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Pálinkás ED, Re F, Peteiro J, Tesic M, Pálinkás A, Torres MAR, Dikic AD, Beleslin B, Van De Heyning CM, D’Alfonso MG, Mori F, Ciampi Q, de Castro Silva Pretto JL, Simova I, Nagy V, Boda K, Sepp R, Olivotto I, Pellikka PA, Picano E. Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy. Int J Cardiovasc Imaging 2022; 38:2593-2604. [DOI: 10.1007/s10554-022-02620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Background
B-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM).
Aim
To assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM.
Methods
We enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e’; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2.
Results
LUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e’ (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e’ (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion.
Conclusions
Two-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.
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Mitrosz-Gołębiewska K, Rydzewska-Rosołowska A, Kakareko K, Zbroch E, Hryszko T. Water - A life-giving toxin - A nephrological oxymoron. Health consequences of water and sodium balance disorders. A review article. Adv Med Sci 2022; 67:55-65. [PMID: 34979423 DOI: 10.1016/j.advms.2021.12.002] [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: 04/13/2021] [Revised: 08/24/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article aims to reveal misconceptions about methods of assessment of hydration status and impact of the water disorders on the progression of kidney disease or renal dysfunction. MATERIALS AND METHODS The PubMed database was searched for reviews, meta-analyses and original articles on hydration, volume depletion, fluid overload and diagnostic methods of hydration status, which were published in English. RESULTS Based on the results of available literature the relationship between the amount of fluid consumed, and the rate of progression of chronic kidney disease, autosomal dominant polycystic kidney disease, and kidney stones disease was discussed. Selected aspects of the assessment of the hydration level in clinical practice based on physical examination, laboratory tests, and imaging are presented. The subject of in-hospital fluid therapy is discussed. Based on available randomized studies, an attempt was made to assess, which fluids should be selected for intravenous treatment. CONCLUSIONS There is some evidence for the beneficial effect of increased water intake in preventing recurrent cystitis and kidney stones, but there are still no convincing data for chronic kidney disease and autosomal dominant polycystic kidney disease. Further studies are needed to clarify the aforementioned issues and establish a reliable way to assess the volemia and perform suitable fluid therapy.
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Affiliation(s)
- Katarzyna Mitrosz-Gołębiewska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland.
| | - Alicja Rydzewska-Rosołowska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Kakareko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Edyta Zbroch
- Department of Internal Medicine and Hypertension, Medical University od Bialystok, Bialystok, Poland
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Reisinger N, Koratala A. Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure. KIDNEY360 2022; 3:176-184. [PMID: 35368560 PMCID: PMC8967614 DOI: 10.34067/kid.0003972021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
Volume overload, and its attendant increase in acute care utilization and cardiovascular morbidity and mortality, represents a critical challenge for the practicing nephrologist. This is particularly true among patients with ESKD on HD, where predialysis volume overload and intradialytic and postdialytic hypovolemia account for almost a third of all cost for the Medicare dialysis benefit. Quantitative lung ultrasound is a tool for assessing the extent of extravascular lung water that outperforms physical exam and plain chest radiography. B-lines are vertical hyperechoic artifacts present in patients with increased extravascular lung water. B-lines have been shown to decrease dynamically during the hemodialysis treatment in proportion to ultrafiltration volume. Among patients with chronic heart failure, titration of diuretics on the basis of the extent of pulmonary congestion noted on lung ultrasonography has been shown to decrease recurrent acute care utilization. Early data from randomized controlled trials of lung ultrasound-guided ultrafiltration therapy among patients with ESKD on HD have shown promise for potential reduction in recurrent episodes of decompensated heart failure and cardiovascular events. Ultimately, lung ultrasound may predict those who are ultrafiltration tolerant and could be used to decrease acute care utilization and, thus, cost in this population.
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Affiliation(s)
- Nathaniel Reisinger
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Division of Renal, Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Karakuş O, Anantrasirichai N, Aguersif A, Silva S, Basarab A, Achim A. Detection of Line Artifacts in Lung Ultrasound Images of COVID-19 Patients Via Nonconvex Regularization. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2218-2229. [PMID: 32784133 PMCID: PMC8544933 DOI: 10.1109/tuffc.2020.3016092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/07/2020] [Indexed: 05/11/2023]
Abstract
In this article, we present a novel method for line artifacts quantification in lung ultrasound (LUS) images of COVID-19 patients. We formulate this as a nonconvex regularization problem involving a sparsity-enforcing, Cauchy-based penalty function, and the inverse Radon transform. We employ a simple local maxima detection technique in the Radon transform domain, associated with known clinical definitions of line artifacts. Despite being nonconvex, the proposed technique is guaranteed to convergence through our proposed Cauchy proximal splitting (CPS) method, and accurately identifies both horizontal and vertical line artifacts in LUS images. To reduce the number of false and missed detection, our method includes a two-stage validation mechanism, which is performed in both Radon and image domains. We evaluate the performance of the proposed method in comparison to the current state-of-the-art B-line identification method, and show a considerable performance gain with 87% correctly detected B-lines in LUS images of nine COVID-19 patients.
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Affiliation(s)
- Oktay Karakuş
- Visual Information LaboratoryUniversity of BristolBristolBS1 5DDU.K
| | | | - Amazigh Aguersif
- Service de RéanimationCentre Hospitalier Universitaire (CHU) Purpan31300ToulouseFrance
| | - Stein Silva
- Service de RéanimationCentre Hospitalier Universitaire (CHU) Purpan31300ToulouseFrance
| | - Adrian Basarab
- CNRS UMR 5505Institut de Recherche en Informatique de Toulouse (IRIT), University of Toulouse31062ToulouseFrance
| | - Alin Achim
- Visual Information LaboratoryUniversity of BristolBristolBS1 5DDU.K
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Seidowsky A, Vilaine È, Mansencal N, Ébel A, Villain C, Cheddani L, Massy ZA. [Pulmonary ultrasound and dialysis]. Nephrol Ther 2018; 14 Suppl 1:S73-S81. [PMID: 29606266 DOI: 10.1016/j.nephro.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/09/2018] [Indexed: 01/08/2023]
Abstract
Profound deficit of the body fluid composition regulation system is present at the end stage kidney disease, leading to the increase the risk of acute or chronic volume overload, which impacts the morbidity and mortality in these patients. Pulmonary ultrasound by its ability to estimate extrapulmonary water at an infraclinical stage has helped to make progress in this area. Line B is the element of fundamental semiology that reflects the presence of water in the pulmonary alveoli. The alteration of left ventricular function and the increase of pulmonary capillary permeability are the determining factors in the genesis of subclinical pulmonary congestion and are positively correlated with B-lines. Because of its non-invasive nature, its ease of use, its intra- and interoperability reproducibility and its ease of learning, nephrologists can be efficiently and quickly trained to use it to measure pulmonary congestion. Recent data have shown an epidemiological association between B-lines and mortality in end stage kidney disease patients. The causal role of subclinical pulmonary congestion assessed by these B lines in the genesis of detrimental events is being evaluated by a randomized, multicentre, open-label European clinical trial (Lung water by ultra-sound guided treatment [LUST] trial). The clinical usefulness of pulmonary ultrasound in the management of subclinical pulmonary congestion in patients with end stage kidney disease remains to be determined, but it could be considered from now as an additional tool to improve the management of this congestion, possibly by complementing bioimpedancemetry data.
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Affiliation(s)
- Alexandre Seidowsky
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Service de néphrologie-hémodialyse, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - Ève Vilaine
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Nicolas Mansencal
- Service de cardiologie, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Alexandre Ébel
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Cédric Villain
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Lynda Cheddani
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Ziad A Massy
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
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Plantinga LC, King LM, Masud T, Shafi T, Burkart JM, Lea JP, Jaar BG. Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study. Nephrol Dial Transplant 2017; 33:1215-1223. [DOI: 10.1093/ndt/gfx335] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura C Plantinga
- Department of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Laura M King
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tahsin Masud
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Tariq Shafi
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Burkart
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Janice P Lea
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
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Anantrasirichai N, Hayes W, Allinovi M, Bull D, Achim A. Line Detection as an Inverse Problem: Application to Lung Ultrasound Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:2045-2056. [PMID: 28682247 PMCID: PMC6051490 DOI: 10.1109/tmi.2017.2715880] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/15/2017] [Accepted: 06/11/2017] [Indexed: 05/25/2023]
Abstract
This paper presents a novel method for line restoration in speckle images. We address this as a sparse estimation problem using both convex and non-convex optimization techniques based on the Radon transform and sparsity regularization. This breaks into subproblems, which are solved using the alternating direction method of multipliers, thereby achieving line detection and deconvolution simultaneously. We include an additional deblurring step in the Radon domain via a total variation blind deconvolution to enhance line visualization and to improve line recognition. We evaluate our approach on a real clinical application: the identification of B-lines in lung ultrasound images. Thus, an automatic B-line identification method is proposed, using a simple local maxima technique in the Radon transform domain, associated with known clinical definitions of line artefacts. Using all initially detected lines as a starting point, our approach then differentiates between B-lines and other lines of no clinical significance, including Z-lines and A-lines. We evaluated our techniques using as ground truth lines identified visually by clinical experts. The proposed approach achieves the best B-line detection performance as measured by the F score when a non-convex [Formula: see text] regularization is employed for both line detection and deconvolution. The F scores as well as the receiver operating characteristic (ROC) curves show that the proposed approach outperforms the state-of-the-art methods with improvements in B-line detection performance of 54%, 40%, and 33% for [Formula: see text], [Formula: see text], and [Formula: see text], respectively, and of 24% based on ROC curve evaluations.
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Abstract
In heart failure patients, we hypothesize the occurrence of the "lung water cascade," with the various markers hierarchically ranked in a well-defined time sequence: (1) early, proximal hemodynamic event with increase in pulmonary capillary wedge pressure; (2) intermediate, direct imaging sign of pulmonary edema (easily detectable at bedside by lung ultrasound as B-lines); (3) late, distal clinical symptoms and signs such as dyspnea and pulmonary crackles. Completion of the cascade (from hemodynamic to pulmonary to clinical congestion) can require minutes (as with exercise), hours or even weeks (as with impending acute heart failure). Backward rewind of the downhill cascade can be achieved with timely pulmonary decongestion therapy, such as diuretics or dialysis, restoring a relatively dry lung. Any therapeutic intervention is more likely to succeed in the early steps of the cascade, at the imaging stage of asymptomatic pulmonary congestion, rather than downstream near to the end of the cascade, when clinical instability occurred.
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Affiliation(s)
| | - Maria C Scali
- Nottola Hospital, Siena, and Cardiothoracic Department, Pisa University Hospital, Pisa, Italy
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