scholarly journals Nitrogen dioxide component of air pollution increases pulmonary congestion assessed by lung ultrasound in patients with chronic coronary syndromes

2021 ◽  
Author(s):  
Quirino Ciampi ◽  
Antonello Russo ◽  
Caterina D’Alise ◽  
Anna Ballirano ◽  
Bruno Villari ◽  
...  
Keyword(s):  
Air Pollution ◽  
Nitrogen Dioxide ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Peak Stress ◽  
Decompensated Heart Failure ◽  
Multivariable Logistic Regression Analysis ◽  
Pulmonary Congestion ◽  
Coronary Syndromes ◽  
B Lines

AbstractPulmonary congestion is an intermediate biomarker and long-term predictor of acute decompensated heart failure.To evaluate the effects of air pollution on pulmonary congestion assessed by lung ultrasound.In a single-center, prospective, observational study design, we enrolled 1292 consecutive patients with chronic coronary syndromes referred for clinically indicated ABCDE-SE, with dipyridamole (n = 1207), dobutamine (n = 84), or treadmill exercise (n = 1). Pulmonary congestion was evaluated with lung ultrasound and a 4-site simplified scan. Same day values of 4 pollutants were obtained on the morning of testing (average of 6 h) from publicly available data sets of the regional authority of environmental protection. Assessment of air pollution included fine (< 2.5 µm diameter) and coarse (< 10 µm) particulate matter (PM), ozone and nitrogen dioxide (NO2).NO2 concentration was weakly correlated with rest (r = .089; p = 0.001) and peak stress B-lines (r = .099; p < 0.001). A multivariable logistic regression analysis, NO2 values above the median (23.1 µg/m3) independently predicted stress B-lines with odds ratio = 1.480 (95% CI 1.118–1.958) together with age, hypertension, diabetes, and reduced (< 50%) ejection fraction. PM2.5 values were higher in 249 patients with compared to those without B-lines (median and IQR, 22.0 [9.1–23.5] vs 17.6 [8.6–22.2] µg/m3, p < 0.001). No other pollutant correlated with other (A-C-D-E) SE steps.Higher concentration of NO2 is associated with more pulmonary congestion mirrored by B-lines at lung ultrasound. Local inflammation mediated by NO2 well within legally allowed limits may increase the permeability of the alveolar-capillary barrier and therefore pulmonary congestion in susceptible subjects.ClinicalTrials.gov Identifier: NCT030.49995.

scholarly journals Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 343-352 ◽  
Author(s):  
Kyle McGivery ◽  
Paul Atkinson ◽  
David Lewis ◽  
Luke Taylor ◽  
Tim Harris ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Emergency Department ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Meta Analysis ◽  
Decompensated Heart Failure ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
B Lines

AbstractObjectivesDyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.MethodsA systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.Data Extraction and SynthesisThe search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).ConclusionsOur results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.

scholarly journals P305 The evaluation of left ventricle filling pressure and lung ultrasound B-lines in the diagnosis of cardiogenic dyspnea

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Valova
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Filling Pressure ◽  
Diagnostic Methods ◽  
Grey Zone ◽  
X Ray ◽  
B Lines

Abstract Introduction Dyspnea is the most frequent symptom of acute heart failure but it could also be a clinical presentation of some other noncardiogenic conditions. The differentiation of the origin of dyspnea could sometimes be a difficult task. The estimated elevation of left ventricle filling pressure with lung ultrasound proved positive B-lines score &gt; 15 could be reliable as diagnostic methods for acute decompensated heart failure and proof of the cardiogenic origin of dyspnea. Purpose To evaluate the reliability of elevated left ventricle filling pressure and positive lung ultrasound B-lines score in differentiation of the origin of dyspnea. Methods Elevated E/e´&gt;15 as a proof for elevated left ventricle filling pressure and multiple bilateral LUS B-lines (&gt;15) were tested against conventional X-ray and NT-proBNP in 44 patients with cardiogenic dyspnea (23 NYHA III patients and 21 NYHA IV patients) and 42 patients with noncardiogenic dyspnea. Results Elevated left ventricle filling pressure detected with echocardography (E/e´&gt;15) as a proof of acute decompensated heart failure was found in 18 NYHA IV patients and strongly correlated with multiple bilateral LUS B-lines &gt; 15 (all 21 NYHA IV patients), alveolar edema from conventional X-ray (21 NYHA IV patients) and NTproBNP &gt; 1000pg/ml in 17 NYHA IV patients. The results for NYHA III patients differ very much. Elevated filling pressure (E/e´ &gt; 15) from echocardiography was found in 10 patients NYHA III. For the left 13 patients NYHA III E/e´ was in grey zone between 8-14. Multiple bilateral LUS B-lines &gt;15 were found in 18 NYHA III patients. Interstitial pulmonary edema was found in 15 NYHA III patients and NTproBNP &gt; 1000pg/ml was found in 16 NYHA III patients. E/e´ between 8-14 (grey zone) moderately correlated with NT-proBNP and strongly with pulmonary blood flow redistribution and interstitial edema from X-ray. Normal left ventricle filling pressure (E/e´ &lt; 8) was found in 36 noncardiogenic patients. Only 6 patients with noncardiogenic dyspnea were with elevated left ventricle filling pressure (E/e´ &gt; 15) which was explained with their overweight (BMI &gt; 30) and hypervolemia and correlated with negative LUS B-lines. Only 1 patient with noncardiogenic dyspnea was with false positive B-lines score &gt; 15 typical for pneumonia. Conclusions Elevated left ventricle filling pressure detected with Tissue Doppler echocardiography (E/e´&gt;15) and positive LUS B-lines score &gt; 15 are reliable modalities for the diagnosis of cardiogenic dyspnea in patients NYHA IV. In patient NYHA III with cardiogenic dyspnea the two presented modalities proved to be with moderate reliability and need references from conventional X-ray and NT-proBNP.

scholarly journals Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, in-hospital changes, prognostic value

Kardiologiia ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 5-14 ◽  
Author(s):  
Zh. D. Kobalava ◽  
A. F. Safarova ◽  
A. E. Soloveva ◽  
F.E. Cabello ◽  
I. A. Meray ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
Functional Class ◽  
Pulmonary Congestion ◽  
Cox Regression Analysis ◽  
History Of ◽  
B Lines

Background. Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF).Objective: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients.Materials and methods. Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively.Results. Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003).Conclusion. During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure

Heart ◽  
2020 ◽  
Vol 106 (24) ◽  
pp. 1934-1939
Author(s):  
Claudia Marini ◽  
Gabriele Fragasso ◽  
Leonardo Italia ◽  
Hamayak Sisakian ◽  
Vincenzo Tufaro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Therapy ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Number Needed To Treat ◽  
Pulmonary Congestion ◽  
Acute Decompensation

ObjectivePulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.MethodsIn this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.ResultsA total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.ConclusionsLUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.

Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography

2019 ◽  
Author(s):  
Kristina Cecilia Miger ◽  
Andreas Fabricius-Bjerre ◽  
Christian Peter Maschmann ◽  
Jesper Wamberg ◽  
Mathilde Marie Winkler Wille ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Decompensated Heart Failure ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Chronic Obstructive ◽  
Pulmonary Congestion ◽  
B Lines

Abstract Background B-lines on lung ultrasound are seen in decompensated heart failure, but their diagnostic value in consecutive patients in the acute setting is not clear. Chest CT is the superior method to evaluate interstitial lung disease, but no studies have compared lung ultrasound directly to congestion on chest CT. Purpose To examine whether congestion on lung ultrasound equals congestion on a low-dose chest CT as the gold standard. Materials and Methods In a single-center, prospective observational study we included consecutive patients ≥ 50 years of age in the emergency department. Patients were concurrently examined by lung ultrasound and chest CT. Congestion on lung ultrasound was examined in three ways: I) the total number of B-lines, II) ≥ 3 B-lines bilaterally, III) ≥ 3 B-lines bilaterally and/or bilateral pleural effusion. Congestion on CT was assessed by two specialists blinded to all other data. Results We included 117 patients, 27 % of whom had a history of heart failure and 52 % chronic obstructive pulmonary disease. Lung ultrasound and CT were performed within a median time of 79.0 minutes. Congestion on CT was detected in 32 patients (27 %). Method I had an optimal cut-point of 7 B-lines with a sensitivity of 72 % and a specificity of 81 % for congestion. Method II had 44 % sensitivity, and 94 % specificity. Method III had a sensitivity of 88 % and a specificity of 85 %. Conclusion Pulmonary congestion in consecutive dyspneic patients ≥ 50 years of age is better diagnosed if lung ultrasound evaluates both B-lines and pleural effusion instead of B-lines alone.

scholarly journals LO074: Point of care ultrasound for lung B-lines in the early diagnosis of acute decompensated heart failure in the emergency department: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S55-S55
Author(s):  
K. McGivery ◽  
P.R. Atkinson ◽  
D. Lewis ◽  
L. Taylor ◽  
K. Gadd
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Emergency Department ◽  
Likelihood Ratio ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Point Of Care Ultrasound ◽  
B Lines

Introduction: Dyspnea is a common presenting problem in the emergency department (ED) that frequently creates a diagnostic challenge for physicians. Acute decompensated heart failure (ADHF) represents a common cause that requires prompt diagnosis and management. Recent studies on dyspneic patients have suggested a potential role for point-of-care ultrasound (PoCUS). The objective of this systematic review was to assess the sensitivity and specificity of early bedside lung ultrasound in patients presenting to the ED with dyspnea. Methods: A search of the literature was conducted using PubMed, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conferences. We included prospective studies that assessed the diagnostic accuracy of B-lines from bedside lung ultrasound in the ED patients compared to a clinical diagnosis of ADHF at hospital discharge. The final diagnosis included at least one of CXR, computed tomography, or BNP. Two reviewers independently screened all titles and abstracts for possible inclusions. Two separate content experts full text-reviewed selected studies and performed quality analysis using a modified Critical Appraisal Skills Program (CASP) questionnaire. Extracted data was assessed with summary receiver operator characteristics curve (SROC) analysis with pooled sensitivity and specificity. Heterogenity was tested. Results: The electronic search yielded 3674 articles of which six met the inclusion criteria and fulfilled CASP requirements for methodological quality. The total number of patients in these studies was 1911. Heterogeneity was noted; due to poorer performance by novice users. Meta-analysis of the data showed that in detecting ADHF, bedside lung ultrasound had a pooled sensitivity of 89.6% (95% CI 69.5 to 97.0%) and a pooled specificity of 88.4% (95% CI 75.0 to 95.1%). The positive likelihood ratio was 6.01 (95% CI 2.93 to 12.32) and negative likelihood ratio was 0.13 (95% CI 0.06 to 0.30). Conclusion: This study suggests that in patients presenting to the ED with undifferentiated dyspnea, early point of care lung ultrasound may be used to confirm the diagnosis of ADHF, which may facilitate earlier appropriate management. Test performance may vary according to experience.

scholarly journals Acute decompensated heart failure: a diagnostic help from lung ultrasound

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 1723-1723 ◽  
Author(s):  
E. Pivetta ◽  
E. Lupia ◽  
S. Locatelli ◽  
G. Casoli ◽  
M. Tizzani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

scholarly journals New Medications in the Treatment of Acute Decompensated Heart Failure

2017 ◽  
Vol 53 (2) ◽  
pp. 85-87
Author(s):  
Ryan Dahn ◽  
Scot Walker
Keyword(s):  
Heart Failure ◽  
Survival Rate ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Pharmacologic Therapy ◽  
Pulmonary Congestion ◽  
Peripheral Edema ◽  
Physiological Pathways ◽  
Pharmacologic Agents

Acute decompensated heart failure is a sudden worsening of heart failure symptoms, typically resulting in peripheral edema and dyspnea as a result of pulmonary congestion. Acute decompensated heart failure is responsible for over 1 million hospitalizations every year. Current pharmacologic therapy is limited in its options. Despite an improved survival rate, statistic still suggests that about 50% of patients die within 5 years of diagnosis. New pharmacologic agents aim to improve efficacy by targeting previously unexplored physiological pathways.

scholarly journals Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

2020 ◽  
Author(s):  
Anna M Maw ◽  
Carolina Ortiz-lopez ◽  
Megan A Morris ◽  
Christine Jones ◽  
Elaine Gee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Structured Interviews ◽  
Patients With Heart Failure ◽  
The Us ◽  
Time Required

AbstractAcute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.

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