Detection of Pulmonary Congestion by Chest Ultrasound in Dialysis Patients

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• 作者：Francesca Mallamaci ; MD^?/sup> ; ^&dagger ; ; Francesco A. Benedetto ; MD^&Dagger ; ; Rocco Tripepi^&dagger ; ; Stefania Rastelli ; MD^§ ; ; Pietro Castellino ; MD Prof.^§ ; ; Giovanni Tripepi ; Stat. Dr.^&dagger ; ; Eugenio Picano ; MD Prof.^?/sup> ; Carmine Zoccali ; MD Prof.^?/sup> ; ^&dagger ; ; ^{carmine.zoccali@tin.it}
• 关键词：dialysis ; lung comets ; pulmonary congestion
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2010
• 出版时间：June 2010
• 年：2010
• 卷：3
• 期：6
• 页码：586-594
• 全文大小：606 K

文摘

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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 = ?.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 = ?.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 = ?.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.