The Experts below are selected from a list of 237 Experts worldwide ranked by ideXlab platform
Barry A Borlaug - One of the best experts on this subject based on the ideXlab platform.
-
the haemodynamic basis of Lung Congestion during exercise in heart failure with preserved ejection fraction
European Heart Journal, 2019Co-Authors: Yogesh N V Reddy, Masaru Obokata, Vojtech Melenovsky, Brandon M Wiley, Katlyn E Koepp, Caitlin C Jorgenson, Alexander C Egbe, Rickey E Carter, Barry A BorlaugAbstract: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.
-
Lung Congestion in chronic heart failure haemodynamic clinical and prognostic implications
European Journal of Heart Failure, 2015Co-Authors: Vojtech Melenovsky, Yogesh N V Reddy, Mads J Andersen, Krystof Andress, Barry A BorlaugAbstract:Aims The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with Lung Congestion in patients with chronic heart failure (HF). Methods and results HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization, echocardiography, pulmonary function testing and chest radiography that was blindly scored for the presence and severity of Lung oedema. Lung Congestion correlated directly with pulmonary vascular resistance (PVR, P = 0.004) and inversely with pulmonary artery (PA) compliance (P median) had 25% lower PA compliance and 25–35% higher PVR, transpulmonary gradients and PA pressures (40 vs. 32 mmHg, P < 0.001) despite marginally higher PA wedge pressure (PAWP; 22 vs. 19 mmHg, P = 0.002). Wet Lung HF patients displayed more right ventricular (RV) dilatation and dysfunction, more restrictive ventilation and greater reduction of DLCO. The strongest correlates of Lung Congestion were NT-proBNP, haemoglobin, albumin, and glomerular filtration, all surpassing PAWP. After a median of 333 days (interquartile range 80–875), 59 patients (32%) died. Lung Congestion was associated with reduced survival (P < 0.0001), even after adjusting for PAWP, NT-proBNP, anaemia, CAD and renal dysfunction. Conclusion Interstitial Lung oedema is associated with pulmonary vascular disease, RV overload and dysfunction and increased mortality in HF. These data reinforce the importance of aggressive deCongestion in HF and suggest that novel agents aimed at reducing Lung water may help to deter progression of pulmonary vascular disease and biventricular HF.
Yogesh N V Reddy - One of the best experts on this subject based on the ideXlab platform.
-
targeting pulmonary capillary permeability to reduce Lung Congestion in heart failure a randomized controlled pilot trial
European Journal of Heart Failure, 2020Co-Authors: Glenn M Stewart, Dennis L Sprecher, Yogesh N V Reddy, Masaru Obokata, Brad Bart, Bruce D Johnson, Steven R Goldsmith, Anna OughtonAbstract:Aims Lung Congestion in patients with heart failure (HF) has traditionally been treated using interventions that reduce pulmonary capillary hydrostatic pressure. The transient receptor potential vanilloid 4 (TRPV4) channel regulates fluid transit across the pulmonary capillary-interface, and represents a novel target to reduce Lung water, independent of pulmonary capillary hypertension. This pilot study examined the safety and potential efficacy of TRPV4 blockade as a novel treatment for HF. Methods and results In this randomized, double-blind, placebo-controlled crossover pilot trial, 11 subjects with chronic, compensated HF were treated with a novel TRPV4 antagonist (GSK2798745) or placebo. The primary endpoint was Lung diffusing capacity for carbon monoxide (DLCO ) after 7 days of treatment with GSK2798745 as compared to placebo. Secondary endpoints included additional diffusion parameters, spirometry and safety assessments. Compared to placebo, treatment with GSK2798745 resulted in a trend to improvement in DLCO (placebo: -0.336 mL/mmHg/min; GSK2798745: +0.458 mL/mmHg/min; treatment difference: +0.793 mL/mmHg/min; 95% confidence interval: -0.925 to 2.512) that was not statistically significant. GSK2798745 was well-tolerated with no serious adverse events. Conclusion In this pilot trial, GSK2798745 was found to be safe and well-tolerated, with a trend toward improved gas transfer. Further investigation is warranted in larger studies to determine whether treatment with TRPV4 antagonists or alternative treatments targeting capillary permeability might be effective to improve Lung Congestion, pulmonary gas transfer and clinical status in patients with acute or chronic HF.
-
the haemodynamic basis of Lung Congestion during exercise in heart failure with preserved ejection fraction
European Heart Journal, 2019Co-Authors: Yogesh N V Reddy, Masaru Obokata, Vojtech Melenovsky, Brandon M Wiley, Katlyn E Koepp, Caitlin C Jorgenson, Alexander C Egbe, Rickey E Carter, Barry A BorlaugAbstract: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.
-
Lung Congestion in chronic heart failure haemodynamic clinical and prognostic implications
European Journal of Heart Failure, 2015Co-Authors: Vojtech Melenovsky, Yogesh N V Reddy, Mads J Andersen, Krystof Andress, Barry A BorlaugAbstract:Aims The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with Lung Congestion in patients with chronic heart failure (HF). Methods and results HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization, echocardiography, pulmonary function testing and chest radiography that was blindly scored for the presence and severity of Lung oedema. Lung Congestion correlated directly with pulmonary vascular resistance (PVR, P = 0.004) and inversely with pulmonary artery (PA) compliance (P median) had 25% lower PA compliance and 25–35% higher PVR, transpulmonary gradients and PA pressures (40 vs. 32 mmHg, P < 0.001) despite marginally higher PA wedge pressure (PAWP; 22 vs. 19 mmHg, P = 0.002). Wet Lung HF patients displayed more right ventricular (RV) dilatation and dysfunction, more restrictive ventilation and greater reduction of DLCO. The strongest correlates of Lung Congestion were NT-proBNP, haemoglobin, albumin, and glomerular filtration, all surpassing PAWP. After a median of 333 days (interquartile range 80–875), 59 patients (32%) died. Lung Congestion was associated with reduced survival (P < 0.0001), even after adjusting for PAWP, NT-proBNP, anaemia, CAD and renal dysfunction. Conclusion Interstitial Lung oedema is associated with pulmonary vascular disease, RV overload and dysfunction and increased mortality in HF. These data reinforce the importance of aggressive deCongestion in HF and suggest that novel agents aimed at reducing Lung water may help to deter progression of pulmonary vascular disease and biventricular HF.
Claudia Torino - One of the best experts on this subject based on the ideXlab platform.
-
inflammation is an amplifier of Lung Congestion by high lv filling pressure in hemodialysis patients a longitudinal study
Journal of Nephrology, 2020Co-Authors: Claudia Torino, Luna Gargani, Krzysztof Letachowicz, Robert Ekart, Danilo Fliser, Aristeidis Stavroulopoulos, Kostas C Siamopoulos, Rosa Sicari, Adrian Covic, Ziad A MassyAbstract:Since inflammation alters vascular permeability, including vascular permeability in the Lung, we hypothesized that it can be an amplifier of Lung Congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a surrogate of the filling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and Lung water in a series of 220 ESKD patients. Lung water was quantified by the number of ultrasound B lines (US-B) on Lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. At baseline, 88 had absent, 101 had mild to moderate Lung Congestion and 31 severe Congestion. The number of US B lines associated with LAVI (r = 0.23, P < 0.001) and serum CRP was a robust modifier of this relationship (P < 0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P = 0.002) and again CRP was a strong modifier of this relationship in adjusted analyses (P ≤ 0.01). Overall, at comparable LAVI levels, Lung Congestion was more pronounced in inflamed than in non-inflamed patients. In ESKD systemic inflammation is a modifier of the relationship between LAVI, an integrate measure of LV filling pressure, and Lung water. For any given pressure, Lung water is increased with higher CRP levels, likely reflecting a higher permeability of the alveolar-capillary barrier.
-
efficacy of a remote web based Lung ultrasound training for nephrologists and cardiologists a lust trial sub project
Nephrology Dialysis Transplantation, 2016Co-Authors: Luna Gargani, Krzysztof Letachowicz, Robert Ekart, Danilo Fliser, Claudia Torino, Rosa Sicari, M Raciti, Luca Serasini, Mirko Passera, Adrian CovicAbstract:Within the framework of the LUST trial (Lung water by Ultra-Sound guided Treatment to prevent death and cardiovascular events in high-risk end-stage renal disease patients), the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis Transplant Association established a central core lab aimed at training and certifying nephrologists and cardiologists participating in this trial. All participants were trained by an expert trainer with an entirely web-based programme. Thirty nephrologists and 14 cardiologists successfully completed the training. At the end of training, a set of 47 Lung ultrasound (US) videos was provided to trainees who were asked to estimate the number of B-lines in each video. The intraclass correlation coefficient (ICC) for the whole series of 47 videos between each trainee and the expert trainer was high (average 0.81 ± 0.21) and >0.70 in all but five cases. After further training, the five underperforming trainees achieved satisfactory agreement with the expert trainer (average post-retraining ICC 0.74 ± 0.14). The Bland-Altman plot showed virtually no bias (difference between the mean 0.03) and strict 95% limits of agreement lines (-1.52 and 1.45 US B-lines). Only four cases overlapped but did not exceed the same limits. Likewise, the Spearman correlation coefficient applied to the same data series was very high (r = 0.979, P < 0.0001). Nephrologists and cardiologists can be effectively trained to measure Lung Congestion by an entirely web-based programme. This web-based training programme ensures high-quality standardization of US B-line measurements and represents a simple, costless and effective preparatory step for clinical trials targeting Lung Congestion.
-
The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study
Clinical Journal of The American Society of Nephrology, 2016Co-Authors: Claudia Torino, Luna Gargani, Krzysztof Letachowicz, Robert Ekart, Danilo Fliser, Aristeidis Stavroulopoulos, Kostas C Siamopoulos, Rosa Sicari, Adrian Covic, Ziad A MassyAbstract:Background and objectives Accumulation of fluid in the Lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary Congestion, but its reliability in ESRD is unknown. Design, setting, participants, & measurements In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a Lung ultrasound–guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre– and postdialysis Lung ultrasound studies (in 79 patients) simultaneous with standardized Lung auscultation (crackles at the Lung bases) and quantification of peripheral edema. Results Lung Congestion by crackles, edema, or a combination thereof poorly reflected the severity of Congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ -statistics ( κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) Lung Congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs. Conclusions Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial Lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating Lung Congestion in high-risk patients on hemodialysis.
-
Lung Congestion as a risk factor in end stage renal disease
Blood Purification, 2013Co-Authors: Carmine Zoccali, Claudia Torino, Rocco Tripepi, Marianna Bellantoni, Giovanni Tripepi, Francesca MallamaciAbstract:Background: Lung Congestion is emerging as a pervasive, insidious problem in end-stage renal disease (ESRD) patients on dialysis. Summary:
-
chest ultrasound and hidden Lung Congestion in peritoneal dialysis patients
Nephrology Dialysis Transplantation, 2012Co-Authors: Vincenzo Panuccio, Claudia Torino, Rocco Tripepi, Giuseppe Enia, M Garozzo, G Battaglia, Carmelita Marcantoni, Lorena Infantone, Guido Giordano, Maria Loreta De GiorgiAbstract:Background. Chest ultrasound (US) is a non-invasive wellvalidated technique for estimating extravascular Lung water (LW) in patients with heart diseases and in end-stage renal disease. We systematically applied this technique to the whole peritoneal dialysis (PD) population of five dialysis units. Methods. We studied the cross-sectional association between LW, echocardiographic parameters, clinical [pedal oedema, New York Heart Association (NYHA) class] and bioelectrical impedance analysis (BIA) markers of volume status in 88 PD patients. Results. Moderate to severe Lung Congestion was evident in 41 (46%) patients. Ejection fraction was the echocardiographic parameter with the strongest independent association with LW (r ¼� 0.40 P ¼ 0.002). Oedema did not associate with LW on univariate and multivariate analysis. NYHA class was slightly associated with LW (r ¼ 0.21 P ¼ 0.05). Among patients with severe Lung Congestion, only 27% had pedal oedema and the majority (57%) had no dyspnoea (NYHA Class I). Similarly, the prevalence of patients with BIA, evidence of volume excess was small (11%) and not significantly different (P ¼ 0.79) from that observed in patients with mild or no Congestion (9%). Conclusions. In PD patients, LW by chest US reveals moderate to severe Lung Congestion in a significant proportion of asymptomatic patients. Intervention studies are necessary to prove the usefulness of chest US for optimizing the control of fluid excess in PD patients.
Rocco Tripepi - One of the best experts on this subject based on the ideXlab platform.
-
Lung ultrasound to detect and monitor pulmonary Congestion in patients with acute kidney injury in nephrology wards a pilot study
Journal of Nephrology, 2020Co-Authors: Vincenzo Panuccio, Rocco Tripepi, Giovanni Tripepi, Francesca Mallamaci, Giovanna Parlongo, Angela Mafrica, Graziella Caridi, Francesco Catalano, Francesco Marino, Carmine ZoccaliAbstract:Lung Congestion and frank pulmonary edema are established complications of acute kidney injury (AKI) and early detection and monitoring of Lung Congestion may be useful for the clinical management of AKI patients. We compared standardized clinical criteria (including Lung crackles and peripheral edema grading) and simultaneous chest ultrasound (US) to detect Lung Congestion in a series of 39 inpatients with AKI. At baseline, twelve patients (31%) were clinically euvolemic and twelve presented clear-cur cardiovascular Congestion (31%) by clinical criteria. Fifteen patients (38%) were hypovolemic. The median number of US-B lines in patients with cardiovascular Congestion was much higher (50, inter-quartile range 27–99) than in euvolemic (14, IQR 11–37) and hypovolemic patients (7, IQR 3–16, P 15 US-B lines) by Lung US. Crackles severity and the number of US-B lines over time were inter-related (Spearman’s ρ = 0.38, P < 0.01) but the agreement (Cohen k statistics) between the two metrics was unsatisfactory. Forty-eight percent of patients had Lung Congestion of moderate to severe degree by Lung US and this estimate by far exceeded that by clinical criteria (32%). This pilot study shows that chest US has potential for the detection of Lung Congestion at a pre-clinical stage in AKI. The results of this pilot study form the basis for a clinical trial testing the usefulness of this technique for guiding Lung Congestion treatment in patients with AKI.
-
Lung Congestion as a risk factor in end stage renal disease
Blood Purification, 2013Co-Authors: Carmine Zoccali, Claudia Torino, Rocco Tripepi, Marianna Bellantoni, Giovanni Tripepi, Francesca MallamaciAbstract:Background: Lung Congestion is emerging as a pervasive, insidious problem in end-stage renal disease (ESRD) patients on dialysis. Summary:
-
chest ultrasound and hidden Lung Congestion in peritoneal dialysis patients
Nephrology Dialysis Transplantation, 2012Co-Authors: Vincenzo Panuccio, Claudia Torino, Rocco Tripepi, Giuseppe Enia, M Garozzo, G Battaglia, Carmelita Marcantoni, Lorena Infantone, Guido Giordano, Maria Loreta De GiorgiAbstract:Background. Chest ultrasound (US) is a non-invasive wellvalidated technique for estimating extravascular Lung water (LW) in patients with heart diseases and in end-stage renal disease. We systematically applied this technique to the whole peritoneal dialysis (PD) population of five dialysis units. Methods. We studied the cross-sectional association between LW, echocardiographic parameters, clinical [pedal oedema, New York Heart Association (NYHA) class] and bioelectrical impedance analysis (BIA) markers of volume status in 88 PD patients. Results. Moderate to severe Lung Congestion was evident in 41 (46%) patients. Ejection fraction was the echocardiographic parameter with the strongest independent association with LW (r ¼� 0.40 P ¼ 0.002). Oedema did not associate with LW on univariate and multivariate analysis. NYHA class was slightly associated with LW (r ¼ 0.21 P ¼ 0.05). Among patients with severe Lung Congestion, only 27% had pedal oedema and the majority (57%) had no dyspnoea (NYHA Class I). Similarly, the prevalence of patients with BIA, evidence of volume excess was small (11%) and not significantly different (P ¼ 0.79) from that observed in patients with mild or no Congestion (9%). Conclusions. In PD patients, LW by chest US reveals moderate to severe Lung Congestion in a significant proportion of asymptomatic patients. Intervention studies are necessary to prove the usefulness of chest US for optimizing the control of fluid excess in PD patients.
-
detection of pulmonary Congestion by chest ultrasound in dialysis patients
Jacc-cardiovascular Imaging, 2010Co-Authors: Francesca Mallamaci, Rocco Tripepi, Giovanni Tripepi, Francesco A Benedetto, Stefania Rastelli, Pietro Castellino, Eugenio Picano, Carmine ZoccaliAbstract:Objectives This study sought to investigate clinical and echocardiographic correlates of the Lung comets score. Background Early detection of pulmonary Congestion is a fundamental goal for the prevention of congestive heart failure in high-risk patients. Methods We undertook an inclusive survey by a validated ultrasound (US) technique in a hemodialysis center to estimate the prevalence of pulmonary Congestion and its reversibility after dialysis in a population of 75 hemodialysis patients. Results Chest US examinations were successfully completed in all patients (N = 75). Before dialysis, 47 patients (63%) exhibited moderate to severe Lung Congestion. This alteration was commonly observed in patients with heart failure but also in the majority of asymptomatic (32 of 56, 57%) and normohydrated (19 of 38, 50%) patients. Lung water excess was unrelated with hydration status but it was strongly associated with New York Heart Association functional class (p < 0.0001), left ventricular ejection fraction (r = –0.55, p < 0.001), early filling to early diastolic mitral annular velocity (r = 0.48, p < 0.001), left atrial volume (r = 0.39, p = 0.001), and pulmonary pressure (r = 0.36, p = 0.002). Lung water reduced after dialysis, but 23 patients (31%) still had pulmonary Congestion of moderate to severe degree. Lung water after dialysis maintained a strong association with left ventricular ejection fraction (r = –0.59, p < 0.001), left atrial volume (r = 0.30, p = 0.01), and pulmonary pressure (r = 0.32, p = 0.006) denoting the critical role of cardiac performance in the control of this water compartment in end-stage renal disease. In a multiple regression model including traditional and nontraditional risk factors only left ventricular ejection fraction maintained an independent link with Lung water excess (beta = –0.61, p < 0.001). Repeatability studies of the chest US technique (Bland-Altman plots) showed good interobserver and inter-US probes reproducibility. Conclusions Pulmonary Congestion is highly prevalent in symptomatic (New York Heart Association functional class III to IV) and asymptomatic dialysis patients. Chest ultrasound is a reliable technique that detects pulmonary Congestion at a pre-clinical stage in end-stage renal disease.
Carmine Zoccali - One of the best experts on this subject based on the ideXlab platform.
-
Lung ultrasound to detect and monitor pulmonary Congestion in patients with acute kidney injury in nephrology wards a pilot study
Journal of Nephrology, 2020Co-Authors: Vincenzo Panuccio, Rocco Tripepi, Giovanni Tripepi, Francesca Mallamaci, Giovanna Parlongo, Angela Mafrica, Graziella Caridi, Francesco Catalano, Francesco Marino, Carmine ZoccaliAbstract:Lung Congestion and frank pulmonary edema are established complications of acute kidney injury (AKI) and early detection and monitoring of Lung Congestion may be useful for the clinical management of AKI patients. We compared standardized clinical criteria (including Lung crackles and peripheral edema grading) and simultaneous chest ultrasound (US) to detect Lung Congestion in a series of 39 inpatients with AKI. At baseline, twelve patients (31%) were clinically euvolemic and twelve presented clear-cur cardiovascular Congestion (31%) by clinical criteria. Fifteen patients (38%) were hypovolemic. The median number of US-B lines in patients with cardiovascular Congestion was much higher (50, inter-quartile range 27–99) than in euvolemic (14, IQR 11–37) and hypovolemic patients (7, IQR 3–16, P 15 US-B lines) by Lung US. Crackles severity and the number of US-B lines over time were inter-related (Spearman’s ρ = 0.38, P < 0.01) but the agreement (Cohen k statistics) between the two metrics was unsatisfactory. Forty-eight percent of patients had Lung Congestion of moderate to severe degree by Lung US and this estimate by far exceeded that by clinical criteria (32%). This pilot study shows that chest US has potential for the detection of Lung Congestion at a pre-clinical stage in AKI. The results of this pilot study form the basis for a clinical trial testing the usefulness of this technique for guiding Lung Congestion treatment in patients with AKI.
-
Lung Congestion as a risk factor in end stage renal disease
Blood Purification, 2013Co-Authors: Carmine Zoccali, Claudia Torino, Rocco Tripepi, Marianna Bellantoni, Giovanni Tripepi, Francesca MallamaciAbstract:Background: Lung Congestion is emerging as a pervasive, insidious problem in end-stage renal disease (ESRD) patients on dialysis. Summary:
-
detection of pulmonary Congestion by chest ultrasound in dialysis patients
Jacc-cardiovascular Imaging, 2010Co-Authors: Francesca Mallamaci, Rocco Tripepi, Giovanni Tripepi, Francesco A Benedetto, Stefania Rastelli, Pietro Castellino, Eugenio Picano, Carmine ZoccaliAbstract:Objectives This study sought to investigate clinical and echocardiographic correlates of the Lung comets score. Background Early detection of pulmonary Congestion is a fundamental goal for the prevention of congestive heart failure in high-risk patients. Methods We undertook an inclusive survey by a validated ultrasound (US) technique in a hemodialysis center to estimate the prevalence of pulmonary Congestion and its reversibility after dialysis in a population of 75 hemodialysis patients. Results Chest US examinations were successfully completed in all patients (N = 75). Before dialysis, 47 patients (63%) exhibited moderate to severe Lung Congestion. This alteration was commonly observed in patients with heart failure but also in the majority of asymptomatic (32 of 56, 57%) and normohydrated (19 of 38, 50%) patients. Lung water excess was unrelated with hydration status but it was strongly associated with New York Heart Association functional class (p < 0.0001), left ventricular ejection fraction (r = –0.55, p < 0.001), early filling to early diastolic mitral annular velocity (r = 0.48, p < 0.001), left atrial volume (r = 0.39, p = 0.001), and pulmonary pressure (r = 0.36, p = 0.002). Lung water reduced after dialysis, but 23 patients (31%) still had pulmonary Congestion of moderate to severe degree. Lung water after dialysis maintained a strong association with left ventricular ejection fraction (r = –0.59, p < 0.001), left atrial volume (r = 0.30, p = 0.01), and pulmonary pressure (r = 0.32, p = 0.006) denoting the critical role of cardiac performance in the control of this water compartment in end-stage renal disease. In a multiple regression model including traditional and nontraditional risk factors only left ventricular ejection fraction maintained an independent link with Lung water excess (beta = –0.61, p < 0.001). Repeatability studies of the chest US technique (Bland-Altman plots) showed good interobserver and inter-US probes reproducibility. Conclusions Pulmonary Congestion is highly prevalent in symptomatic (New York Heart Association functional class III to IV) and asymptomatic dialysis patients. Chest ultrasound is a reliable technique that detects pulmonary Congestion at a pre-clinical stage in end-stage renal disease.
