III HF patients (76 male; mean age 64 ± 12 years) with depressed left ventricular ejection fraction (35 ± 8%). B-lines were measured by scanning 28 intercostal spaces on antero-lateral chest, both at rest and at peak stress. Resting plasma B-type natriuretic peptide (BNP) levels and exercise capacity during cardiopulmonary testing with peak oxygen uptake (peak VO2 ) were assessed in all patients. All patients were followed up for a median of 8 months (first quartile, 6; third quartile, 11). LUS was feasible and interpretable in all subjects. The overall number of B-lines increased from rest (median 5, interquartile range 0-10) to peak stress (median 12, interquartile range 0-45) (P < 0.0001). The number of stress B-lines was closely correlated with resting log-BNP (r = 0.88, P < 0.0001) and peak VO2 (r = -0.90, P < 0.0001). During follow-up, 37 events occurred: 10 deaths, 23 re-hospitalizations for acute HF, and 4 non-fatal myocardial infarctions. Twelve-month event-free survival was 95% in the 36 patients with stress B-lines <30 (best cut-off identified by receiver operating characteristic curve analysis) vs. 7% in patients with ≥30 B-lines (P < 0.0001). CONCLUSION B-lines are easy to obtain, frequent in HF patients, and often increase during ESE. Adverse events were more frequent in patients with more B-lines during ESE.
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Affiliation(s)
- Maria Chiara Scali
- Cardiothoracic Department, Pisa University, Pisa, Italy and Nottola Cardiology Division, Siena, Italy
| | | | - Anca Simionuc
- Cardiothoracic Department, Pisa University, Pisa, Italy and Nottola Cardiology Division, Siena, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Padova University, Padova, Italy
| | - Mario Marzilli
- Cardiothoracic Department, Pisa University, Pisa, Italy and Nottola Cardiology Division, Siena, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, Biomedicine Department, National Research Council, Pisa, Italy
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250
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Delgado V, Gaemperli O, Lombardi M, Kaufmann PA, Bax JJ. The year in cardiology 2016: imaging. Eur Heart J 2017; 38:390-399. [PMID: 28043972 DOI: 10.1093/eurheartj/ehw633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/21/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Oliver Gaemperli
- Cardiac Imaging, University Heart Center, Moussonstrasse 4, CH 8091 Zurich, Switzerland
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 San Donato Milanese Milan, Italy
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Raemistr 100, 809 1 Zürich, Switzerland
| | - Jeroen J Bax
- Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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