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