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Keskinis C, Panagoutsos S, Kyriklidou P, Pateinakis P, Manou E, Soilemezi E, Papadopoulou D, Passadakis P. Scanning more corresponds to more accuracy in hemodialysis patients: 28-zone protocol's superior findings from an observational study. J Ultrasound 2024:10.1007/s40477-024-00964-y. [PMID: 39432062 DOI: 10.1007/s40477-024-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/23/2024] [Indexed: 10/22/2024] Open
Abstract
AIMS Hypervolemia remains a problem in hemodialysis patients and is associated with hypertension, cardiovascular events and mortality. Lung Ultrasound (LUS) is a technique that detects hypervolemia via 4 different protocols depending on the number of sites checked on the chest wall. It has not been established which protocol should be preferred in the literature. METHODS This study included 68 hemodialysis patients from one Dialysis Unit. All the patients underwent LUS with every single protocol 30 min before and after the end of the middle-week dialysis session by a nephrology trainee. Patients' ideal weight was modified based on daily clinical practice rather than ultrasound findings. RESULTS Seventeen patients (25%) had ultrasound findings compatible with hypervolemia before the dialysis session, while eleven patients (16.2%) had still pulmonary congestion after the end of the session. These findings were similar to the number of patients considered hyperhydrated based on clinical criteria (10 patients). The rest protocols (8-zone, 6-zone and 4-zone protocol) considered fewer patients as hypervolemic. CONCLUSIONS The 28-zone protocol can effectively detect hypervolemia and even classify the degree of it, although It is a time-consuming method. However, the other protocols can detect the hypervolemia in hemodialysis patients only when severe lung congestion exists. Their usefulness is limited in daily clinical practice in hemodialysis patients. More studies should be carried out for further and more reliable conclusions.
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Affiliation(s)
- Christodoulos Keskinis
- Department of Nephrology, Papageorgiou Hospital, Thessaloniki, Greece.
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Stylianos Panagoutsos
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Nephrology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - Eleni Manou
- Department of Nephrology, Papageorgiou Hospital, Thessaloniki, Greece
| | - Eleni Soilemezi
- Intensive Care Unit, Papageorgiou Hospital, Thessaloniki, Greece
| | | | - Ploumis Passadakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Emeritus Professor of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Zachariah VK, Sunitha VC, Ramachandran N, Vairappan B, Parameswaran S, Priyamvada PS. Does lung ultrasound-guided ultrafiltration lead to better outcomes in acute kidney injury requiring intermittent hemodialysis: A randomized control trial. Hemodial Int 2024; 28:435-443. [PMID: 38965069 DOI: 10.1111/hdi.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Optimization of ultrafiltration during hemodialysis is a critical parameter in achieving therapeutic efficacy and ensuring hemodynamic stability. While various modalities such as blood volume monitoring, inferior vena cava diameter assessment, natriuretic peptide levels, bioimpedance assay, and lung ultrasound have been widely explored in the context of maintenance hemodialysis, the concept of volume-guided ultrafiltration in dialysis patients with acute kidney injury remains unexplored. METHODS Adult patients with acute kidney injury requiring dialysis, who were hemodynamically stable and not on ventilator support, without underlying lung pathology or cardiac failure, were randomized into two groups. All patients underwent 28-zone lung ultrasound before dialysis. The ultrafiltration was decided based on the treating physician's clinical judgment in controls. In the intervention group, the ultrafiltration orders prescribed by the treating physician were modified, based on the Kerley B line scores obtained by lung ultrasound. The rest of the dialysis prescriptions were similar. A postdialysis lung ultrasound was done in both groups to assess the postdialysis volume status 30 min after the dialysis session. RESULTS A total of 74 patients undergoing hemodialysis for acute kidney injury were randomized. The baseline characteristics were comparable except for higher baseline B line score scores in the intervention arm. All patients received similar dialysis prescriptions. The lung ultrasound-guided ultrafiltration arm had a higher change in B line scores (BLS) from baseline (4 [0-9.5] vs. 0 [0-4]; p value 0.004) during the first dialysis session. The predialysis BLS indexed to ultrafiltration (mL/kbw/h) were significantly lower in controls, reflecting a relatively higher rate of ultrafiltration in controls compared with intervention (p = 0.006). The total number of dialysis sessions done in the control and intervention arm were 61 and 59, respectively. Among controls, 23/61 sessions (37.7%) had intradialytic adverse events, whereas, in the intervention arm, only 4/59 sessions (6.7) had any adverse intradialytic events (p < 0.01). CONCLUSION Lung ultrasound-guided ultrafiltration was associated with a better safety profile, as demonstrated by reduced intradialytic events.
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Affiliation(s)
- Vidhya K Zachariah
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Natarajan Ramachandran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balasubramanian Vairappan
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Rastogi T, Gargani L, Pellicori P, Lamiral Z, Ambrosio G, Bayés-Genis A, Domingo M, Lupon J, Simonovic D, Pugliese NR, Ruocco G, Duarte K, Coiro S, Palazzuoli A, Girerd N. Prognostic implication of lung ultrasound in heart failure: a pooled analysis of international cohorts. Eur Heart J Cardiovasc Imaging 2024; 25:1216-1225. [PMID: 38606932 DOI: 10.1093/ehjci/jeae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Lung ultrasound (LUS) is often used to assess congestion in heart failure (HF). In this study, we assessed the prognostic role of LUS in patients with HF at admission and hospital discharge, and in an outpatient setting, and explored whether clinical factors [age, sex, left ventricular ejection fraction (LVEF), and atrial fibrillation] impact the prognostic value of LUS findings. Further, we assessed the incremental prognostic value of LUS on top of the following two clinical risk scores: (i) the atrial fibrillation, haemoglobin, elderly, abnormal renal parameters, diabetes mellitus (AHEAD) and (ii) the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) clinical risk scores. METHODS AND RESULTS We pooled data on patients hospitalized for HF or followed up in outpatient clinics from international cohorts. We enrolled 1947 patients at admission (n = 578), discharge (n = 389), and in outpatient clinics (n = 980). The total LUS B-line count was calculated for the eight-zone scanning protocol. The primary outcome was a composite of rehospitalization for HF and all-cause death. Compared with those in the lower tertiles of B lines, patients in the highest tertiles were older, more likely to have signs of HF and had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels. A higher number of B lines was associated with increased risk of primary outcome at discharge [Tertile 3 vs. Tertile 1: adjusted hazard ratio (HR): 5.74 (3.26-10.12), P < 0.0001] and in outpatients [Tertile 3 vs. Tertile 1: adjusted HR: 2.66 (1.08-6.54), P = 0.033]. Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to the MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings. CONCLUSION A higher number of B lines in patients with HF was associated with an increased risk of morbidity and mortality, regardless of the clinical setting.
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Affiliation(s)
- Tripti Rastogi
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Zohra Lamiral
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
| | - Giuseppe Ambrosio
- Department of Cardiology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Antoni Bayés-Genis
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Mar Domingo
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Josep Lupon
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Dejan Simonovic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | | | - Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, ASL CN-1, Mondovì, Cuneo, Italy
| | - Kevin Duarte
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
| | - Stefano Coiro
- Department of Cardiology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Cardio Thoracic and Vascular, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Nicolas Girerd
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
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Muñoz F, Born P, Bruna M, Ulloa R, González C, Philp V, Mondaca R, Blanco JP, Valenzuela ED, Retamal J, Miralles F, Wendel-Garcia PD, Ospina-Tascón GA, Castro R, Rola P, Bakker J, Hernández G, Kattan E. Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study. Crit Care 2024; 28:52. [PMID: 38374167 PMCID: PMC10877871 DOI: 10.1186/s13054-024-04834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This study aims to compare the prevalence of venous congestion in fluid responsive and fluid unresponsive critically ill patients after intensive care (ICU) admission. METHODS Multicenter, prospective cross-sectional observational study conducted in three medical-surgical ICUs in Chile. Consecutive mechanically ventilated patients that required vasopressors and admitted < 24 h to ICU were included between November 2022 and June 2023. Patients were assessed simultaneously for fluid responsiveness and VC at a single timepoint. Fluid responsiveness status, VC signals such as central venous pressure, estimation of left ventricular filling pressures, lung, and abdominal ultrasound congestion indexes and relevant clinical data were collected. RESULTS Ninety patients were included. Median age was 63 [45-71] years old, and median SOFA score was 9 [7-11]. Thirty-eight percent of the patients were fluid responsive (FR+), while 62% were fluid unresponsive (FR-). The most prevalent diagnosis was sepsis (41%) followed by respiratory failure (22%). The prevalence of at least one VC signal was not significantly different between FR+ and FR- groups (53% vs. 57%, p = 0.69), as well as the proportion of patients with 2 or 3 VC signals (15% vs. 21%, p = 0.4). We found no association between fluid balance, CRT status, or diagnostic group and the presence of VC signals. CONCLUSIONS Venous congestion signals were prevalent in both fluid responsive and unresponsive critically ill patients. The presence of venous congestion was not associated with fluid balance or diagnostic group. Further studies should assess the clinical relevance of these results and their potential impact on resuscitation and monitoring practices.
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Affiliation(s)
- Felipe Muñoz
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Pablo Born
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Mario Bruna
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
| | - Rodrigo Ulloa
- Unidad de Cuidados Intensivos, Hospital Las Higueras, Talcahuano, Chile
| | - Cecilia González
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Valerie Philp
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Roberto Mondaca
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Juan Pablo Blanco
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Emilio Daniel Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | | | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gustavo A Ospina-Tascón
- Department of Intensive Care Medicine, Fundación Valle del Lili, Cali, Colombia
- Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Philippe Rola
- Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, USA
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile.
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Xu P, Nasr B, Li L, Huang W, Liu W, Wang X. Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:125-132. [PMID: 38263970 PMCID: PMC10800768 DOI: 10.1016/j.jointm.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/01/2023] [Accepted: 08/18/2023] [Indexed: 01/25/2024]
Abstract
Background No convenient, inexpensive, and non-invasive screening tools exist to identify pulmonary hypertension (PH) - left heart disease (LHD) patients during the early stages of the disease course. This study investigated whether different methods of lung ultrasound (LUS) could be used for the initial investigation of PH-LHD. Methods This was a single-center prospective observational study which was performed in the Zigong Fourth People's Hospital. We consecutively enrolled patients with heart failure (HF) admitted to the emergency intensive care unit from January 2018 to May 2020. Transthoracic echocardiography and LUS were performed within 24 h before discharge. We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure (PASP). Bland-Altman plots were generated to inspect possible bias, and receiver operating characteristic (ROC) curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD. Results Seventy-one patients were enrolled in this study, with an overall median age of 79 (interquartile range: 71.5-84.0) years. Among the 71 patients, 36 (50.7%) cases were male, and 26 (36.6%) had an intermediate and high echocardiographic probability of PH. All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH (P <0.05). The correlation coefficient (r) between different LUS scoring methods and PASP was moderate for the 6-zone (r=0.455, P <0.001), 8-zone (r=0.385, P=0.001), 12-zone (r=0.587, P <0.001), and 28-zone (r=0.535, P <0.001) methods. In Bland-Altman plots, each of the four LUS scoring methods had a good agreement with PASP (P <0.001). The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH (P <0.05). Conclusions LUS is a readily available, inexpensive, and risk-free method that moderately correlates with PASP. LUS is a potential screening tool used for the initial investigation of PH-LHD, especially in emergencies or critical care settings.
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Affiliation(s)
- Ping Xu
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China
- Artificial Intelligence Key Laboratory of Sichuan Province, Zigong, China
| | - Basma Nasr
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liang Li
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China
| | - Wenbin Huang
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China
| | - Wei Liu
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China
| | - Xuelian Wang
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China
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Xu P, Ye L, Li L, Huang W, Liu W, Huang K. Comparison of the prognostic value, feasibility, and reproducibility among different scoring methods of 8‑point lung ultrasonography in patients with acute heart failure. Intern Emerg Med 2023; 18:2321-2332. [PMID: 37747589 DOI: 10.1007/s11739-023-03433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
There is no strong evidence that one of the B-line quantification approaches is clinically superior to the others, as the use of lung ultrasound (LUS) protocol becomes more commonplace in the treatment of heart failure (HF). This study, thus, aimed to evaluate to the prognostic value, feasibility, and reproducibility for selecting optimal B-line quantification methods. We enrolled patients with HF admitted to the emergency intensive care unit (EICU) in a single-center, prospective, observational study. LUS were performed before EICU discharge, and six B-line quantification methods were used to calculate scores. A total of 71 patients were enrolled. There was a moderately good discriminative value between six quantification methods and the composite outcome. The calibration curve of six B-line quantification methods for the probability of the composite outcome showed good agreement between prediction and observation. Decision curve presented that six B-line quantification methods presented similar net benefits at the entire range of threshold probabilities. Image interpretation time of Quantitative methods 1 and 2 was significantly less than that of other methods. Intraclass correlation coefficients (ICC) for B-pattern scoring systems (Quantitative methods 1 and 2) between two experts demonstrated the excellent level of clinical significance. Despite the similar discrimination, calibration and clinical usefulness, pattern-B scoring systems have the benefit of the feasibility and reproducibility over other methods.
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Affiliation(s)
- Ping Xu
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China.
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China.
| | - Li Ye
- Emergency Department, Fushun People's Hospital, Fushun, Sichuan, China
| | - Liang Li
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
| | - Wenbin Huang
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
| | - Wei Liu
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China
| | - Kui Huang
- Department of Health Management Center, Zigong Fourth People's Hospital, Zigong, China
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Boriani G, Imberti JF, Bonini N, Carriere C, Mei DA, Zecchin M, Piccinin F, Vitolo M, Sinagra G. Remote multiparametric monitoring and management of heart failure patients through cardiac implantable electronic devices. Eur J Intern Med 2023; 115:1-9. [PMID: 37076404 DOI: 10.1016/j.ejim.2023.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
In this review we focus on heart failure (HF) which, as known, is associated with a substantial risk of hospitalizations and adverse cardiovascular outcomes, including death. In recent years, systems to monitor cardiac function and patient parameters have been developed with the aim to detect subclinical pathophysiological changes that precede worsening HF. Several patient-specific parameters can be remotely monitored through cardiac implantable electronic devices (CIED) and can be combined in multiparametric scores predicting patients' risk of worsening HF with good sensitivity and moderate specificity. Early patient management at the time of pre-clinical alerts remotely transmitted by CIEDs to physicians might prevent hospitalizations. However, it is not clear yet which is the best diagnostic pathway for HF patients after a CIED alert, which kind of medications should be changed or escalated, and in which case in-hospital visits or in-hospital admissions are required. Finally, the specific role of healthcare professionals involved in HF patient management under remote monitoring is still matter of definition. We analyzed recent data on multiparametric monitoring of patients with HF through CIEDs. We provided practical insights on how to timely manage CIED alarms with the aim to prevent worsening HF. We also discussed the role of biomarkers and thoracic echo in this context, and potential organizational models including multidisciplinary teams for remote care of HF patients with CIEDs.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Cosimo Carriere
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide A Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Francesca Piccinin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
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Olusanya O, Baston C. Lung Ultrasound in COVID-19: Sweeping the Surface or Sounding the Depths. Chest 2023; 163:12-13. [PMID: 36628663 PMCID: PMC9826953 DOI: 10.1016/j.chest.2022.08.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Saint Bartholomew's Hospital, Barts Health NHS Trust, London, England
| | - Cameron Baston
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Zhang H, Zhu Y, Li N, Zeng J. Update on the Value of Lung Ultrasound Examination in Acute Decompensated Heart Failure Patients with Various Left Ventricular Ejection Fraction. Rev Cardiovasc Med 2022; 23:350. [PMID: 39077125 PMCID: PMC11267337 DOI: 10.31083/j.rcm2310350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 07/31/2024] Open
Abstract
Acute decompensated heart failure (ADHF) is one of the most common causes of hospital admission for cardiovascular diseases. ADHF often affects the elderly population, is associated with high morbidity, admission rate and mortality. Pulmonary congestion (PC) is the most common cause of hospitalization among ADHF patients. Previous studies have shown that lung ultrasound (LUS) serves as a valuable tool for the evaluation of PC in patients with heart failure in terms of diagnosis, guiding of the treatment, and post-discharge monitoring. The use of LUS for ADHF is well described and already widely used in the daily clinical practice. PC might differ in ADHF patients with different left ventricular ejection fraction value and treatment options should be steadily adjusted according to the LUS-derived PC results to improve the outcome. This review summarized the value of LUS examination in patients with ADHF with preserved, mildly reduced, and reduced left ventricular ejection fraction, aiming to expand the rational use of LUS, promote the LUS-guided management and improve the outcome among patients with ADHF.
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Affiliation(s)
- Hui Zhang
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
| | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
| | - Na Li
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
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Xie Q, Liu F, Wang Y, Wang G, Xu P. Eight versus 28‑point lung ultrasonography in moderate acute heart failure: comment. Intern Emerg Med 2022; 17:1555-1556. [PMID: 35428966 DOI: 10.1007/s11739-022-02978-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Qian Xie
- School of Education and Sports, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Fuqiang Liu
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Guan Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Ping Xu
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China.
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, 19 Tanmulin Road, Zigong, Sichuan, China.
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