Document Detail


Detection of pulmonary congestion by chest ultrasound in dialysis patients.
MedLine Citation:
PMID:  20541714     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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.
Affiliation:
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
Descriptor/Qualifier:
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:
JACC Cardiovasc Imaging. 2011 Apr;4(4):438-9   [PMID:  21492821 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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