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Barchitta A, Rossitto G, Ruzza L, Maio D, Scaparotta G, Bagordo D, Antonini Canterin F, Piovesana P, Seccia TM, Nalesso F, Calò L, Rossi GP. Coronary sinus diameter to estimate congestion and predict survival. IJC HEART & VASCULATURE 2023; 49:101294. [PMID: 38020054 PMCID: PMC10663896 DOI: 10.1016/j.ijcha.2023.101294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Background Congestion predicts a poor prognosis, but its assessment is challenging in clinical practice and requires a multiparametric approach. We investigated if the coronary sinus (CS) diameter can predict mortality in a human model of rapid fluid unloading. Methods We measured by echocardiography the CS, and the inferior vena cava (IVC) for comparison, in 60 patients with end-stage chronic kidney disease (ESKD) immediately before and after hemodialysis (HD; age 76 [57-81] years, 40% female, left ventricular ejection fraction 57 [53-56]%). Patients were prospectively followed up for all-cause mortality. Results HD-induced decongestion decreased the maximum diameters of both CS and IVC (p ≤ 0.001 for all). The maximum diameter of the CS (CSmax) was as accurate as the IVC maximum diameter and collapsibility for the identification of congestion, defined as pre-hemodialysis status (AUROC CSmax = 0.902 vs IVC = 0.895, p = n.s.). A CSmax diameter after hemodialysis > 9 mm predicted all-cause mortality at 12 months (Log-rank Chi square = 11.49, p < 0.001). Conclusions A persistently dilated CS after hemodialysis is a marker of residual congestion and predicts death at one year in high-risk ESKD patients.
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Affiliation(s)
- Agatella Barchitta
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | - Giacomo Rossitto
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Luisa Ruzza
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | - Daniele Maio
- University of Ferrara, Cardiology, St Anna Hospital, Ferrara, Italy
| | | | - Domenico Bagordo
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | | | | | - Teresa Maria Seccia
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | - Federico Nalesso
- University of Padova, Nephrology, University Hospital, Padova, Italy
| | - Lorenzo Calò
- University of Padova, Nephrology, University Hospital, Padova, Italy
| | - Gian Paolo Rossi
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
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2
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Coiro S, Echivard M, Simonovic D, Duarte K, Santos M, Deljanin-Ilic M, Kobayashi M, Ambrosio G, Girerd N. Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study. Clin Res Cardiol 2023:10.1007/s00392-023-02219-y. [PMID: 37210700 DOI: 10.1007/s00392-023-02219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/27/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis. METHODS We studied two independent case-control studies of HFpEF patients and control subjects undergoing different exercise protocols: (i) submaximal exercise stress echocardiography (ESE) with LUS performed by expert cardiologists (N = 116, HFpEF = 65.5%), and (ii) maximal cycle ergometer test (CET) (N = 54, HFpEF = 50%) with LUS performed by unexperienced physicians shortly trained for the study. B-line kinetics (i.e. peak values and their changes from rest) were assessed. RESULTS In the ESE cohort, the C-index (95% CI) of peak B-lines for HFpEF diagnosis was 0.985 (0.968-1.000), whereas the C-index of rest and exercise HFA-PEFF scores (i.e. including stress echo findings) were < 0.90 (CI 0.823-0.949), and that of H2FPEF score was < 0.70 (CI 0.558-0.764). The C-index increase of peak B-lines on top of the above-mentioned scores was significant (C-index increase > 0.090 and P-value < 0.001 for all). Similar results were observed for change B-lines. Peak B-lines > 5 (sensitivity = 93.4%, specificity = 97.5%) and change B-lines > 3 (sensitivity = 94.7%, specificity = 87.5%) were the best cutoffs for HFpEF diagnosis. Adding peak or change B-lines on top of HFpEF scores and BNP significantly improved diagnostic accuracy. Peak B-lines showed a good diagnostic accuracy in the LUS beginner-led CET cohort (C-index = 0.713, 0.588-0.838). CONCLUSIONS Exercise LUS showed excellent diagnostic value for HFpEF diagnosis regardless of different exercise protocols/level of expertise, with additive diagnostic accuracy on top of available scores and natriuretic peptides.
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Affiliation(s)
- Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Mathieu Echivard
- Département de Cardiologie, CHRU de Nancy, 54500, Vandœuvre-lès-Nancy, France
| | - Dejan Simonovic
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | - Kevin Duarte
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Mario Santos
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
- ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Marina Deljanin-Ilic
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | - Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
- CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
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3
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Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function. J Clin Med 2022; 11:jcm11030842. [PMID: 35160293 PMCID: PMC8836698 DOI: 10.3390/jcm11030842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Lung ultrasound is a bedside technique for the assessment of pulmonary congestion. The study aims to assess the severity of lung congestion in kidney transplant recipients (KTR) in relation to arteriovenous fistula (AVF) patency. One hundred fifty-seven patients at least 12 months after kidney transplantation were recruited to participate in a cross-sectional study. Apart from routine visits, lung ultrasound at 28 typical points was performed. The patients were assigned to either AVF+ or AVF− groups. The mean number of lung ultrasound B-lines (USBLs) was 5.14 ± 4.96 with no differences between groups: 5.5 ± 5.0 in AVF+ and 4.8 ± 4.9 in AVF−, p = 0.35. The number and proportion of patients with no congestion (0–5 USBLs), mild congestion (6–15 USBLs), and moderate congestion (16–30 USBLs) were as follows: 101 (64.7%), 49 (31.4%), and 6 (3.8%), respectively. In multivariate analysis, only symptoms (OR 5.90; CI 2.43,14.3; p = 0.0001), body mass index (BMI) (OR 1.09; CI 1.03,1.17; p = 0.0046), and serum cholesterol level (OR 0.994; CI 0.998,1.000; p = 0.0452) contributed significantly to the severity of lung congestion. Lung ultrasound is a valuable tool for the evaluation of KTR. Functioning AVF in KTR is not the major factor affecting the severity of pulmonary congestion.
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4
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Dupont V, Bonnet-Lebrun AS, Boileve A, Debrumetz A, Wynckel A, Braconnier A, Colosio C, Mokri L, Schvartz B, Vuiblet V, Barbe C, Jozwiak M, Rieu P. A pilot study on the association between early fluid status indicators after kidney transplantation and graft function recovery. Kidney Int Rep 2022; 7:1416-1419. [PMID: 35685327 PMCID: PMC9171620 DOI: 10.1016/j.ekir.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/13/2022] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Vincent Dupont
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Nephrology, Centre Hospitalier Universitaire de Reims, Reims, France
- French Clinical Research Infrastructure Network, Investigation Network Initiative—Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT), Reims, France
- Correspondence: Vincent Dupont, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
| | | | - Alice Boileve
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
| | - Alexandre Debrumetz
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alain Wynckel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Antoine Braconnier
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Charlotte Colosio
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Laetitia Mokri
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Betoul Schvartz
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vincent Vuiblet
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Coralie Barbe
- Research on Health University Department, Université de Reims Champagne-Ardenne, Reims, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, CHU Archet 1, Nice, France
- Equipe 2 CARRES, UR2CA—Unité de Recherche Clinique Côte d’Azur, Université Côte d’Azur UCA, Nice, France
| | - Philippe Rieu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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5
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Kobayashi M, Douair A, Coiro S, Giacomin G, Bassand A, Jaeger D, Duarte K, Huttin O, Zannad F, Rossignol P, Chouihed T, Girerd N. A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure. Front Cardiovasc Med 2022; 8:752915. [PMID: 35087878 PMCID: PMC8787280 DOI: 10.3389/fcvm.2021.752915] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED). Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit. Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho <0 .10, p > 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value > 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89). Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.
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Affiliation(s)
- Masatake Kobayashi
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Amine Douair
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Stefano Coiro
- Division of Cardiology, University of Perugia, Perugia, Italy
| | - Gaetan Giacomin
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Déborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Tahar Chouihed
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- *Correspondence: Nicolas Girerd
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6
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Simonovic D, Coiro S, Deljanin-Ilic M, Kobayashi M, Carluccio E, Girerd N, Ambrosio G. Exercise-induced B-lines in heart failure with preserved ejection fraction occur along with diastolic function worsening. ESC Heart Fail 2021; 8:5068-5080. [PMID: 34655174 PMCID: PMC8712838 DOI: 10.1002/ehf2.13575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 12/27/2022] Open
Abstract
Aims Pulmonary congestion during exercise assessed by lung ultrasound predicts negative outcome in patients with heart failure with preserved ejection fraction (HFpEF). We aimed at assessing predictors of exercise‐induced pulmonary B‐lines in HFpEF patients. Methods and results Eighty‐one I–II NYHA class HFpEF patients (65.0 ± 8.2 y/o, 56.8% females) underwent standard and strain echocardiography, lung ultrasound, and natriuretic peptide assessment during supine exercise echocardiography (baseline and peak exercise). Peak values and their changes were compared in subgroups according to exercise lung congestion grading (peak B‐lines >10 or ≤10). Exercise elicited significant changes for all echocardiographic parameters in both subgroups [39/81 (48.1%) with peak B‐lines >10; 42/81 (51.9%) with B‐lines ≤10]. Peak values and changes of E‐wave (and its derived indices) were significantly higher in patients with >10 peak B‐lines compared with those with ≤10 B‐line (all P‐values <0.03), showing significant correlation with peak B‐lines for all parameters; concomitantly, global longitudinal strain (GLS) and global strain rate (GSR) during systole (GSRs), early (GSRe) and late (GSRa) diastole, and isovolumic relaxation (GSRivr) were reduced in patients with B‐lines >10 (all P‐values <0.05), showing a negative correlation with peak B‐lines. By adjusted linear regression analysis, peak and change diastolic parameters (E‐wave, E/e′, GSRivr, and E/GSRivr) and peak GLS were individually significantly associated with peak B‐lines. By covariate‐adjusted multivariable model, E/e′ and GSRa at peak exercise were retained as independent predictors of peak B‐lines, with substantial goodness of fit of model (adjusted R2 0.776). Conclusions In HFpEF, development of pulmonary congestion upon exercise is mostly concomitant with exercise‐induced worsening of diastolic function.
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Affiliation(s)
- Dejan Simonovic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | - Stefano Coiro
- Cardiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy.,Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France
| | - Marina Deljanin-Ilic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | - Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Erberto Carluccio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.,CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy
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7
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Accardi AJ, Matsubara BS, Gaw RL, Daleiden-Burns A, Heywood JT. Clinical Utility of Fluid Volume Assessment in Heart Failure Patients Using Bioimpedance Spectroscopy. Front Cardiovasc Med 2021; 8:636718. [PMID: 33898536 PMCID: PMC8060148 DOI: 10.3389/fcvm.2021.636718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bioimpedance spectroscopy (BIS) is a non-invasive method used to measure fluid volumes. In this report, we compare BIS measurements from patients with heart failure (HF) to those from healthy adults, and describe how these point-of-care fluid volume assessments may be applied to HF management. Methods and results: Fluid volumes were measured in 64 patients with NYHA class II or III HF and 69 healthy control subjects. BIS parameters including extracellular fluid (ECF), intracellular fluid (ICF), total body water (TBW), and ECF as a percentage of TBW (ECF%TBW) were analyzed. ECF%TBW values for the HF and control populations differed significantly (49.2 ± 3.2% vs. 45.2 ± 2.1%, respectively; p < 0.001); both distributions satisfied criteria for normality. Interquartile ranges did not overlap (46.7–51.0% vs. 43.8–46.4%, respectively; p < 0.001). Subgroup analyses of HF patients who underwent transthoracic echocardiography showed that impedance measurements correlated with inferior vena cava size (Pearson correlation −0.73, p < 0.0001). A case study is presented for illustrative purposes. Conclusions: BIS-measured ECF%TBW values were significantly higher in HF patients as compared to adults without HF. We describe three strata of ECF%TBW (normal, elevated, fluid overload) that may aid in clinical risk stratification and fluid volume monitoring of HF patients. Clinical Trial Registration: COMPARE – www.ClinicalTrials.gov; IMPEL – www.ClinicalTrials.gov; Heart Failure at Home – www.ClinicalTrials.gov, identifier: NCT02939053; NCT02857231; NCT04013373.
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Affiliation(s)
- Andrew J Accardi
- Department of Emergency Medicine, Scripps Memorial Hospital Encinitas, Encinitas, CA, United States
| | | | | | - Anne Daleiden-Burns
- Heart Failure Recovery and Research Program, Scripps Memorial Hospital La Jolla, La Jolla, CA, United States
| | - James Thomas Heywood
- Heart Failure Recovery and Research Program, Scripps Memorial Hospital La Jolla, La Jolla, CA, United States
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8
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Dupont V, Debrumetz A, Leguillou A, Morland D, Wynckel A, Colosio C, Mokri L, Schvartz B, Vuiblet V, Larre S, Barbe C, Rieu P. Intra-abdominal hypertension in early post-kidney transplantation period is associated with impaired graft function. Nephrol Dial Transplant 2021; 35:1619-1628. [PMID: 32678426 DOI: 10.1093/ndt/gfaa104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/14/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Moderate hyperhydration is often achieved in the early post-kidney transplantation period. Whether this strategy could lead to the development of intra-abdominal hypertension (IAH) has never been assessed so far. We aimed to study the incidence of IAH after kidney transplantation and its association with graft function recovery. METHODS We conducted a prospective monocentric study among patients undergoing kidney transplantation at the University Hospital of Reims between May 2017 and April 2019. Intravesical pressure (IVP) was monitored every 8 h from Day 0 to 3. RESULTS A total of 107 patients were enrolled. Among 55 patients included in the analysis, 74.5% developed IAH. Body mass index >25 kg/m2 was associated with IAH development {odds ratio [OR] 10.4 [95% confidence interval (CI) 2.0-52.9]; P = 0.005}. A previous history of peritoneal dialysis was protective [OR 0.06 (95% CI 0.01-0.3); P = 0.001]. IAH Grades III and IV occurred in 30.9% of patients and correlated with higher Day 3 creatininaemia (419.6 ± 258.5 versus 232.5 ± 189.4 μmol/L; P = 0.02), higher delayed graft function incidence (41.2 versus 7.9%; P = 0.04), lower Kirchner index measured using scintigraphy (0.47 ± 0.09 versus 0.64 ± 0.09; P = 0.0005) and decreased Day 30 estimated glomerular filtration rate (35.8 ± 18.8 versus 52.5 ± 21.3, P = 0.05). IAH patients had higher fluid balance (P = 0.02). Evolution of IVP correlated with weight gain (P < 0.01) and central venous pressure (P < 0.001). CONCLUSIONS IAH is frequent after kidney transplantation and IAH Grades III and IV are independently associated with impaired graft function. These results question current haemodynamic objectives and raise for the first time interest in intra-abdominal pressure monitoring in these patients. CLINICAL TRIAL NOTATION ClinicalTrials.gov identifier: NCT03478176.
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Affiliation(s)
- Vincent Dupont
- Department of Nephrology, University Hospital of Reims, Reims, France
| | | | - Adrien Leguillou
- Clinical Research Unit, University Hospital of Reims, Reims, France
| | - David Morland
- Department of Nuclear Medicine, Jean Godinot Institut, Reims, France
| | - Alain Wynckel
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Charlotte Colosio
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Laetitia Mokri
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Betoul Schvartz
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Vincent Vuiblet
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Stephane Larre
- Department of Urology, University Hospital of Reims, Reims, France
| | - Coralie Barbe
- Clinical Research Unit, University Hospital of Reims, Reims, France
| | - Philippe Rieu
- Department of Nephrology, University Hospital of Reims, Reims, France
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9
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Buda N, Kosiak W, Wełnicki M, Skoczylas A, Olszewski R, Piotrkowski J, Skoczyński S, Radzikowska E, Jassem E, Grabczak EM, Kwaśniewicz P, Mathis G, Toma TP. Recommendations for Lung Ultrasound in Internal Medicine. Diagnostics (Basel) 2020; 10:E597. [PMID: 32824302 PMCID: PMC7460159 DOI: 10.3390/diagnostics10080597] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.
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Affiliation(s)
- Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, 80-365 Gdansk, Poland
| | - Wojciech Kosiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-365 Gdansk, Poland;
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Agnieszka Skoczylas
- Geriatrics Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Jakub Piotrkowski
- Department of Internal Medicine and Gastroenterology, Independent Public Health Care Facility of the Ministry of the Internal Affairs with the Oncology in Olsztyn, 10-900 Olsztyn, Poland;
| | - Szymon Skoczyński
- Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Elżbieta Radzikowska
- III Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | - Ewa Jassem
- Department of Pulmonology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Elżbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Piotr Kwaśniewicz
- Diagnostic Imaging Department, Mother and Child Institute, 01-211 Warsaw, Poland;
| | - Gebhard Mathis
- Emergency Ultrasound in the Austrian Society for Ultrasound in Medicine and Biology, 1100 Vienna, Austria;
| | - Tudor P. Toma
- Consultant Respiratory Physician and Honorary Clinical Senior Lecturer, King’s College University Hospital Lewisham and Greenwich NHS Trust, London SE6 2LR, UK;
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10
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Miller LH, Keller F, Mertens A, Klein M, Allen K, Castellino S, Woods WG. Impact of fluid overload and infection on respiratory adverse event development during induction therapy for childhood acute myeloid leukemia. Pediatr Blood Cancer 2019; 66:e27975. [PMID: 31502412 PMCID: PMC6803045 DOI: 10.1002/pbc.27975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment-related morbidity and mortality occur frequently in childhood acute myeloid leukemia (AML) induction. Yet the contributions of respiratory adverse events (AEs) within this population are poorly understood. Furthermore, the roles of fluid overload (FO) and infection in AML pulmonary complications have been inadequately examined. OBJECTIVES To describe the incidence, categories, and grades of respiratory AEs and to assess the associations of FO and infection on respiratory AE development in childhood AML induction. METHODS We retrospectively examined the induction courses of a cohort of de novo pediatric AML patients for any NCI CTCAE grade 2 to 5 respiratory AE, FO, and systemic/pulmonary infection occurrence. Demographic, disease, and treatment-related data were abstracted. Descriptive, univariate, survival, and multivariable analyses were conducted. RESULTS Among 105 eligible subjects from 2009 to 2016, 49.5% (n = 52) experienced 63 discrete respiratory AEs. FO occurred in 28.6% of subjects (n = 30), with half occurring within 24 hours of hospitalization. Positive FO status < 10 days (aHR 5.5, 95% CI 2.3-12.8), ≥ 10 days (aHR 13, 95% CI 4.1-41.8), and positive infection status ≥ 10 days into treatment (aHR 14.9, 5.4-41.6) were each independently associated with AE development. CONCLUSIONS We describe a higher incidence of respiratory AEs during childhood AML induction than previously illustrated. FO occurs frequently and early in this course. Late infections and FO at any time frame were strongly associated with AE development. Interventions focused on the prevention and management of FO and infectious respiratory complications could be instrumental in reducing preventable treatment-related morbidity and mortality.
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Affiliation(s)
- Lane H Miller
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Frank Keller
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann Mertens
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristen Allen
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Sharon Castellino
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA,Drs Castellino and Woods provided equal contribution as senior authors
| | - William G Woods
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA,Drs Castellino and Woods provided equal contribution as senior authors
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