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Pezzuto B, Contini M, Berna G, Galotta A, Cattaneo G, Maragna R, Gugliandolo P, Agostoni P. Dynamic trend of lung fluid movement during exercise in heart failure: From lung imaging to alveolar-capillary membrane function. Int J Cardiol 2024; 407:132041. [PMID: 38643800 DOI: 10.1016/j.ijcard.2024.132041] [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: 08/13/2023] [Revised: 03/10/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND In chronic heart failure (HF), exercise-induced increase in pulmonary capillary pressure may cause an increase of pulmonary congestion, or the development of pulmonary oedema. We sought to assess in HF patients the exercise-induced intra-thoracic fluid movements, by measuring plasma brain natriuretic peptide (BNP), lung comets and lung diffusion for carbon monoxide (DLCO) and nitric oxide (DLNO), as markers of hemodynamic load changes, interstitial space and alveolar-capillary membrane fluids, respectively. METHODS AND RESULTS Twenty-four reduced ejection fraction HF patients underwent BNP, lung comets and DLCO/DLNO measurements before, at peak and 1 h after the end of a maximal cardiopulmonary exercise test. BNP significantly increased at peak from 549 (328-841) to 691 (382-1207, p < 0.0001) pg/mL and almost completely returned to baseline value 1 h after exercise. Comets number increased at peak from 9.4 ± 8.2 to 24.3 ± 16.7, returning to baseline (9.7 ± 7.4) after 1 h (p < 0.0001). DLCO did not change significantly at peak (from 18.01 ± 4.72 to 18.22 ± 4.73 mL/min/mmHg), but was significantly reduced at 1 h (16.97 ± 4.26 mL/min/mmHg) compared to both baseline (p = 0.0211) and peak (p = 0.0174). DLNO showed a not significant trend toward lower values 1 h post-exercise. CONCLUSIONS Moderate/severe HF patients have a 2-step intra-thoracic fluid movement with exercise: the first during active exercise, from the vascular space toward the interstitial space, as confirmed by comets increase, without any effect on diffusion, and the second, during recovery, toward the alveolar-capillary membrane, clearing the interstitial space but worsening gas diffusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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2
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Zamorano JL, González Leal A. Advances in heart failure management. Med Clin (Barc) 2024; 163:32-39. [PMID: 38418309 DOI: 10.1016/j.medcli.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024]
Abstract
Heart failure is a pathological condition characterized by substantial prevalence and mortality, particularly in the Western world. Over recent decades, both pharmacological and non-pharmacological interventions have emerged, significantly enhancing patient survival and overall quality of life. Moreover, advancements in diverse imaging modalities facilitate precise diagnosis and comprehensive investigation into the fundamental etiology, enabling the development of more precise therapeutic approaches. Nonetheless, discernible gaps persist in comprehending specific facets of this condition, albeit persistent research endeavors seek to elucidate these inquiries.
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Affiliation(s)
- José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
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Pare JR, Gjesteby LA, Tonelli M, Leo MM, Muruganandan KM, Choudhary G, Brattain LJ. Transfer Learning-Based B-Line Assessment of Lung Ultrasound for Acute Heart Failure. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:825-832. [PMID: 38423896 DOI: 10.1016/j.ultrasmedbio.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE B-lines assessed by lung ultrasound (LUS) outperform physical exam, chest radiograph, and biomarkers for the associated diagnosis of acute heart failure (AHF) in the emergent setting. The use of LUS is however limited to trained professionals and suffers from interpretation variability. The objective was to utilize transfer learning to create an AI-enabled software that can aid novice users to automate LUS B-line interpretation. METHODS Data from an observational AHF LUS study provided standardized cine clips for AI model development and evaluation. A total of 49,952 LUS frames from 30 patients were hand scored and trained on a convolutional neural network (CNN) to interpret B-lines at the frame level. A random independent evaluation set of 476 LUS clips from 60 unique patients assessed model performance. The AI models scored the clips on both a binary and ordinal 0-4 multiclass assessment. RESULTS A multiclassification AI algorithm had the best performance at the binary level when applied to the independent evaluation set, AUC of 0.967 (95% CI 0.965-0.970) for detecting pathologic conditions. When compared to expert blinded reviewer, the 0-4 multiclassification AI algorithm scale had a reported linear weighted kappa of 0.839 (95% CI 0.804-0.871). CONCLUSIONS The multiclassification AI algorithm is a robust and well performing model at both binary and ordinal multiclass B-line evaluation. This algorithm has the potential to be integrated into clinical workflows to assist users with quantitative and objective B-line assessment for evaluation of AHF.
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Affiliation(s)
- Joseph R Pare
- Alpert Medical School of Brown University, Providence, RI, USA; Lifespan, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA; Boston University, Boston, MA, USA.
| | - Lars A Gjesteby
- Human Health & Performance Systems Group, MIT Lincoln Laboratory, Lexington, MA, USA
| | | | | | | | - Gaurav Choudhary
- Alpert Medical School of Brown University, Providence, RI, USA; Lifespan, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Laura J Brattain
- Human Health & Performance Systems Group, MIT Lincoln Laboratory, Lexington, MA, USA
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Coiro S, Lacomblez C, Duarte K, Gargani L, Rastogi T, Chouihed T, Girerd N. A machine learning-based lung ultrasound algorithm for the diagnosis of acute heart failure. Intern Emerg Med 2024:10.1007/s11739-024-03627-2. [PMID: 38780749 DOI: 10.1007/s11739-024-03627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
Lung ultrasound (LUS) is an effective tool for diagnosing acute heart failure (AHF). However, several imaging protocols currently exist and how to best use LUS remains undefined. We aimed at developing a lung ultrasound-based model for AHF diagnosis using machine learning. Random forest and decision trees were generated using the LUS data (via an 8-zone scanning protocol) in patients with acute dyspnea admitted to the Emergency Department (PLUME study, N = 117) and subsequently validated in an external dataset (80 controls from the REMI study, 50 cases from the Nancy AHF cohort). Using the random forest model, total B-line sum (i.e., in both hemithoraces) was the most significant variable for identifying AHF, followed by the difference in B-line sum between the superior and inferior lung areas. The decision tree algorithm had a good diagnostic accuracy [area under the curve (AUC) = 0.865] and identified three risk groups (i.e., low 24%, high 70%, and very high-risk 96%) for AHF. The very high-risk group was defined by the presence of 14 or more B-lines in both hemithoraces while the high-risk group was described as having either B-lines mostly localized in superior points or in the right hemithorax. Accuracy in the validation cohort was excellent (AUC = 0.906). Importantly, adding the algorithm on top of a validated clinical score and classical definition of positive LUS scanning for AHF resulted in a significant improvement in diagnostic accuracy (continuous net reclassification improvement = 1.21, P < 0.001). Our simple lung ultrasound-based machine learning algorithm features an excellent performance and may constitute a validated strategy to diagnose AHF.
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Affiliation(s)
- Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Claire Lacomblez
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Tripti Rastogi
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Tahar Chouihed
- Emergency Department, INSERM, UMRS 1116, University Hospital of Nancy, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France.
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Landolfo M, Spannella F, Giulietti F, Di Pentima C, Giordano P, Borioni E, Landi L, Di Rosa M, Galeazzi R, Sarzani R. Role of NT-proBNP and lung ultrasound in diagnosing and classifying heart failure in a hospitalized oldest-old population: a cross-sectional study. BMC Geriatr 2024; 24:354. [PMID: 38643091 PMCID: PMC11032608 DOI: 10.1186/s12877-024-04977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024] Open
Abstract
AIM Diagnosing and classifying heart failure (HF) in the oldest-old patients has technical and interpretation issues, especially in the acute setting. We assessed the usefulness of both N-terminal pro-brain natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) for confirming HF diagnosis and predicting, among hospitalized HF patients, those with reduced ejection fraction (HFrEF). METHODS We performed a cross-sectional study on 148 consecutive patients aged ≥ 80 years admitted to our Internal Medicine and Geriatrics ward with at least one symptom/sign compatible with HF and NT-proBNP ≥ 125 pg/mL. We measured serum NT-proBNP levels and performed LUS and transthoracic echocardiography (TTE) on admission before diuretic therapy. We divided our cohort into three subgroups according to the left ventricular ejection fraction (LVEF): reduced (LVEF ≤ 40%), mildly-reduced (LVEF = 41-49%) and preserved (LVEF ≥ 50%). RESULTS The mean age was 88±5 years. Male prevalence was 42%. Patients with HFrEF were 19%. Clinical features and laboratory parameters did not differ between the three subgroups, except for higher NT-proBNP in HFrEF patients, which also had a higher number of total B-lines and intercostal spaces of pleural effusion at LUS. Overall, NT-proBNP showed an inverse correlation with LVEF (r = -0.22, p = 0.007) and a direct correlation with age, total pulmonary B-lines, and intercostal spaces of pleural effusion. According to the ROCs, NT-proBNP levels, pulmonary B-lines and pleural effusion extension were poorly predictive for HFrEF. The best-performing cut-offs were 9531 pg/mL for NT-proBNP (SP 0.70, SE 0.50), 13 for total B-lines (SP 0.69, SE 0.85) and one intercostal space for pleural effusion (SP 0.55, SE 0.89). Patients with admission NT-proBNP ≥ 9531 pg/mL had a 2-fold higher risk for HFrEF (OR 2.5, 95% CI 1.3-4.9), while we did not find any association for total B-lines ≥ 13 or pleural effusion ≥ 1 intercostal space with HFrEF. A significant association with HFrEF emerged for the combination of NT-proBNP ≥ 9531 pg/mL, total B-lines ≥ 13 and intercostal spaces of pleural effusion ≥ 1 (adjusted OR 4.3, 95% CI 1.5-12.9). CONCLUSIONS Although NT-proBNP and LUS help diagnose HF, their accuracy in discriminating HFrEF from non-HFrEF was poor in our real-life clinical study on oldest-old hospitalized patients, making the use of TTE still necessary to distinguish HF phenotypes in this peculiar setting. These data require confirmation in more extensive and longer prospective studies.
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Affiliation(s)
- Matteo Landolfo
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica Delle Marche, Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy.
- Department of Clinical and Molecular Sciences, University Politecnica Delle Marche, Ancona, Italy.
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Chiara Di Pentima
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Elisabetta Borioni
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica Delle Marche, Ancona, Italy
| | - Laura Landi
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica Delle Marche, Ancona, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona, Italy
| | - Roberta Galeazzi
- Clinical Laboratory and Molecular Diagnostic, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica Delle Marche, Ancona, Italy
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Szyszkowska A, Olesiewicz T, Płońska-Korabiewska I, Tarasiuk E, Olesiewicz B, Knapp M, Śledziewski R, Sobkowicz B, Lisowska A. The Importance of Lung Ultrasound and IGFBP7 (Insulin-like Growth Factor Binding Protein 7) Assessment in Diagnosing Patients with Heart Failure. J Clin Med 2024; 13:2220. [PMID: 38673493 PMCID: PMC11051327 DOI: 10.3390/jcm13082220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: In daily practice, there are problems with adequately diagnosing the cause of dyspnea in patients with heart failure with preserved and mildly reduced ejection fractions (HFpEF and HFmrEF). This study aimed to assess the usefulness of lung ultrasound in diagnosing HFpEF and HFmrEF and determine its correlation with IGFBP7 (insulin-like growth factor binding protein 7), NTproBNP (N-terminal pro-B-type natriuretic peptide), and echocardiographic markers. Methods: The research was conducted on 143 patients hospitalized between 2018 and 2020, admitted due to dyspnea, and diagnosed with HFpEF and HFmrEF. Venous blood was collected from all participants to obtain basic biochemical parameters, NTproBNP, and IGFBP7. Moreover, all participants underwent echocardiography and transthoracic lung ultrasound. Two years after hospitalization a follow-up telephone visit was performed. Results: The number of B-lines in the LUS ≥ 16 was determined with a sensitivity of-73% and specificity of-62%, indicating exacerbation of heart failure symptoms on admission. The number of B-lines ≥ 14 on admission was determined as a cut-off point, indicating an increased risk of death during the 2-year follow-up period. The factors that significantly impacted mortality in the study patient population were age and the difference between the number of B-lines on ultrasound at admission and at hospital discharge. IGFBP7 levels had no significant effect on the duration of hospitalization, risk of rehospitalization, or mortality during follow-up. Conclusions: Lung ultrasonography provides additional diagnostic value in patients with HFpEF or HFmrEF and exacerbation of heart failure symptoms. The number of B-lines ≥ 14 may indicate an increased risk of death.
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Affiliation(s)
- Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Tomasz Olesiewicz
- Department of Cardiology, Hospital in Ostrów Mazowiecka, 07-300 Ostrów Mazowiecka, Poland; (T.O.); (B.O.)
| | - Izabela Płońska-Korabiewska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Ewa Tarasiuk
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Barbara Olesiewicz
- Department of Cardiology, Hospital in Ostrów Mazowiecka, 07-300 Ostrów Mazowiecka, Poland; (T.O.); (B.O.)
| | - Małgorzata Knapp
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Rafał Śledziewski
- Department of Radiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Anna Lisowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
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7
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Alevroudis I, Kotoulas SC, Tzikas S, Vassilikos V. Congestion in Heart Failure: From the Secret of a Mummy to Today's Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review. J Clin Med 2023; 13:12. [PMID: 38202020 PMCID: PMC10779505 DOI: 10.3390/jcm13010012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach.
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Affiliation(s)
- Ioannis Alevroudis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
- Intensive Care Medicine Clinic, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
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Lindow T, Quadrelli S, Ugander M. Noninvasive Imaging Methods for Quantification of Pulmonary Edema and Congestion: A Systematic Review. JACC Cardiovasc Imaging 2023; 16:1469-1484. [PMID: 37632500 DOI: 10.1016/j.jcmg.2023.06.023] [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: 10/20/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/28/2023]
Abstract
Quantification of pulmonary edema and congestion is important to guide diagnosis and risk stratification, and to objectively evaluate new therapies in heart failure. Herein, we review the validation, diagnostic performance, and clinical utility of noninvasive imaging modalities in this setting, including chest x-ray, lung ultrasound (LUS), computed tomography (CT), nuclear medicine imaging methods (positron emission tomography [PET], single photon emission CT), and magnetic resonance imaging (MRI). LUS is a clinically useful bedside modality, and fully quantitative methods (CT, MRI, PET) are likely to be important contributors to a more accurate and precise evaluation of new heart failure therapies and for clinical use in conjunction with cardiac imaging. There are only a limited number of studies evaluating pulmonary congestion during stress. Taken together, noninvasive imaging of pulmonary congestion provides utility for both clinical and research assessment, and continued refinement of methodologic accuracy, validation, and workflow has the potential to increase broader clinical adoption.
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Affiliation(s)
- Thomas Lindow
- Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia; Department of Clinical Physiology, Research and Development, Växjö Central Hospital, Region Kronoberg, Sweden; Clinical Physiology, Clinical Sciences, Lund University, Sweden
| | - Scott Quadrelli
- Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockhom, Sweden.
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9
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Bloise S, Marcellino A, Sanseviero M, Martucci V, Testa A, Leone R, Del Giudice E, Frasacco B, Gizzone P, Proietti Ciolli C, Ventriglia F, Lubrano R. Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting. Diagnostics (Basel) 2023; 13:diagnostics13101765. [PMID: 37238249 DOI: 10.3390/diagnostics13101765] [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: 05/05/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Point-of-care thoracic ultrasound at the patient's bedside has increased significantly recently, especially in pediatric settings. Its low cost, rapidity, simplicity, and repeatability make it a practical examination to guide diagnosis and treatment choices, especially in pediatric emergency departments. The fields of application of this innovative imaging method are many and include primarily the study of lungs but also that of the heart, diaphragm, and vessels. This manuscript aims to describe the most important evidence for using thoracic ultrasound in the pediatric emergency setting.
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Affiliation(s)
- Silvia Bloise
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Alessia Marcellino
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Mariateresa Sanseviero
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Vanessa Martucci
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Alessia Testa
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Rita Leone
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Emanuela Del Giudice
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Beatrice Frasacco
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Pietro Gizzone
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Claudia Proietti Ciolli
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Flavia Ventriglia
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Riccardo Lubrano
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
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10
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Cohen A, Li T, Maybaum S, Fridman D, Gordon M, Shi D, Nelson M, Stevens GR. Pulmonary Congestion on Lung Ultrasound Predicts Increased Risk of 30-Day Readmission in Heart Failure Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36840718 DOI: 10.1002/jum.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Heart failure exacerbations are a common cause of hospitalizations with a high readmission rate. There are few validated predictors of readmission after treatment for acute decompensated heart failure (ADHF). Lung ultrasound (LUS) is sensitive and specific in the assessment of pulmonary congestion; however, it is not frequently utilized to assess for congestion before discharge. This study assessed the association between number of B-lines, on LUS, at patient discharge and risk of 30-day readmission in patients hospitalized for acute decompensated heart failure (ADHF). METHODS This was a single-center prospective study of adults admitted to a quaternary care center with a diagnosis of ADHF. At the time of discharge, the patient received an 8-zone LUS exam to evaluate for the presence of B-lines. A zone was considered positive if ≥3 B-lines was present. We assessed the risk of 30-day readmission associated with the number of lung zones positive for B-lines using a log-binomial regression model. RESULTS Based on data from 200 patients, the risk of 30-day readmission in patients with 2-3 positive lung zones was 1.25 times higher (95% CI: 1.08-1.45), and in patients with 4-8 positive lung zones was 1.50 times higher (95% CI: 1.23-1.82, compared with patients with 0-1 positive zones, after adjusting for discharge blood urea nitrogen, creatinine, and hemoglobin. CONCLUSION Among patients admitted with ADHF, the presence of B-lines at discharge was associated with a significantly increased risk of 30-day readmission, with greater number of lung zones positive for B-lines corresponding to higher risk.
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Affiliation(s)
- Allison Cohen
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Timmy Li
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Simon Maybaum
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - David Fridman
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
| | - Miles Gordon
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Columbia University, Manhattan, New York, USA
| | - Dorothy Shi
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, South Shore University Hospital, Bay Shore, New York, USA
| | - Mathew Nelson
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Gerin R Stevens
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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11
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Balabanova AA, Kurazhov AP, Zavadovskaya VD. Lung ultrasound in the diagnosis of COVID-19-associated pneumonia. BULLETIN OF SIBERIAN MEDICINE 2023. [DOI: 10.20538/1682-0363-2022-4-150-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Over the past decades, lung ultrasound in the diagnosis of lung diseases has become widespread. Ultrasound examination has a number of advantages (no radiation exposure, real-time imaging, clear visualization of the subpleural lung regions and costophrenic angles), which make it possible to use ultrasound to monitor the dynamics of pneumonia in children and pregnant women. Currently, in the context of the COVID-19 pandemic, lung ultrasound is widely used due to its high diagnostic efficiency, which is comparable with classical radiography and X-ray computed tomography (CT) by a number of parameters.The article describes the method of lung ultrasound and the radiographic pattern of COVID-19-associated pneumonia. It also provides a review of the literature, according to which the severity of pneumonia was determined, depending on the radiographic pattern, and the need for a lung ultrasound was identified.The article indicates that information on assessment of the radiographic pattern of the lungs at runtime in different variants of the course of coronavirus infection, as well as many methodological issues, including the frequency of second-look lung ultrasound, has not been sufficiently studied.
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Kwon H, Jo YH, Lee JH, Hwang JE, Park I, Kim S, Jang DH, Kim D, Chang H. MONITORING OF PULMONARY EDEMA USING ULTRASOUND RADIOFREQUENCY SIGNAL. Shock 2023; 59:118-124. [PMID: 36377364 DOI: 10.1097/shk.0000000000002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ABSTRACT Objectives: Excessive accumulation of extravascular lung water impairs respiratory gas exchange and results in respiratory distress. Real-time radiofrequency signals of ultrasound can continuously and quantitatively monitor excessive lung water. This study aims to evaluate the availability of continuous real-time quantitative pulmonary edema monitoring using ultrasound radiofrequency signals and compare it with Pa o2 (partial pressure of arterial oxygen)/F io2 (fraction of inspired oxygen) (PF) ratio, conventional lung ultrasound, and the Hounsfield unit of chest computed tomography. Methods: Male Yorkshire pigs (40.5 ± 0.5 kg) were anesthetized and mechanically ventilated. A balanced crystalloid was administered to induce hydrostatic pulmonary edema. Three different infusion rates of 2, 4, and 6 mL/kg per minute were tested to determine the infusion rate for the appropriate swine model. The chest computed tomography and ultrasonography with radiofrequency signals were taken every 5 min during the full inspiration. The ultrasonography scans with radiofrequency signals were measured at the intercostal space where the line crossing the two armpits and the right anterior axillary line intersected. Results: The infusion rate of fluid for the pulmonary edema model was determined to be 6 mL/kg per minute, and a total of four pigs were tested at an injection rate of 6 mL/kg. The adjusted R2 values of regression analysis between the radiofrequency signal and computer tomography Hounsfield score were 0.990, 0.993, 0.988, and 0.993 (all P values <0.05). All radiofrequency signal changes preceded changes in PF ratio or lung ultrasound changes. The area under the receiver operating characteristic curve of the radiofrequency signal for predicting PF ratio <300 was 0.88 (95% confidence interval, 0.82-0.93). Conclusion: We evaluated ultrasound radiofrequency signals to assess pulmonary edema in a swine model that can worsen gradually and showed that quantitative ultrasound radiofrequency signal analysis could assess pulmonary edema and its progression before PF ratio or lung ultrasound changes.
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Affiliation(s)
| | | | | | | | | | - Seonghye Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Hyun Jang
- Department of Emergency Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Doyun Kim
- Department of Emergency Medicine, Incheon Sarang Hospital, Incheon, Republic of Korea
| | - Hyunglan Chang
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia. Diagnostics (Basel) 2022; 12:diagnostics12123082. [PMID: 36553089 PMCID: PMC9776793 DOI: 10.3390/diagnostics12123082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/04/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background: In the setting of a coronary care unit (CCU), the early detection of pneumonia is of paramount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia and compared with chest X-ray (CXR). Method: We enrolled 110 consecutive patients admitted to the CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs. no pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n = 34). Results: The mean age was 70 ± 11 years old, and 68% were males. Pneumonia was clinically diagnosed in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92%, specificity 81%). Chest radiography was positive for pneumonia in nine patients (sensitivity 43%, specificity 95%). Using CT scan as a reference, LUS exhibited 92% sensitivity and a specificity of 96%. In ROC curve analysis, the diagnostic accuracy of CXR and LUS for the diagnosis of pneumonia was 0.86 (95% CI 0.77−0.94), which was higher than CXR 0.68 (95% CI 0.55−0.84), p < 0.05. Conclusion: Based on the findings of the present study, the accuracy of LUS in the detection of pneumonia was significantly higher than chest X-ray with comparable sensibility to CT scan.
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14
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Kok B, Wolthuis D, Bosch F, van der Hoeven H, Blans M. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Eur J Intern Med 2022; 106:9-38. [PMID: 35927185 DOI: 10.1016/j.ejim.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has been adopted as a powerful tool in acute medicine. This systematic review aims to critically appraise the existing literature on point-of-care ultrasound in respiratory or circulatory deterioration. METHODS Original studies on POCUS and dyspnea, nontraumatic hypotension, and shock from March 2002 until March 2022 were assessed in the PubMed and Embase Databases. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTS We included 89 articles in this review. Point-of-care ultrasound in the initial workup increases the diagnostic accuracy in patients with dyspnea, nontraumatic hypotension and shock in the ED, ICU and medical ward setting. No improvement is found in patients with severe sepsis in the ICU setting. POCUS is capable of narrowing the differential diagnoses and is faster, and more feasible in the acute setting than other diagnostics available. Results on outcome measures are heterogenous. The quality of the included studies is considered low most of the times, mainly because of performance and selection bias and absence of a gold standard as the reference test. CONCLUSION We conclude that POCUS contributes to a higher diagnostic accuracy in dyspnea, nontraumatic hypotension, and shock. It aides in narrowing the differential diagnoses and shortening the time to correct diagnosis and effective treatment. TRIAL REGISTRY INPLASY; Registration number: INPLASY202220020; URL: https://inplasy.com/.
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Affiliation(s)
- Bram Kok
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands.
| | - David Wolthuis
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands
| | - Frank Bosch
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands; Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands
| | | | - Michiel Blans
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands; Intensive Care Unit, Rijnstate, Arnhem, the Netherlands
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15
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Lee KK, Doudesis D, Anwar M, Astengo F, Chenevier-Gobeaux C, Claessens YE, Wussler D, Kozhuharov N, Strebel I, Sabti Z, deFilippi C, Seliger S, Moe G, Fernando C, Bayes-Genis A, van Kimmenade RRJ, Pinto Y, Gaggin HK, Wiemer JC, Möckel M, Rutten JHW, van den Meiracker AH, Gargani L, Pugliese NR, Pemberton C, Ibrahim I, Gegenhuber A, Mueller T, Neumaier M, Behnes M, Akin I, Bombelli M, Grassi G, Nazerian P, Albano G, Bahrmann P, Newby DE, Japp AG, Tsanas A, Shah ASV, Richards AM, McMurray JJV, Mueller C, Januzzi JL, Mills NL. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study. BMJ 2022; 377:e068424. [PMID: 35697365 PMCID: PMC9189738 DOI: 10.1136/bmj-2021-068424] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2012] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN Individual patient level data meta-analysis and modelling study. SETTING Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE Adjudicated diagnosis of acute heart failure. RESULTS Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. CONCLUSIONS In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. STUDY REGISTRATION PROSPERO CRD42019159407.
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Affiliation(s)
- Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Contributed equally
| | - Dimitrios Doudesis
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Contributed equally
| | - Mohamed Anwar
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Contributed equally
| | - Federica Astengo
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Yann-Erick Claessens
- Department of Emergency Medicine, Princess Grace Hospital Center, Monaco, Principality of Monaco
| | - Desiree Wussler
- Cardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ivo Strebel
- Cardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Zaid Sabti
- Cardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Stephen Seliger
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gordon Moe
- University of Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Carlos Fernando
- University of Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Spain
| | | | - Yigal Pinto
- University of Amsterdam, Amsterdam, Netherlands
| | - Hanna K Gaggin
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jan C Wiemer
- BRAHMS, Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Martin Möckel
- Department of Emergency and Acute Medicine with Chest Pain Units, Charité - Universitätsmedizin Berlin, Campus Mitte and Virchow, Berlin, Germany
| | - Joost H W Rutten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anton H van den Meiracker
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Nicola R Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, Singapore
| | - Alfons Gegenhuber
- Department of Internal Medicine, Krankenhaus Bad Ischl, Bad Ischl, Austria
| | - Thomas Mueller
- Department of Laboratory Medicine, Hospital Voecklabruck, Voecklabruck, Austria
| | - Michael Neumaier
- Institute for Clinical Chemistry, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michele Bombelli
- University of Milan Bicocca, ASST-Brianza, Pio XI Hospital of Desio, Internal Medicine, Desio, Italy
| | - Guido Grassi
- Clinica Medica, University Milan Bicocca, Milan, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Albano
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Philipp Bahrmann
- Department of Internal Medicine III, Division of Cardiology, University Hospital of Heidelberg, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alan G Japp
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Christian Mueller
- Cardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - James L Januzzi
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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17
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Szabó IA, Gargani L, Morvai-Illés B, Polestyuk-Németh N, Frigy A, Varga A, Ágoston G. Prognostic Value of Lung Ultrasound in Aortic Stenosis. Front Physiol 2022; 13:838479. [PMID: 35480045 PMCID: PMC9037236 DOI: 10.3389/fphys.2022.838479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Aortic stenosis (AS) is the most common primary valve lesion requiring intervention in Europe and North America. It has a prolonged subclinical period during which, as AS worsens, left ventricular adaptation becomes inadequate and impaired systolic and/or diastolic dysfunction may lead to overt heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a cardinal feature in HF, and lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, noninvasive tool to assess pulmonary congestion. Aim: To assess the presence and the prognostic value of sonographic pulmonary congestion in patients with moderate or severe AS. Methods: 75 consecutive patients (39 women, mean age 73.85 ± 7.7 years) with moderate or severe AS were enrolled. All patients underwent comprehensive echocardiography and LUS with the 28 scanning-site assessment. Patients were followed-up for 13.4 ± 6 months to establish the prognostic value of LUS. A composite endpoint of death (of any cause), hospitalization for HF and intensification of loop diuretic therapy was considered. Results: We found a severe degree of B-lines (≥30) in 29.33% of patients. The number of B-lines correlated with the estimated pulmonary artery systolic pressure (p < 0.001, r = 0.574) and increased along with NYHA class (p < 0.05, rho = 0.383). At multivariable analysis, B-lines ≥30, and mean gradient were the independent predictors of events [B-lines: 2.79 (CI 1.03–7.54), p = 0.04; mean gradient: 1.04 (CI 1.01–1.07), p = 0.004]. Conclusion: Evaluation of B-lines is a simple, highly feasible method to detect pulmonary congestion in AS. The number of B-lines correlates with the hemodynamic changes caused by AS and with the functional status of patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events.
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Affiliation(s)
- István Adorján Szabó
- GE Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mure, Tîrgu Mure, Romania
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Attila Frigy
- GE Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mure, Tîrgu Mure, Romania
| | - Albert Varga
- Department of Family Medicine, University of Szeged, Szeged, Hungary
| | - Gergely Ágoston
- Department of Family Medicine, University of Szeged, Szeged, Hungary
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18
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Morvai-Illés B, Polestyuk-Németh N, Szabó IA, Monoki M, Gargani L, Picano E, Varga A, Ágoston G. The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting. Front Cardiovasc Med 2021; 8:758147. [PMID: 34926610 PMCID: PMC8674474 DOI: 10.3389/fcvm.2021.758147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed. Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting. Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death. Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001). Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.
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Affiliation(s)
- Blanka Morvai-Illés
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Nóra Polestyuk-Németh
- Emergency Patient Care Unit, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Adorján Szabó
- Mures County Clinical Hospital, Cardiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Magdolna Monoki
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Albert Varga
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Gergely Ágoston
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Magrelli S, Valentini P, De Rose C, Morello R, Buonsenso D. Classification of Lung Disease in Children by Using Lung Ultrasound Images and Deep Convolutional Neural Network. Front Physiol 2021; 12:693448. [PMID: 34512375 PMCID: PMC8432935 DOI: 10.3389/fphys.2021.693448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/05/2021] [Indexed: 01/12/2023] Open
Abstract
Bronchiolitis is the most common cause of hospitalization of children in the first year of life and pneumonia is the leading cause of infant mortality worldwide. Lung ultrasound technology (LUS) is a novel imaging diagnostic tool for the early detection of respiratory distress and offers several advantages due to its low-cost, relative safety, portability, and easy repeatability. More precise and efficient diagnostic and therapeutic strategies are needed. Deep-learning-based computer-aided diagnosis (CADx) systems, using chest X-ray images, have recently demonstrated their potential as a screening tool for pulmonary disease (such as COVID-19 pneumonia). We present the first computer-aided diagnostic scheme for LUS images of pulmonary diseases in children. In this study, we trained from scratch four state-of-the-art deep-learning models (VGG19, Xception, Inception-v3 and Inception-ResNet-v2) for detecting children with bronchiolitis and pneumonia. In our experiments we used a data set consisting of 5,907 images from 33 healthy infants, 3,286 images from 22 infants with bronchiolitis, and 4,769 images from 7 children suffering from bacterial pneumonia. Using four-fold cross-validation, we implemented one binary classification (healthy vs. bronchiolitis) and one three-class classification (healthy vs. bronchiolitis vs. bacterial pneumonia) out of three classes. Affine transformations were applied for data augmentation. Hyperparameters were optimized for the learning rate, dropout regularization, batch size, and epoch iteration. The Inception-ResNet-v2 model provides the highest classification performance, when compared with the other models used on test sets: for healthy vs. bronchiolitis, it provides 97.75% accuracy, 97.75% sensitivity, and 97% specificity whereas for healthy vs. bronchiolitis vs. bacterial pneumonia, the Inception-v3 model provides the best results with 91.5% accuracy, 91.5% sensitivity, and 95.86% specificity. We performed a gradient-weighted class activation mapping (Grad-CAM) visualization and the results were qualitatively evaluated by a pediatrician expert in LUS imaging: heatmaps highlight areas containing diagnostic-relevant LUS imaging-artifacts, e.g., A-, B-, pleural-lines, and consolidations. These complex patterns are automatically learnt from the data, thus avoiding hand-crafted features usage. By using LUS imaging, the proposed framework might aid in the development of an accessible and rapid decision support-method for diagnosing pulmonary diseases in children using LUS imaging.
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Affiliation(s)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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20
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Faragli A, Abawi D, Quinn C, Cvetkovic M, Schlabs T, Tahirovic E, Düngen HD, Pieske B, Kelle S, Edelmann F, Alogna A. The role of non-invasive devices for the telemonitoring of heart failure patients. Heart Fail Rev 2021; 26:1063-1080. [PMID: 32338334 PMCID: PMC8310471 DOI: 10.1007/s10741-020-09963-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) patients represent one of the most prevalent as well as one of the most fragile population encountered in the cardiology and internal medicine departments nowadays. Estimated to account for around 26 million people worldwide, diagnosed patients present a poor prognosis and quality of life with a clinical history accompanied by repeated hospital admissions caused by an exacerbation of their chronic condition. The frequent hospitalizations and the extended hospital stays mean an extremely high economic burden for healthcare institutions. Meanwhile, the number of chronically diseased and elderly patients is continuously rising, and a lack of specialized physicians is evident. To cope with this health emergency, more efficient strategies for patient management, more accurate diagnostic tools, and more efficient preventive plans are needed. In recent years, telemonitoring has been introduced as the potential answer to solve such needs. Different methodologies and devices have been progressively investigated for effective home monitoring of cardiologic patients. Invasive hemodynamic devices, such as CardioMEMS™, have been demonstrated to be reducing hospitalizations and mortality, but their use is however restricted to limited cases. The role of external non-invasive devices for remote patient monitoring, instead, is yet to be clarified. In this review, we summarized the most relevant studies and devices that, by utilizing non-invasive telemonitoring, demonstrated whether beneficial effects in the management of HF patients were effective.
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Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Abawi
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - C Quinn
- Department of Biological Sciences, Rensselaer Polytechnic Institute, 110 Eighth Street, Troy, NY, USA
| | - M Cvetkovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - T Schlabs
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - E Tahirovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - H-D Düngen
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - B Pieske
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Edelmann
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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21
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Ward JL, Murphy SD, Lisciandro GR, Tropf MA, Viall AK, DeFrancesco TC. Comparison of curvilinear-array (microconvex) and phased-array transducers for ultrasonography of the lungs in dogs. Am J Vet Res 2021; 82:619-628. [PMID: 34296938 DOI: 10.2460/ajvr.82.8.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the use of curvilinear-array (microconvex) and phased-array transducers for ultrasonographic examination of the lungs in dogs. ANIMALS 13 client-owned dogs with left-sided congestive heart failure. PROCEDURES In a prospective methods comparison study, 24 ultrasonographic examinations of the lungs (4 sites/hemithorax) were performed with both curvilinear-array and phased-array transducers at 3 clinical time points. Two observers independently assessed the number of B lines (scored per site and in total), number of sites strongly positive for B lines (ie, those with > 3 B lines/site), and image quality (scored on a 5-point scale). Analyses included assessment of interobserver agreement with κ analysis, comparison of quality scores between transducers with mixed-effects modeling, and investigation of agreement and bias for B-line data and quality scores between transducers with Passing-Bablok regression. RESULTS Interobserver agreement for total B-line scores and number of strong-positive sites was excellent (κ > 0.80) for both transducers. There was no evidence of analytic bias for the number of B lines or strong-positive sites between transducers. Interobserver agreement for image quality scores was moderate (κ, 0.498 and 0.517 for the curvilinear-array and phased-array transducers, respectively). Both observers consistently assigned higher-quality scores to curvilinear-array images than to phased-array images. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated both curvilinear-array (microconvex) and phased-array transducers can be used by experienced sonographers to obtain diagnostic ultrasonographic images of the lungs in dogs with acute or resolving left-sided congestive heart failure and suggested the former transducer may be preferred, particularly to aid identification of anatomic landmarks for orientation.
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Affiliation(s)
- Jessica L Ward
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Shane D Murphy
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | | | - Melissa A Tropf
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Austin K Viall
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
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22
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Wang A, McCabe M, Gow-Lee E, James S, Austin B, Wailes D, Dinh V, Ramsingh D. Evaluation of a survey for acute care programme directors on the utilisation of point-of-care ultrasound. Postgrad Med J 2021; 98:694-699. [PMID: 37062971 DOI: 10.1136/postgradmedj-2021-140127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/21/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is ultrasound brought to the patient's bedside and performed in 'real time' by the healthcare provider. The utility of POCUS to facilitate management of the acutely ill patient has been demonstrated for multiple pathologies. However, the integration of ultrasonography and echocardiography training into residency curriculum varies across the acute care specialties. STUDY DESIGN After an institutional review board approval, anaesthesiology, emergency medicine, family medicine, internal medicine, paediatrics and general surgery programme directors (PDs) were surveyed. The survey consisted of 11 questions evaluating the primary bedside assessment tool for common acute care situations, POCUS topics that the PDs were comfortable practising and topics that the PDs felt were useful for their specialty. Barriers to POCUS use, certification and documentation were also surveyed. RESULTS Overall, 270 PD surveys were completed. The preferred primary assessment tool for common acute care situations varied with specialty; emergency medicine PDs consistently responded that POCUS was the diagnostic modality of choice (p<0.0001). The majority of the PDs reported lack of educational opportunities as the primary barrier to learning POCUS (64%). Most PDs indicated that POCUS examinations should be documented (95.7%), and 39% reported that departmental certification would be sufficient. CONCLUSIONS This study is the first to evaluate differences in the preferred initial bedside assessment tool between the acute care specialties. Although POCUS is a superior tool for evaluating acute pathologies, disconnect between education and utilisation remains. This study highlights the need to incorporate POCUS into the acute care specialty curriculum.
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Affiliation(s)
- Annie Wang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Melissa McCabe
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Esther Gow-Lee
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Stephanie James
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Briahnna Austin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Dustin Wailes
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Vi Dinh
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
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23
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Gargani L, Pugliese NR, Frassi F, Frumento P, Poggianti E, Mazzola M, De Biase N, Landi P, Masi S, Taddei S, Pang PS, Sicari R. Prognostic value of lung ultrasound in patients hospitalized for heart disease irrespective of symptoms and ejection fraction. ESC Heart Fail 2021; 8:2660-2669. [PMID: 33932105 PMCID: PMC8318481 DOI: 10.1002/ehf2.13206] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/14/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023] Open
Abstract
Aims Lung ultrasound B‐lines are the sonographic sign of pulmonary congestion and can be used in the differential diagnosis of dyspnoea to rule in or rule out acute heart failure (AHF). Our aim was to assess the prognostic value of B‐lines, integrated with echocardiography, in patients admitted to a cardiology department, independently of the initial clinical presentation, thus in patients with and without AHF, and in AHF with reduced and preserved ejection fraction (HFrEF and HFpEF). Methods and results We enrolled consecutive patients admitted for various cardiac conditions. Patients were classified into three groups: (i) acute HFrEF; (ii) acute HFpEF; and (iii) non‐AHF. All patients underwent an echocardiogram coupled with lung ultrasound at admission, according to standardized protocols. We followed up 1021 consecutive inpatients (69 ± 12 years) for a median of 14.4 months (interquartile range 4.6–24.3) for death and rehospitalization for AHF. During the follow‐up, 126 events occurred. Admission B‐lines > 30, ejection fraction < 50%, tricuspid regurgitation velocity > 2.8 m/s, and tricuspid annular plane systolic excursion < 17 mm were independent predictors at multivariable analysis. B‐lines > 30 had a strong predictive value in HFpEF and non‐AHF, but not in HFrEF. Conclusions Ultrasound B‐lines can detect subclinical pulmonary interstitial oedema in patients thought to be free of congestion and provide useful information not only for the diagnosis but also for the prognosis in different cardiac conditions. Their added prognostic value among standard echocardiographic parameters is more robust in patients with HFpEF compared with HFrEF.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | | | - Francesca Frassi
- Emergency Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | | | - Matteo Mazzola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA
| | - Rosa Sicari
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
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24
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Araiza-Garaygordobil D, Gopar-Nieto R, Martínez-Amezcua P, Cabello-López A, Manzur-Sandoval D, García-Cruz E, De la Fuente-Mancera JC, Martínez-Gutiérrez J, Luna-Carrera MJ, Lerma-Landeros E, Gutiérrez-González FM, González-Pacheco H, Briseño-De la Cruz JL, Arias-Mendoza A. Point-of-care lung ultrasound predicts in-hospital mortality in acute heart failure. QJM 2021; 114:111-116. [PMID: 33151302 DOI: 10.1093/qjmed/hcaa298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/15/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung ultrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined. AIM To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF. METHODS Hand-held LUS was used to examine patients with acute HF. LUS was performed in eight chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models. RESULTS We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal receiver operating characteristic-determined cut-off of ≥19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (area under the curve 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0-18.8, P = 0.02). Patients with ≥19 B-lines had a 4-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37-13.95, P < 0.01). CONCLUSION In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.
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Affiliation(s)
- D Araiza-Garaygordobil
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - R Gopar-Nieto
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - P Martínez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Wolfe Street 615, Baltimore 21205, Maryland, USA
| | - A Cabello-López
- Unidad de Investigación de Salud en el Trabajo, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Doctores, Cuauhtémoc 06720, Mexico City, Mexico
| | - D Manzur-Sandoval
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, Mexico City, Mexico
| | - E García-Cruz
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, Mexico City, Mexico
| | - J C De la Fuente-Mancera
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - J Martínez-Gutiérrez
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - M J Luna-Carrera
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - E Lerma-Landeros
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - F M Gutiérrez-González
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - H González-Pacheco
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - J L Briseño-De la Cruz
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
| | - A Arias-Mendoza
- Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico
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Abstract
PURPOSE OF REVIEW Among noninvasive lung imaging techniques that can be employed at the bedside electrical impedance tomography (EIT) and lung ultrasound (LUS) can provide dynamic, repeatable data on the distribution regional lung ventilation and response to therapeutic manoeuvres.In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT and Point of Care Ultrasound (PoCUS, mainly but not limited to LUS) in the management of mechanically ventilated patients. RECENT FINDINGS The use of EIT in clinical practice is supported by several studies demonstrating good correlation between impedance tomography data and other validated methods of assessing lung aeration during mechanical ventilation. Similarly, LUS also correlates with chest computed tomography in assessing lung aeration, its changes and several pathological conditions, with superiority over other techniques. Other PoCUS applications have shown to effectively complement the LUS ultrasound assessment of the mechanically ventilated patient. SUMMARY Bedside techniques - such as EIT and PoCUS - are becoming standards of the care for mechanically ventilated patients to monitor the changes in lung aeration, ventilation and perfusion in response to treatment and to assess weaning from mechanical ventilation.
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Lung Ultrasound: Its Findings and New Applications in Neonatology and Pediatric Diseases. Diagnostics (Basel) 2021; 11:diagnostics11040652. [PMID: 33916882 PMCID: PMC8066390 DOI: 10.3390/diagnostics11040652] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Lung ultrasound has become increasingly used in both adult and pediatric populations, allowing the rapid evaluation of many lung and pleura diseases. This popularity is due to several advantages of the method such as the low cost, rapidity, lack of ionizing radiation, availability of bedside and repeatability of the method. These features are even more important after the outbreak of the SARS-CoV-2 pandemic, given the possibility of recognizing through ultrasound the signs of interstitial lung syndrome typical of pneumonia caused by the virus. The purpose of this paper is to review the available evidence of lung ultrasound (LUS) in children and its main applications in pediatric diseases.
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Bidaut A, Hubert A, Charton M, Paven E, Leclercq C, Galli E, Donal E. One year prognostic value of B-lines in dyspnoeic patients. ESC Heart Fail 2021; 8:1759-1766. [PMID: 33704921 PMCID: PMC8120353 DOI: 10.1002/ehf2.12739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Auriane Bidaut
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
| | - Arnaud Hubert
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
| | - Marion Charton
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
| | - Elise Paven
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
| | - Christophe Leclercq
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
| | - Elena Galli
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
| | - Erwan Donal
- Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France.,INSERM, Rennes, France
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Msolli MA, Sekma A, Marzouk MB, Chaabane W, Bel Haj Ali K, Boukadida L, Bzeouich N, Gannoun I, Trabelssi I, Laaouiti K, Grissa MH, Beltaief K, Dridi Z, Belguith A, Methamem M, Bouida W, Boukef R, Boubaker H, Nouira S. Bedside lung ultrasonography by emergency department residents as an aid for identifying heart failure in patients with acute dyspnea after a 2-h training course. Ultrasound J 2021; 13:5. [PMID: 33559777 PMCID: PMC7873143 DOI: 10.1186/s13089-021-00207-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea. PATIENTS AND METHODS This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18 years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients' clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leading diagnosis was assessed by two expert sonographers, who were blinded to the residents' interpretations, based on clinical findings, chest X-ray, brain natriuretic peptide, cardiac and lung ultrasound testing. Accuracy and agreement of B-lines score and B-profile pattern were calculated. RESULTS We included 700 patients with a mean age of 68 ± 12.6 years and a sex ratio (M/F) of 1.43. The diagnosis of CHF was recorded in 371 patients (53%). The diagnostic performance of B-lines score at a cut-off 15 and B-profile pattern was, respectively, 88% and 82.5% for sensitivity, 75% and 84% for specificity, 80% and 85% for positive predictive value, 84% and 81% for negative predictive value. The area under receiver operating characteristic curve was 0.86 [0.83-0.89] and 0.83 [0.80-0.86], respectively, for B-lines score and B-profile pattern. There was an excellent agreement between residents for the diagnosis of CHF using both scores (kappa = 0.81 and 0.85, respectively, for ordinal scale B-lines score and B-profile pattern). CONCLUSION Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry: clinicaltrials.gov; Trial registration number: NCT03717779; Date of registration: October 24, 2018 'Retrospectively registered'; URL of trial registry record: clinicaltrials.gov.
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Affiliation(s)
- Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Maryem Ben Marzouk
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Wael Chaabane
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
| | - Lotfi Boukadida
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Imen Trabelssi
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Kamel Laaouiti
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Zohra Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Asma Belguith
- Department of Preventive Medicine, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Mehdi Methamem
- Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
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Second-order grey-scale texture analysis of pleural ultrasound images to differentiate acute respiratory distress syndrome and cardiogenic pulmonary edema. J Clin Monit Comput 2020; 36:131-140. [PMID: 33313979 PMCID: PMC8894303 DOI: 10.1007/s10877-020-00629-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022]
Abstract
Discriminating acute respiratory distress syndrome (ARDS) from acute cardiogenic pulmonary edema (CPE) may be challenging in critically ill patients. Aim of this study was to investigate if gray-level co-occurrence matrix (GLCM) analysis of lung ultrasound (LUS) images can differentiate ARDS from CPE. The study population consisted of critically ill patients admitted to intensive care unit (ICU) with acute respiratory failure and submitted to LUS and extravascular lung water monitoring, and of a healthy control group (HCG). A digital analysis of pleural line and subpleural space, based on the GLCM with second order statistical texture analysis, was tested. We prospectively evaluated 47 subjects: 16 with a clinical diagnosis of CPE, 8 of ARDS, and 23 healthy subjects. By comparing ARDS and CPE patients' subgroups with HCG, the one-way ANOVA models found a statistical significance in 9 out of 11 GLCM textural features. Post-hoc pairwise comparisons found statistical significance within each matrix feature for ARDS vs. CPE and CPE vs. HCG (P ≤ 0.001 for all). For ARDS vs. HCG a statistical significance occurred only in two matrix features (correlation: P = 0.005; homogeneity: P = 0.048). The quantitative method proposed has shown high diagnostic accuracy in differentiating normal lung from ARDS or CPE, and good diagnostic accuracy in differentiating CPE and ARDS. Gray-level co-occurrence matrix analysis of LUS images has the potential to aid pulmonary edemas differential diagnosis.
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30
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Murphy SD, Ward JL, Viall AK, Tropf MA, Walton RL, Fowler JL, Ware WA, DeFrancesco TC. Utility of point-of-care lung ultrasound for monitoring cardiogenic pulmonary edema in dogs. J Vet Intern Med 2020; 35:68-77. [PMID: 33270302 PMCID: PMC7848339 DOI: 10.1111/jvim.15990] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023] Open
Abstract
Background Point‐of‐care lung ultrasound (LUS) is an effective tool to diagnose left‐sided congestive heart failure (L‐CHF) in dogs via detection of ultrasound artifacts (B‐lines) caused by increased lung water. Hypothesis/Objectives To determine whether LUS can be used to monitor resolution of cardiogenic pulmonary edema in dogs, and to compare LUS to other indicators of L‐CHF control. Animals Twenty‐five client‐owned dogs hospitalized for treatment of first‐onset L‐CHF. Methods Protocolized LUS, thoracic radiographs (TXR), and plasma N‐terminal pro‐B‐type natriuretic peptide were performed at hospital admission, hospital discharge, and recheck examinations. Lung ultrasound findings were compared between timepoints and to other clinical measures of L‐CHF. Results From time of hospital admission to discharge (mean 19.6 hours), median number of LUS sites strongly positive for B‐lines (>3 B‐lines per site) decreased from 5 (range, 1‐8) to 1 (range, 0‐5; P < .001), and median total B‐line score decreased from 37 (range, 6‐74) to 5 (range, 0‐32; P = .002). Lung ultrasound indices remained improved at first recheck (P < .001). Number of strong positive sites correlated positively with respiratory rate (r = 0.52, P = .008) and TXR edema score (r = 0.51, P = .009) at hospital admission. Patterns of edema resolution differed between LUS and TXR, with cranial quadrants showing more significant reduction in B‐lines compared to TXR edema score (80% vs 29% reduction, respectively; P = .003). Conclusions and Clinical Importance Lung ultrasound could be a useful tool for monitoring resolution of pulmonary edema in dogs with L‐CHF.
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Affiliation(s)
- Shane D Murphy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Austin K Viall
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Melissa A Tropf
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca L Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jennifer L Fowler
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA.,Present address: Jennifer L. Fowler, Idexx Laboratories, 1 Idexx Dr., Westbrook, ME, USA
| | - Wendy A Ware
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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31
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Pellicori P, Platz E, Dauw J, Ter Maaten JM, Martens P, Pivetta E, Cleland JGF, McMurray JJV, Mullens W, Solomon SD, Zannad F, Gargani L, Girerd N. Ultrasound imaging of congestion in heart failure: examinations beyond the heart. Eur J Heart Fail 2020; 23:703-712. [PMID: 33118672 DOI: 10.1002/ejhf.2032] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state-of-the-art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).
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Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jozine M Ter Maaten
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, University of Turin, Turin, Italy
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
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32
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Palazzuoli A, Evangelista I, Nuti R. Congestion occurrence and evaluation in acute heart failure scenario: time to reconsider different pathways of volume overload. Heart Fail Rev 2020; 25:119-131. [PMID: 31628648 DOI: 10.1007/s10741-019-09868-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although congestion is considered to be the main reason for hospital admission in patients with acute heart failure, a simplistic view considering idro saline retention and total body volume accumulation did not provide convincing data. Clinical congestion occurrence is often the tip of the iceberg of several different mechanisms ranging from increased filling pressure to extravascular fluid accumulation and blood flow redistribution. Therefore, the clinical evaluation is often restricted to a simple physical examination including few and inaccurate signs and symptoms. This superficial approach has led to contradictory data and patients have not been evaluated according to a more realistic clinical scenario. The integration with new diagnostic ultrasonographic and laboratory tools would substantially improve these weaknesses. Indeed, congestion could be assessed by following the most recognized HF subtypes including primitive cardiac defect, presence of right ventricular dysfunction, and organ perfusion. Moreover, there is a tremendous gap regarding the interchangeable concept of fluid retention and redistribution used with a univocal meaning. Overall, congestion assessment should be revised, considering it as either central, peripheral, or both. In this review, we aim to provide different evidence regarding the concept of congestion starting from the most recognized pathophysiological mechanisms of AHF decompensation. We highlight the fact that a better knowledge of congestion is a challenge for future investigation and it could lead to significant advances in HF treatment.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Viale Bracci, Siena, 53100, Italy.
| | - Isabella Evangelista
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Viale Bracci, Siena, 53100, Italy
| | - Ranuccio Nuti
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Viale Bracci, Siena, 53100, Italy
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33
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Reddy YNV, Obokata M, Wiley B, Koepp KE, Jorgenson CC, Egbe A, Melenovsky V, Carter RE, Borlaug BA. The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction. Eur Heart J 2020; 40:3721-3730. [PMID: 31609443 DOI: 10.1093/eurheartj/ehz713] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/11/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS Increases in extravascular lung water (EVLW) during exercise contribute to symptoms, morbidity, and mortality in patients with heart failure and preserved ejection fraction (HFpEF), but the mechanisms leading to pulmonary congestion during exercise are not well-understood. METHODS AND RESULTS Compensated, ambulatory patients with HFpEF (n = 61) underwent invasive haemodynamic exercise testing using high-fidelity micromanometers with simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise. The presence or absence of EVLW was determined by lung ultrasound to evaluate for sonographic B-line artefacts. An increase in EVLW during exercise was observed in 33 patients (HFpEFLW+, 54%), while 28 (46%) did not develop EVLW (HFpEFLW-). Resting left ventricular function was similar in the groups, but right ventricular (RV) dysfunction was two-fold more common in HFpEFLW+ (64 vs. 31%), with lower RV systolic velocity and RV fractional area change. As compared to HFpEFLW-, the HFpEFLW+ group displayed higher pulmonary capillary wedge pressure (PCWP), higher pulmonary artery (PA) pressures, worse RV-PA coupling, and higher right atrial (RA) pressures during exercise, with increased haemoconcentration indicating greater loss of water from the vascular space. The development of lung congestion during exercise was significantly associated with elevations in PCWP and RA pressure as well as impairments in RV-PA coupling (area under the curve values 0.76-0.84). CONCLUSION Over half of stable outpatients with HFpEF develop increases in interstitial lung water, even during submaximal exercise. The acute development of lung congestion is correlated with increases in pulmonary capillary hydrostatic pressure that favours fluid filtration, and systemic venous hypertension due to altered RV-PA coupling, which may interfere with fluid clearance. CLINICAL TRIAL REGISTRATION NCT02885636.
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Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Brandon Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Katlyn E Koepp
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Caitlin C Jorgenson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Alexander Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Vojtech Melenovsky
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Rickey E Carter
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 First Street SW, MN, USA
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34
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Demi L. Lung ultrasound: The future ahead and the lessons learned from COVID-19. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:2146. [PMID: 33138522 PMCID: PMC7857508 DOI: 10.1121/10.0002183] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Lung ultrasound (LUS) is a rapidly evolving field of application for ultrasound technologies. Especially during the current pandemic, many clinicians around the world have employed LUS to assess the condition of the lung for patients suspected and/or affected by COVID-19. However, LUS is currently performed with standard ultrasound imaging, which is not designed to cope with the high air content present in lung tissues. Nowadays LUS lacks standardization and suffers from the absence of quantitative approaches. To elevate LUS to the level of other ultrasound imaging applications, several aspects deserve attention from the technical and clinical world. This overview piece tries to provide the reader with a forward-looking view on the future for LUS.
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Affiliation(s)
- Libertario Demi
- Ultrasound Laboratory Trento (ULTRa), Department of Information Engineering and Computer Science, University of Trento, Via Sommarive 9, 38123, Trento, Italy
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35
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CONANGLA LAURA, DOMINGO MAR, LUPÓN JOSEP, WILKE ASUNCIÓN, JUNCÀ GLADYS, TEJEDOR XAVIER, VOLPICELLI GIOVANNI, EVANGELISTA LIDIA, PERA GUILLEM, TORAN PERE, MAS ARIADNA, CEDIEL GERMÁN, VERDÚ JOSÉMARÍA, BAYES-GENIS ANTONI. Lung Ultrasound for Heart Failure Diagnosis in Primary Care. J Card Fail 2020; 26:824-831. [DOI: 10.1016/j.cardfail.2020.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/07/2023]
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36
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La Franca E, Manno G, Ajello L, Di Gesaro G, Minà C, Visconti C, Bellavia D, Falletta C, Romano G, Dell' Oglio S, Licata P, Caronia A, Gallo M, Clemenza F. Physiopathology and Diagnosis of Congestive Heart Failure: Consolidated Certainties and New Perspectives. Curr Probl Cardiol 2020; 46:100691. [PMID: 33012532 DOI: 10.1016/j.cpcardiol.2020.100691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 12/01/2022]
Abstract
Volume overload and fluid congestion are a fundamental issue in the assessment and management of patients with heart failure (HF). Recent studies have found that in acute decompensated heart failure (ADHF), right and left-sided pressures generally start to increase before any notable weight changes take place preceding an admission. ADHF may be a problem of volume redistribution among different vascular compartments instead of, or in addition to, fluid shift from the interstitial compartment. Thus, identifying heterogeneity of volume overload would allow guidance of tailored therapy. A comprehensive evaluation of congestive HF needs to take into account myriad parameters, including physical examination, echocardiographic values, and biomarker serum changes. Furthermore, potentially useful diagnostic tools include bioimpedance to measure intercompartmental fluid shifts, and evaluation of ultrasound lung comets to detect extravascular lung water.
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37
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Gargani L, Soliman-Aboumarie H, Volpicelli G, Corradi F, Pastore MC, Cameli M. Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution. Eur Heart J Cardiovasc Imaging 2020; 21:941-948. [PMID: 32515793 PMCID: PMC7314093 DOI: 10.1093/ehjci/jeaa163] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Hatem Soliman-Aboumarie
- Department of Anaesthesia and Critical Care', Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.,Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, Genova, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Glöckner E, Wening F, Christ M, Dechêne A, Singler K. Lung Ultrasound Eight-Point Method in Diagnosing Acute Heart Failure in Emergency Patients with Acute Dyspnea: Diagnostic Accuracy and 72 h Monitoring. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56080379. [PMID: 32731477 PMCID: PMC7466324 DOI: 10.3390/medicina56080379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022]
Abstract
Background and Objectives: Acute dyspnea is a common chief complaint in the emergency department (ED), with acute heart failure (AHF) as a frequent underlying disease. Early diagnosis and rapid therapy are highly recommended by international guidelines. This study evaluates the accuracy of point-of-care B-line lung ultrasound in diagnosing AHF and monitoring the therapeutic success of heart failure patients. Materials and Methods: This is a prospective mono-center study in adult patients presenting with undifferentiated acute dyspnea to a German ED. An eight-zone pulmonary ultrasound was performed by experienced sonographers in the ED and 24 and 72 h after. Along with the lung ultrasound evaluation patients were asked to assess the severity of shortness of breath on a numeric rating scale. The treating ED physicians were asked to assess the probability of AHF as the underlying cause. Final diagnosis was adjudicated by two independent experts. Follow-up was done after 30 and 180 days. Results: In total, 102 patients were enrolled. Of them, 89 patients received lung ultrasound evaluation in the ED. The sensitivity of lung ultrasound evaluation in ED in diagnosing AHF was 54.2%, specificity 97.6%. As much as 96.3% of patients with a positive LUS test result for AHF in ED actually suffered from AHF. Excluding diuretically pretreated patients, sensitivity of LUS increased to 75% in ED. Differences in the sum of B-lines between admission time point, 24 and 72 h were not statistically significant. There were no statistically significant differences in the subjectively assessed severity of dyspnea between AHF patients and those with other causes of dyspnea. Of the 89 patients, 48 patients received the final adjudicated diagnosis of AHF. ED physicians assessed the probability of AHF in patients with a final diagnosis of AHF as 70%. Roughly a quarter (23.9%) of the overall cohort patients were rehospitalized within 30 days after admission, 38.6% within 180 days of follow-up. Conclusion: In conclusion, point-of-care lung ultrasound is a helpful tool for the early rule-in of acute heart failure in ED but only partially suitable for exclusion. Of note, the present study shows no significant changes in the number of B-lines after 24 and 72 h.
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Affiliation(s)
- Erika Glöckner
- Department of Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutrition, Klinikum Nuernberg, Paracelsus Medical University Nuernberg, 90419 Nuernberg, Germany;
- Correspondence: ; Tel.: +49(911)-398-114402
| | - Felicitas Wening
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nürnberg, Paracelsus Medical University Nuernberg, 90419 Nuernberg, Germany;
| | - Michael Christ
- Emergency Department, Luzerner Kantonsspital, 6000 Luzern, Switzerland;
| | - Alexander Dechêne
- Department of Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutrition, Klinikum Nuernberg, Paracelsus Medical University Nuernberg, 90419 Nuernberg, Germany;
| | - Katrin Singler
- Department of Geriatrics, Klinikum Nuernberg, Paracelsus Medical University, 90419 Nuernberg, Germany;
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nuernberg, 90419 Nuernberg, Germany
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Alexandrou ME, Balafa O, Sarafidis P. Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques. Am J Nephrol 2020; 51:589-612. [PMID: 32721969 DOI: 10.1159/000509115] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The majority of patients undergoing peritoneal dialysis (PD) suffer from volume overload and this overhydration is associated with increased mortality. Thus, optimal assessment of volume status in PD is an issue of paramount importance. Patient symptoms and physical signs are often unreliable indexes of true hydration status. SUMMARY Over the past decades, a quest for a valid, reproducible, and easily applicable technique to assess hydration status is taking place. Among existing techniques, inferior vena cava diameter measurements with echocardiography and natriuretic peptides such as brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were not extensively examined in PD populations; while having certain advantages, their interpretation are complicated by the underlying cardiac status and are not widely available. Bioelectrical impedance analysis (BIA) techniques are the most studied tool assessing volume overload in PD. Volume overload assessed with BIA has been associated with technique failure and increased mortality in observational studies, but the results of randomized trials on the value of BIA-based strategies to improve volume-related outcomes are contradictory. Lung ultrasound (US) is a recent technique with the ability to identify volume excess in the critical lung area. Preliminary evidence in PD showed that B-lines from lung US correlate with echocardiographic parameters but not with BIA measurements. This review presents the methods currently used to assess fluid status in PD patients and discusses existing data on their validity, applicability, limitations, and associations with intermediate and hard outcomes in this population. Key Message: No method has proved its value as an intervening tool affecting cardiovascular events, technique, and overall survival in PD patients. As BIA and lung US estimate fluid overload in different compartments of the body, they can be complementary tools for volume status assessment.
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Affiliation(s)
- Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece,
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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40
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Russell FM, Ferre R, Ehrman RR, Noble V, Gargani L, Collins SP, Levy PD, Fabre KL, Eckert GJ, Pang PS. What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines? ESC Heart Fail 2020; 7:2941-2947. [PMID: 32697034 PMCID: PMC7524048 DOI: 10.1002/ehf2.12907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS The goal of this study was to determine the number of scans needed for novice learners to attain proficiency in B-line quantification compared with expert interpretation. METHODS AND RESULTS This was a prospective, multicentre observational study of novice learners, physicians and non-physicians from three academic institutions. Learners received a 2 h lung ultrasound (LUS) training session on B-line assessment, including lecture, video review to practice counting and hands-on patient scanning. Learners quantified B-lines using an eight-zone scanning protocol in patients with suspected acute heart failure. Ultrasound (US) machine settings were standardized to a depth of 18 cm and clip length of 6 s, and tissue harmonics and multibeam former were deactivated. For quantification, the intercostal space with the greatest number of B-lines within each zone was used for scoring. Each zone was given a score of 0-20 based on the maximum number of B-lines counted during one respiratory cycle. The B-line score was determined by multiplying the percentage of the intercostal space filled with B-lines by 20. We compared learner B-line counts with a blinded expert reviewer (five US fellowship-trained faculty with > 5 years of clinical experience) for each lung zone scanned; proficiency was defined as an intraclass correlation of > 0.7. Learning curves for each learner were constructed using cumulative sum method for statistical analysis. The Wilcoxon rank-sum test was used to compare the number of scans required to reach proficiency between different learner types. Twenty-nine learners (21 research associates, 5 residents and 3 non-US-trained emergency medicine faculty) scanned 2629 lung zones with acute pulmonary oedema. After a mean of 10.8 (standard deviation 14.0) LUS zones scanned, learners reached the predefined proficiency standard. The number of scanned zones required to reach proficiency was not significantly different between physicians and non-physicians (P = 0.26), learners with no prior US experience vs. > 25 prior patient scans (P = 0.64) and no prior vs. some prior LUS experience (P = 0.59). The overall intraclass correlation for agreement between learners and experts was 0.74 and 0.80 between experts. CONCLUSIONS Our results show that after a short, structured training, novice learners are able to achieve proficiency for quantifying B-lines on LUS after scanning 11 zones. These findings support the use of LUS for B-line quantification by non-physicians in clinical and research applications.
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Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robinson Ferre
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vicki Noble
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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41
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Toma TP, Volpicelli G. Essential Image Acquisition Protocols for Thoracic Ultrasonography. Respiration 2020; 99:231-238. [PMID: 32101863 DOI: 10.1159/000503585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
Image acquisition is the technique of correct placement, holding, and manipulation of the ultrasound probe in an ultrasound examination for the purpose of answering a specific clinical question. We review the literature and discuss the image acquisition protocols used for thoracic ultrasound, explaining, where possible, the associated advantages, disadvantages, and alternatives. A better understanding of how to fine-tune image acquisition specifically for thoracic ultrasound will help physicians on all levels to standardise their practice and improve networking and collaboration. It will also lead to better-quality investigations and, potentially, new applications.
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Affiliation(s)
- Tudor P Toma
- Respiratory Medicine, University Hospital Lewisham & Greenwich NHS Trust, London, United Kingdom,
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42
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Arystan AZ, Khamzina YT, Benberin VV, Fettser DV, Belenkov YN. [Lung Ultrasound: new Opportunities for a Cardiologist]. KARDIOLOGIIA 2020; 60:81-92. [PMID: 32245358 DOI: 10.18087/cardio.2020.1.n617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 06/11/2023]
Abstract
This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.
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Affiliation(s)
- A Z Arystan
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - Y T Khamzina
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - V V Benberin
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - D V Fettser
- Municipal Clinical Hospital #52 at the Health Care Department of Moscow City
| | - Y N Belenkov
- I.M. Sechenov First Moscow State Medical University
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43
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Abstract
Abnormal fluid handling leads to physiologic abnormalities in multiple organ systems. Deranged hemodynamics, neurohormonal activation, excessive tubular sodium reabsorption, inflammation, oxidative stress, and nephrotoxic medications are important drivers of harmful cardiorenal interactions in patients with heart failure. Accurate quantitative measurement of fluid volume is vital to individualizing therapy for such patients. Blood volume analysis and pulmonary artery pressure monitoring seem the most reliable methods for assessing fluid volume and guiding decongestive therapies. Still the cornerstone of decongestive therapy, diuretics' effectiveness decreases with progression of heart failure. Extracorporeal ultrafiltration, an alternative to diuretics, has been shown to reduce heart-failure events.
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Affiliation(s)
- Maria Rosa Costanzo
- Heart Failure Research, Advocate Heart Institute, Edward Hospital Center for Advanced Heart Failure, 801 South Washington Street, Naperville, IL, USA.
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44
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Abstract
Lung ultrasound (LUS) is a growing and fascinating field of application for ultrasound imaging. Despite the difficulties in imaging an organ largely filled with air, the potential benefits originating from an effective ultrasound method focusing on monitoring and diagnosing lung diseases represent a tremendous stimulus for research in this direction. This paper presents a technical review where, after a brief historical overview, the current limitations of LUS imaging are discussed together with a description of the physical phenomena at stake. Next, the paper focuses on the latest technical developments of LUS.
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45
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Gargani L, Ferre RM, Pang PS. B‐lines in heart failure: will comets guide us? Eur J Heart Fail 2019; 21:1616-1618. [DOI: 10.1002/ejhf.1641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council Pisa Italy
| | - Robinson M. Ferre
- Department of Emergency Medicine, Indiana University School of Medicine Indianapolis IN USA
| | - Peter S. Pang
- Department of Emergency Medicine, Indiana University School of Medicine Indianapolis IN USA
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46
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Picano E, Scali MC, Ciampi Q, Lichtenstein D. Lung Ultrasound for the Cardiologist. JACC Cardiovasc Imaging 2019; 11:1692-1705. [PMID: 30409330 DOI: 10.1016/j.jcmg.2018.06.023] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/25/2018] [Accepted: 06/19/2018] [Indexed: 02/06/2023]
Abstract
For a cardiologist, lung ultrasound is an add-on to transthoracic echocardiography, just as lung auscultation is part of a cardiac physical examination. A cardiac 3.5- to 5.0-MHz transducer is generally suitable because the small footprint makes it ideal for scanning intercostal spaces. The image quality is often adequate, and the lung acoustic window is always patent. The cumulative increase in imaging time is <1 min for the 2 main applications targeted on pleural water (pleural effusion) and lung water (pulmonary congestion as multiple B-lines). In these settings, lung ultrasound outperforms the diagnostic accuracy of the chest radiograph, with a low-cost, portable, real-time, radiation-free method. A "wet lung" detected by lung ultrasound predicts impending acute heart failure decompensation and may trigger lung decongestion therapy. The doctors of tomorrow may still listen with a stethoscope to their patient's lung, but they will certainly be seeing it with ultrasound.
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Affiliation(s)
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Daniel Lichtenstein
- Medical Intensive Care Unit, Ambroise-Paré Hospital, Paris-West University, Boulogne, France
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47
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Rivas‐Lasarte M, Álvarez‐García J, Fernández‐Martínez J, Maestro A, López‐López L, Solé‐González E, Pirla MJ, Mesado N, Mirabet S, Fluvià P, Brossa V, Sionis A, Roig E, Cinca J. Lung ultrasound‐guided treatment in ambulatory patients with heart failure: a randomized controlled clinical trial (LUS‐HF study). Eur J Heart Fail 2019; 21:1605-1613. [DOI: 10.1002/ejhf.1604] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mercedes Rivas‐Lasarte
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Jesús Álvarez‐García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Juan Fernández‐Martínez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Alba Maestro
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Laura López‐López
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Eduard Solé‐González
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Maria J. Pirla
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Nuria Mesado
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Sonia Mirabet
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Paula Fluvià
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Vicens Brossa
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Eulàlia Roig
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCVUniversitat Autónoma de Barcelona Barcelona Spain
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48
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Buonsenso D, Musolino AM, Gatto A, Lazzareschi I, Curatola A, Valentini P. Lung ultrasound in infants with bronchiolitis. BMC Pulm Med 2019; 19:159. [PMID: 31445523 PMCID: PMC6708215 DOI: 10.1186/s12890-019-0925-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
Lung ultrasound (LUS) is nowadays a fast-growing field of study since the technique has been widely acknowledged as a cost-effective, radiation free, and ready available alternative to standard X-ray imaging. However, despite extensive acoustic characterization studies and documented medical evidences, a lot is still unknown about how ultrasounds interact with lung tissue. One of the most discussed lung artifacts are the B-lines [in all ages] and the subpleural consolidations (in young infants). Recently, LUS has been claimed to be able to detect pneumonia in infants with bronchiolitis, although this can be an overestimation due to the peculiar physiology of small peripheral airways of the pediatric lung (particularly in neonate/infants). Distinguishing consolidations from atelectasis in young infants with bronchiolitis can be challenging and those criteria well defined for adults and older children (size and bronchogram) cannot easily translated in this specific subset. Therefore, if decades of studies clearly defined the low risk of SBI in bronchiolitis, we need to be careful before stating that LUS may confirm pneumonia in such a high number of cases and, importantly, new and promising techniques such as LUS should give us new insights bringing us to improvements and not back to overuse of antibiotics. More studies are surely need on this topic.
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Affiliation(s)
- Danilo Buonsenso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. .,Universita Cattolica del Sacro Cuore, Roma, Italy.
| | - Anna Maria Musolino
- Department of Pediatric Emergency, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Gatto
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Piero Valentini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma, Italy
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49
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Bailón MM, Rodrigo JMC, Lorenzo-Villalba N, Cerqueiro JM, García JC, Manuel EC, Martín-Sánchez FJ, Freire RB, Romano PC, Espinosa LM, Arévalo-Lorido JC, Rojo JMC, Macho JT. Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study). Cardiovasc Drugs Ther 2019; 33:453-459. [PMID: 31332655 DOI: 10.1007/s10557-019-06891-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound has shown to be highly sensitive for detecting PC in HF. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF compared with conventional treatment. MATERIALS AND METHODS Randomized, multicenter, single-blind clinical trial in patients discharged from Internal Medicine Departments after hospitalization for decompensated HF. Participants will be assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus clinical assessment of congestion. The primary outcome is the combination of cardiovascular death and readmission for HF at 6 months. CONCLUSIONS The results of this study will provide more evidence about the impact of lung ultrasound on treatment monitoring in patients with chronic HF.
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Affiliation(s)
- Manuel Méndez Bailón
- Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IDISSC), Facultad de Medicina, Universidad Complutense, Avda. Prof. Martin Lago S/N, 28040, Madrid, Spain.
| | | | - Noel Lorenzo-Villalba
- Internal Medicine Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jose Curbelo García
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Elpidio Calvo Manuel
- Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IDISSC), Facultad de Medicina, Universidad Complutense, Avda. Prof. Martin Lago S/N, 28040, Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Ramon Bover Freire
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Cubo Romano
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | | | | | - Jose Manuel Casas Rojo
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Juan Torres Macho
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
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50
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Diagnostic accuracy of lung ultrasound for identification of elevated left ventricular filling pressure. Int J Cardiol 2019; 281:62-68. [DOI: 10.1016/j.ijcard.2019.01.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
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