FP615NUMBER OF B-LINES DETECTED BY LUNG ULTRASOUND IS ASSOCIATED WITH MORTALITY AMONG HEMODIALYSIS PATIENTS

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shigeru Otsubo ◽  
Katsuya Kajimoto
Keyword(s):  
Lung Ultrasound ◽  
Hemodialysis Patients ◽  
B Lines

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.

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.

scholarly journals Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Shinzo Kuzuhara ◽  
Shigeru Otsubo ◽  
Katsuya Kajimoto ◽  
Takashi Akiba ◽  
Kosaku Nitta
Keyword(s):  
Lung Ultrasound ◽  
Hemodialysis Patients ◽  
B Lines

MO102LUNG ULTRASOUND-GUIDED DRY-WEIGHT REDUCTION DECREASES AMBULATORY BLOOD PRESSURE LEVELS IN HYPERTENSIVE HEMODIALYSIS PATIENTS: LONG-TERM ANALYSIS OF A LUST SUB-STUDY*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Charalampos Loutradis ◽  
Pantelis Sarafidis ◽  
Robert Ekart ◽  
Ioannis Tsouchnikas ◽  
Christodoulos Papadopoulos ◽  
...  
Keyword(s):  
Weight Reduction ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Active Group ◽  
Control Group ◽  
Ultrasound Guided ◽  
B Lines

Abstract Background and Aims Hypertension is highly prevalent and independently associated with adverse outcomes in patients undergoing hemodialysis. The main mechanism leading to BP elevation in these individuals is their inability to maintain water homeostasis. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory BP in hypertensive hemodialysis patients. Method This is the report of the 12-month trial phase of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized (1:1 ratio) in the active group (23 male and 12 female), following dry-weight reduction guided by the total number of US-B lines prior to a mid-week dialysis session and the control group (24 male and 12 female), following standard-of-care treatment. A 48-hour ABPM was performed in all study participants at baseline and after 12 months. Results During follow-up more patients in the active compared to control group had dry weight reduction (71.4% vs 22.2%; p&lt;0.001). US-B lines -4.83±13.73 vs 5.53±16.01; p=0.005) and dry-weight (-1.68±2.38 vs 0.54±2.32; p&lt;0.001) decreased in the active and slightly increased in the control group. At 12 months, 48-hour SBP (136.19±14.78 vs 130.31±13.57; p=0.034) and DBP (80.72±9.83 vs 76.82±8.97; p=0.008) were lower compared to baseline in the active but similar in the control group. Changes in 48-hour SBP (-7.78±13.29 vs -0.10±14.75; p=0.021) were significantly greater in the active compared to the control group. Comparisons for intradialytic, 44-hour, Day-1, Day-2 and day- and night-time BP were to the same direction. The proportion of patients experiencing at least one episode of intradialytic hypotension was numerically lower in the active group (71.4% vs 88.9%, p=0.065). Conclusion A lung-ultrasound-guided strategy for dry-weight reduction can effectively and safely decrease ambulatory BP levels during a 12-month follow-up period This method is a simple treatment approach to improve hypertension management in hemodialysis patients.

scholarly journals POS0842 LUNG ULTRASOUND TO ASSESS THE SEVERITY OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 675.1-675
Author(s):  
C. Bruni ◽  
L. Mattolini ◽  
L. Tofani ◽  
L. Gargani ◽  
N. Landini ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Quantitative Methods ◽  
Lung Ultrasound ◽  
Significant Negative Correlation ◽  
High Resolution Computed Tomography ◽  
Quantitative Score ◽  
Quantitative Scoring ◽  
B Lines

Background:Interstitial lung disease (ILD) is one of the most common complications and one of the main causes of morbidity and mortality in Systemic Sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for the diagnosis of ILD and it allows its quantification. Among semi-quantitative methods, Goh et al proposed a semi-quantitative scoring system to visually quantify ILD extent, with categorical cut-off of 20% to distinguish limited and extensive parenchymal involvement with prognostic implications. More recently, the use of radiomics has allowed the objective quantification of ILD through the use of dedicated software, which calculate different parameters of lung density.Given the exposure to ionizing radiation that the procedure entails, other methods of ILD evaluation are being studied, among which lung ultrasound (LUS) identifies the B-lines as a main feature of ILD. So far, different evidences have proposed the use of LUS for the screening of ILD, even in the early phases of the disease and in subclinical lung involvement.Objectives:the aim of this study is to test the role of LUS in quantifying the severity of SSc-ILD, evaluated with both semi-quantitative visual radiological and quantitative radiomic scores.Methods:Adult SSc patients classified according to the ACR/EULAR 2013 criteria patients were assessed with pulmonary function test (PFTs), lung ultrasound and HRCT over 60 days. CT images were analysed qualitatively (by presence/absence of ILD), semi-quantitatively (categorical Goh score <20% vs> 20% of extent and the continuous extent Goh score made from 5 levels’ assessment– 0 to 100%) and quantitatively [with the densitometric radiomic data obtained through the Horos software - Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume (LV)]. LUS was used to quantify the B-lines detected in each patient by scanning a total of 13 intercostal spaces, on both anterior and posterior chest wall.Results:Among 59 SSc patients (81% women, mean age 48±14 years, 45% anti-Scl70 positive), 23 (39%) presented ILD on HRCT, of which 14 limited and 9 extensive. The mean visual semi-quantitative score was 6%, ranging from 0 to 66%. Our data showed a significantly different number of B-Lines in ILD vs non-ILD patients (median 38 vs 9, p <.005), a result which was further confirmed among non-ILD vs ILD> 20% (median 47 vs 9, p=.001) and ILD <20% (median 36 vs 9, p=.001) patients. Conversely, the number of B-lines was not statistically different between patients with ILD <20% and >20% (median 47 vs 36, p=.78). We observed a significant negative correlation between the number of B-lines and FVC (r=-.472, p<.05) TLC (r=-.436, p=.003), DLco (r=-.515, p<.001), DLCO/VA (r=.-306, p=.03). Finally, the number of B-lines showed a statistically significant correlation with the Goh score on 5 levels (r=.437, p=.001), MLA (r=.571, p<.001), kurtosis (r=-.285, p=.028), skewness (r=-.370, p = .004) and LV (r=-.277, p=.033). All data were confirmed analysing anterior and posterior B-Lines separately.Conclusion:Our study confirms that LUS represents a useful tool for the identification of SSc-ILD. In addition, we showed that LUS may be useful also for the quantification of the severity of SSc-ILD, by correlating with PFT parameters, radiomics parameters and visual radiological evaluation. Together with the PFTs, LUS could be used to increase the accuracy of the screening and, potentially, of the follow-up of SSc-ILD patients.Disclosure of Interests:Cosimo Bruni: None declared, Lavinia Mattolini: None declared, Lorenzo Tofani: None declared, Luna Gargani Consultant of: GE Healthcare, Philips Healthcare and Caption Health, Nicholas Landini: None declared, Gemma Lepri: None declared, Martina Orlandi: None declared, Serena Guiducci: None declared, Silvia Bellando Randone: None declared, Marco Matucci-Cerinic: None declared

scholarly journals Patients in intensive care unit for COVID-19 pneumonia: the lung ultrasound patterns at admission and discharge. An observational pilot study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Persona Paolo ◽  
Valeri Ilaria ◽  
Zarantonello Francesco ◽  
Forin Edoardo ◽  
Sella Nicolò ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lung Ultrasound ◽  
Low Cost ◽  
Low Frequency ◽  
Specific Pattern ◽  
University Hospital ◽  
Left Hemithorax ◽  
Significant Difference ◽  
The Right ◽  
B Lines

Abstract Background During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease. Methods We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern. Results Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17). Conclusions LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.

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