FC 104CARDIAC GEOMETRY, FUNCTION, AND REMODELING PATTENRS AND LUNG WATER CONTENT IN PATIENTS UNDER MAINTENANCE HEMODIALYSIS AND PERITONEAL DIALYSIS TREATMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Charalampos Loutradis ◽  
Maria Eleni Alexandrou ◽  
Vassilios Sachpekidis ◽  
Christodoulos Papadopoulos ◽  
Vasileios Kamperidis ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Linear Regression ◽  
Diastolic Function ◽  
Lung Ultrasound ◽  
Systolic Function ◽  
Hemodialysis Patients ◽  
Right Atrial ◽  
Lung Water ◽  
Lung Water Content ◽  
B Lines

Abstract Background and Aims Cardiovascular disease is the leading cause of mortality in patients with end-stage kidney disease (ESKD). Evidence on the possible echocardiographic differences between patients undergoing different dialysis modalities is scarce. This study aimed to evaluate differences in left (LA) and right atrial (RA) and left (LV) and right ventricular (RV) geometry, systolic and diastolic function, as well as lung water content in hemodialysis and peritoneal dialysis (PD) patients. Method A total of 38 hemodialysis and 38 PD patients receiving treatment for ≥3 months, matched in a 1:1 ratio for age, sex and dialysis vintage were included in this study. Lung ultrasound, two-dimensional and tissue-Doppler echocardiography were performed during an interdialytic day in hemodialysis and before a programmed follow-up visit in PD patients. To identify factors possible associated with LVH (left ventricular hypertrophy), we performed univariate and multivariate linear regression analyses in the total population studied. Results No significant differences were evidenced in ultrasound B-lines (4.00 [6.00] vs 3.00 [4.25]; p=0.623) between the two groups. Vena cava diameter (11.09±4.53 vs 14.91±4.30 mm; P<0.001) was significantly lower in hemodialysis patients. Indices of LA, RA, LV and RV dimensions were similar between the two groups. LVMi (116.91 [38.56] vs 122.83 [52.33] g/m2; P=0.767) was similar, but relative wall thickness (RWT) was marginally (0.40 [0.14] vs 0.45 [0.15] cm; P=0.055) lower in hemodialysis patients. LV hypertrophy prevalence, defined as LVMi values >95 or >115 g/m2 for female and male patients, was similar between groups (73.7% vs 71.1%; p=0.798), but relative wall thickness (RWT) was numerically lower (0.40 [0.14] vs 0.45 [0.15] cm; P=0.055) and fractional shortening (29.12±7.07% vs 23.37±8.84%; P=0.003) was significantly higher in patients under hemodialysis compared to those under PD. Hemodialysis patients presented mainly eccentric (normal RWT and increased LVMi), while PD patients presented mainly concentric LVH (increased RWT and increased LVMi). Left atrial (LA), right atrial (RA) and ventricular (RV) echocardiographic indices were again similar between the two study groups. Ventricular systolic function was similar between-groups, except for stroke volume (78.97 [24.24] vs 64.66 [27.35] ml; P=0.030) and cardiac output (5.75 [2.29] vs 4.93 [2.10] L/min; P=0.036) which were higher in hemodialysis. With regards to RV systolic function indices, RV systolic pressure (RVSP) was significantly lower in the hemodialysis compared to the PD group (20.37 [22.54] vs 27.68 [14.32] mmHg; P=0.009). All diastolic function indices were similar between the two groups. Prevalence of mitral valve (MV) regurgitation was significantly lower in the hemodialysis group (10.5% vs 39.5%; p=0.004). According to the results of multivariate linear regression analysis, only male gender (β=20.677, 95%CI: 3.479 to 37.874; P=0.019) and number of US-B lines (β=0.892, 95%CI:0.071 to 1.713; P=0.034) were independently associated with LVMi. Conclusion Hemodialysis and PD patients present similar volume overload, evaluated with lung ultrasound, and no significant differences in echocardiographic indices reflecting cardiac geometry, but different patterns of abnormal LV remodeling was evident in each dialysis modality, with hemodialysis presenting eccentric and PD concentric LVH. These results clearly support that PD is no better than HD with regards to cardiovascular stress, despite the fact that they experience a more stable volume status.

B-Lines Quantify the Lung Water Content: A Lung Ultrasound Versus Lung Gravimetry Study in Acute Lung Injury

2010 ◽  
Vol 36 (12) ◽  
pp. 2004-2010 ◽  
Author(s):  
Zoltán Jambrik ◽  
Luna Gargani ◽  
Ágnes Adamicza ◽  
József Kaszaki ◽  
Albert Varga ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Water Content ◽  
Lung Ultrasound ◽  
Lung Water ◽  
Lung Water Content ◽  
B Lines

scholarly journals The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction

2019 ◽  
Author(s):  
Yogesh N V Reddy ◽  
Masaru Obokata ◽  
Brandon Wiley ◽  
Katlyn E Koepp ◽  
Caitlin C Jorgenson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Submaximal Exercise ◽  
Right Atrial ◽  
Preserved Ejection Fraction ◽  
Lung Water ◽  
Fluid Filtration ◽  
Pulmonary Capillary

Abstract 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 Ultrasound Predicts Well Extravascular Lung Water but Is of Limited Usefulness in the Prediction of Wedge Pressure

2014 ◽  
Vol 121 (2) ◽  
pp. 320-327 ◽  
Author(s):  
Giovanni Volpicelli ◽  
Stefano Skurzak ◽  
Enrico Boero ◽  
Giuseppe Carpinteri ◽  
Marco Tengattini ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Congestion ◽  
Lung Water ◽  
Ventricular Ejection Fraction ◽  
B Lines ◽  
Limited Usefulness

Abstract Background: Pulmonary congestion is indicated at lung ultrasound by detection of B-lines, but correlation of these ultrasound signs with pulmonary artery occlusion pressure (PAOP) and extravascular lung water (EVLW) still remains to be further explored. The aim of the study was to assess whether B-lines, and eventually a combination with left ventricular ejection fraction (LVEF) assessment, are useful to differentiate low/high PAOP and EVLW in critically ill patients. Methods: The authors enrolled 73 patients requiring invasive monitoring from the intensive care unit of four university-affiliated hospitals. Forty-one patients underwent PAOP measurement by pulmonary artery catheterization and 32 patients had EVLW measured by transpulmonary thermodilution method. Lung and cardiac ultrasound examinations focused to the evaluation of B-lines and gross estimation of LVEF were performed. The absence of diffuse B-lines (A-pattern) versus the pattern showing prevalent B-lines (B-pattern) and the combination with normal or impaired LVEF were correlated with cutoff levels of PAOP and EVLW. Results: PAOP of 18 mmHg or less was predicted by the A-pattern with 85.7% sensitivity (95% CI, 70.5 to 94.1%) and 40.0% specificity (CI, 25.4 to 56.4%), whereas EVLW 10 ml/kg or less with 81.0% sensitivity (CI, 62.6 to 91.9%) and 90.9% specificity (CI, 74.2 to 97.7%). The combination of A-pattern with normal LVEF increased sensitivity to 100% (CI, 84.5 to 100%) and specificity to 72.7% (CI, 52.0 to 87.2%) for the prediction of PAOP 18 mmHg or less. Conclusions: B-lines allow good prediction of pulmonary congestion indicated by EVLW, whereas are of limited usefulness for the prediction of hemodynamic congestion indicated by PAOP. Combining B-lines with estimation of LVEF at transthoracic ultrasound may improve the prediction of PAOP.

scholarly journals Lung Ultrasound to Quantitatively Evaluate Extravascular Lung Water Content and its Clinical Significance

2020 ◽  
Author(s):  
Guo Guo ◽  
Xue-Feng Zhang ◽  
Jing Liu ◽  
Hai-Feng Zong
Keyword(s):  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Rabbit Model ◽  
Dry Weight ◽  
Type I ◽  
Lung Water ◽  
Arterial Blood Gas ◽  
Injection Volume ◽  
Arterial Blood ◽  
B Lines

Abstract Background:B-line assessment with lung ultrasound (LUS) has recently been proposed as a reliable, noninvasive semiquantitative tool for evaluating extravascular lung water (EVLW). Currently, there has been no easy quantitative method to evaluate EVLW by LUS. To establish a simple, accurate and clinically operable method for quantitative assessment of EVLW using LUS. Methods:Forty-five New Zealand rabbits were randomized into 9 groups (n=5). After anesthesia, each group of rabbits was injected with different amounts of warm sterile NS (0 ml/kg, 2 ml/kg, 4 ml/kg, 6 ml/kg, 8 ml/kg, 10 ml/kg, 15 ml/kg, 20 ml/kg, 30 ml/kg) via the endotracheal tube. Each rabbit was examined by LUS before and after NS injection. At the same time, the spontaneous respiratory rate (RR, breaths per minute), heart rate (HR, bpm) and arterial blood gas (ABG) of the rabbits were recorded. Then, both lungs were dissected to obtain the wet and dry weight and conduct a complete histological examination.Results:Injecting NS into the lungs through a tracheal tube can successfully establish a rabbit model with increased EVLW. When theNS injection volume is 2~6 ml/kg, comet-tail artifacts and B-lines are the main patterns found on LUS; as additional NS is injected into the lungs, the rabbits' RR gradually increases, while their HR gradually decreases. Confluent B-lines grow gradually but significantly, reaching a dominant position when the NS injection volume reaches 6~8 ml/kg and predominating almost entirely when the NS injection volume is 8~15 ml/kg; at that time, rabbits' RRs and HRs decrease sharply, and the ABG indicated type I respiratory failure (RF). Compact B-lines occur and predominate almost entirely when the NS injection volume reaches 10 ml/kg and 15~20 ml/kg, respectively. At that time, rabbits begin to enter cardiac and respiratory arrest, and ABG shows type II RF and metabolic acidosis (MA).Conclusion: LUS can estimate EVLW content based on the type of B-line.We can give clinical treatment depending on the type of LUS B-line.

MO737EVALUATION OF EXTRAVASCULAR FLUID IN HEMODIALYSIS PATIENTS BY LUNG ULTRASOUND IN COMPARISON WITH BIOIMPEDANCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anastasiia Putintceva ◽  
Irina Zdanova ◽  
Ekaterina Tsukanova ◽  
Julia Fadeeva ◽  
Ashot Esayan
Keyword(s):  
Lung Ultrasound ◽  
Statistical Significance ◽  
The Body ◽  
Water Volume ◽  
Maintenance Hemodialysis ◽  
Hydration Status ◽  
Lung Water ◽  
Cardiac Pacemakers ◽  
Fluid Status ◽  
B Lines

Abstract Background and Aims The aim of study was to compare the lung ultrasound (LUS) and bioimpedance analysis (BIA) as methods to assess the hydration (fluid) status in maintenance hemodialysis (MHD) patients. Method The comparative analysis was performed in 87 MHD patients aged 24 to 82 years (43 women, and 44 men). Patients with cardiac pacemakers and permanent catheters as vascular access were excluded from the study. Extravascular lung water (EVLW) in MHD patients was assessed simultaneously by LUS (Acuson X150 ultrasound system with a CH5-2 curvilinear transducer, Siemens) and by the bioimpedance spectroscopy (BIS) (Bodystat Multiscan 5000) with frequency range of 5-1000K Hz. Both LUS and BIS were performed before and 30 minutes after the hemodialysis (HD) session in the second and third sessions of the week. Ultrasonic measurements were performed by summing LUS comets or B-lines along four anatomical lines (parasternal, mid-clavicular, anterior, middle, and posterior axillary lines) from II to V intercostal spaces on the right and from the II to IV intercostal spaces on the left. The quantitative assessment of B-lines (B-lines score, BLS) was performed according to Picano E. et al. [2006]: normohydration – zero degree (<4 B lines) with the absence of EVLW, overhydration (OH) – 1st degree (5-14 BLS), 2nd degree OH (15-30 BLS), and 3d degree OH – >30 BLS with an insignificant, moderate and severe amount of EVLW, respectively. The body hydration status assessment technique by BIS was based on the overhydration (OH) index, the total body water volume, extra- and intracellular water, and the body composition. Patient's fluid status classified as normohydration (1.0-1.0 L), moderate OH (>1.0-<2.5 L), and severeOH (>2.5 L), and dehydration (<1.0 L) [Henry C. Lukaski et al., 2019]. The LUS do not allow assessing the state of dehydration, therefore, the normohydration by LUS was the sum of normo- and dehydration by BIS. We used SPSS Statistics 21.0 software for statistical processing of the data. To assess the correlation between BLS and OH indicators, we used Spearman's rank correlation coefficient. The statistical significance level was assumed to be 0.05. Results Data of the body fluid status using LUS and BIS before and after HD-session fully coincided in 33 of 87 MHD patients, partially coincided in 20 patients before and in 25 patients after HD-session. LUS and BIS didn’t coincide completely in only 9 patients. Statistically significant correlation was revealed between BLS and OH before (Rs=0.336; p<0.01), and after (Rs=0,317, p<0,01) HD session. A positive correlation between BLS and OH data was revealed in 53 patients, whose results were almost identical before (Rs=0,488, p<0.01), and in 58 patients after (Rs=0,658, p<0.01) HD session. Conclusion BIS remains the gold standard for the assessment of over-, normo- and dehydration in MHD patients. LUS is a simple and adequate technique for assessing the hydration status in MHD patients, and it is comparable to BIS in assessing over-, as well as normohydration. However, the LUS doesn’t allow diagnosing the body dehydration.

P2640The effect of dry-weight reduction guided by lung ultrasound on ambulatory aortic blood pressure and arterial stiffness parameters in hemodialysis patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Loutradis ◽  
C E Papadopoulos ◽  
V Sachpekidis ◽  
E Pagourelias ◽  
R Ekart ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Weight Reduction ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Active Group ◽  
Control Group ◽  
Aortic Blood ◽  
Aortic Blood Pressure ◽  
B Lines

Abstract Introduction and purpose Arterial stiffness and aortic blood pressure (BP) augmentation are significantly increased in hemodialysis patients. Recent studies suggest that the prognostic significance of ambulatory recordings of arterial stiffness is high in hemodialysis. This study examines for the first time the effect of dry weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic BP and arterial stiffness parameters in hypertensive hemodialysis patients. Methods A total 71 hemodialysis patients with hypertension (mean home BP ≥135/85 mmHg), that were clinically euvolemic, were included in this single-blind randomized clinical trial. Patients were randomized in a 1:1 ratio in the active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session and the control group (n=), following standard-of-care treatment. All patients underwent 48-hour ABPM with the Mobil-O-Graph monitor (IEM, Stolberg, Germany) and PWV measurement in office with SphygmoCor (ArtCor, Sydney, Australia) at baseline and after 8-weeks. Results Overall, the US-B lines change during follow-up were −5.3±12.5 in active versus +2.2±7.6 in control group (p<0.001), which corresponded to dry-weight changes of −0.71±1.39 versus +0.51±0.98 kg (p<0.001). The change in 48-hour cSBP was significantly greater in the active group (−6.30±8.90 vs −0.50±12.46, p=0.027); the relevant cDBP fall was marginally greater (−3.85±6.61 vs −0.63±8.36, p=0.077) in the active group. 48-hour cPP (41.51±9.63 vs 39.06±9.61 mmHg, p=0.004) and 48-hour PWV (9.30±2.00 vs 9.08±2.04 m/sec, p=0.032) were significantly reduced from baseline to study-end in the active group but remained unchanged in controls. In contrast, 48-hour AIx and AIx(75) did not change between baseline and study-end in both groups; changes in AIx(75) were similar in the two groups (−0.97±3.51 vs −0.36±4.25, p=0.517). PWV measured in office was decreased from baseline to study-end in the active (10.07±2.66 vs 9.79±2.81, p=0.038) but not in the control group. Conclusions A lung-ultrasound-guided strategy for dry-weight reduction reduces ambulatory aortic BP and ambulatory or office PWV, but not ambulatory AIx(75). These results suggest that dry-weight reduction can primarily reduce aortic BP levels and large arteries stiffness but not wave reflections from the periphery.

scholarly journals Lung ultrasound and BNP to detect hidden pulmonary congestion in euvolemic hemodialysis patients: a single centre experience

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Domenico Giannese ◽  
Alessandro Puntoni ◽  
Adamasco Cupisti ◽  
Riccardo Morganti ◽  
Enrico Varricchio ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Serum Levels ◽  
Hemodialysis Patients ◽  
Pulmonary Congestion ◽  
Single Centre ◽  
Single Centre Experience ◽  
B Lines

Abstract Background Dry weight assessment in hemodialysis (HD) remains a challenge. The aim of the study was to investigate the prevalence of subclinical pulmonary congestion using lung ultrasound (LUS) in maintenance HD patients with no clinical or bioimpedance signs of hyperhydration. The correlation between B-lines Score (BLS) and brain natriuretic peptide (BNP) was also evaluated. Methods Twenty-four HD patients underwent LUS and BNP dosage at the end of the mid-week HD session, monthly for 6 months . LUS was considered as positive when BLS was >15. Hospitalizations and cardiovascular events were also evaluated in relation to the BLS. Results LUS+ patients at baseline were 16 (67%), whereas 11 (46%) showed LUS + in at least 50% of the measurements (rLUS+ patients). Only the rLUS+ patients had a higher number of cardiovascular events [p=0.019, OR: 7.4 (CI 95%. 1.32-39.8)] and hospitalizations [p=0.034, OR 5.5 (CI 95% 1.22- 24.89)]. A BNP level of 165 pg/ml was identified as cut-off value for predicting pulmonary congestion, defined by BLS >15. Conclusion Prevalence of pulmonary congestion as assessed by LUS and persistent or recurrent BLS >15 were quite prevalent findings in euvolemic HD patients. In the patients defined as rLUS+, a higher rate of cardiovascular events and hospital admissions was registered. BNP serum levels > 165 pg/ml resulted predictive of pulmonary congestion at LUS. In the dialysis care, regular LUS examination should be reasonably included among the methods useful to detect subclinical lung congestion and to adjust patients’ dry weight.

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