Document Detail

Detection of pulmonary congestion by chest ultrasound in dialysis patients.
MedLine Citation:
PMID:  20541714     Owner:  NLM     Status:  MEDLINE    
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.
Francesca Mallamaci; Francesco A Benedetto; Rocco Tripepi; Stefania Rastelli; Pietro Castellino; Giovanni Tripepi; Eugenio Picano; Carmine Zoccali
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  3     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-14     Completed Date:  2010-09-28     Revised Date:  2011-06-01    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  586-94     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Nephrology and Renal Transplantation Unit Ospedali Riuniti, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
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MeSH Terms
Aged, 80 and over
Chi-Square Distribution
Extravascular Lung Water / ultrasonography*
Heart Failure / epidemiology,  ultrasonography
Kidney Failure, Chronic / epidemiology,  physiopathology,  therapy*,  ultrasonography
Middle Aged
Observer Variation
Predictive Value of Tests
Pulmonary Edema / epidemiology,  physiopathology,  ultrasonography*
Regression Analysis
Renal Dialysis*
Reproducibility of Results
Severity of Illness Index
Water-Electrolyte Balance
Comment In:
JACC Cardiovasc Imaging. 2011 Apr;4(4):438-9   [PMID:  21492821 ]

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