Association between lung ultrasound findings and invasive exercise haemodynamics in patients with undifferentiated dyspnoea

Platz, Elke; Merz, Allison A.; Silverman, Montane B; Lewis, Eldrin F.; Groarke, John D.; Waxman, Aaron B.; Systrom, David M.

doi:10.1002/ehf2.12381

Cited by 12 publications

(21 citation statements)

References 16 publications

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“…These findings indicate the complexity of dyspnoea pathophysiology and suggest that dyspnoea is not a simple equivalent of lung congestion assessed on physical examination. 21,35,36 These data are consistent with our previous study, in which we analysed the pattern of dyspnoea onset in AHF, and we have shown that only 26% of patients with dyspnoea at rest, as a major symptom of AHF on admission, presented moderate/severe pulmonary congestion. 17 Our study provides additional interesting finding that the patients with peripheral signs of congestion experienced longer duration of dyspnoea before admission to hospital than patients with pulmonary congestion, in whom dyspnoea onset was more rapid.…”

Section: Discussionsupporting

confidence: 91%

“…Another noticeable observation to emerge from data comparison showed that dyspnoea constituted a common symptom of AHF and was experienced also by 68% of patients without signs of pulmonary congestion. These findings indicate the complexity of dyspnoea pathophysiology and suggest that dyspnoea is not a simple equivalent of lung congestion assessed on physical examination 21,35,36 . These data are consistent with our previous study, in which we analysed the pattern of dyspnoea onset in AHF, and we have shown that only 26% of patients with dyspnoea at rest, as a major symptom of AHF on admission, presented moderate/severe pulmonary congestion 17 .…”

Section: Discussionsupporting

confidence: 89%

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Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes

et al. 2020

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Aims Patients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and evaluate treatment response and outcomes in studied phenotypes. Methods and results We investigated retrospectively 352 patients (mean age: 68 ± 13 years, 77% men) hospitalized due to AHF with the signs of congestion on admission. Patients were divided according to the type of signs of congestion into three groups: A, isolated pulmonary congestion (n = 52, 15%); B, isolated peripheral congestion (n = 31, 9%); and C, signs of mixed (peripheral and central) congestion (n = 269, 76%). Patients from Group A had lower concentration of urea, bilirubin, and gamma-glutamyl transferase whereas higher level of haematocrit, albumin, and leukocytes on admission. The highest baseline N-terminal pro-B-type natriuretic peptide level (median: 4113 vs. 3634 vs. 6093 pg/mL) and percentage of patients with chronic heart failure (56 vs. 58 vs. 74%; A vs. B. vs. C, respectively, all P < 0.01) were observed in Group C. There were no differences in terms of demographics, co-morbidities, left ventricular ejection fraction, and applied treatment between studied groups. Patients from Group A had the highest systolic blood pressure on admission (145 ± 37 vs. 122 ± 20 vs. 130 ± 29 mmHg) and the biggest decrease in systolic blood pressure [À22 (À45 to À4) vs. À2 (À13 to 2) vs. À10 (À25 to 0) mmHg] and heart rate [À16 (À35 to À1.5) vs. À1 (À10 to 5) vs. À7 (À20 to 0) b.p.m.] with the lowest weight change [À1.0 (À1.0 to 0) vs. À2.9 (À3.8 to À0.9) vs. À2.0 (À3.0 to À1.0) kg; all P < 0.01] after 48 h of hospitalization. There were differences in short-term and long-term outcomes with favourable results in Group A. Group A experienced less frequent in-hospital heart failure worsening during the first 48 h (4 vs. 23 vs. 7%), had shorter length of hospital stay [6 (5-8) vs. 7 (5-11) vs. 7 (6-11) days], and had lower 1 year all-cause mortality (12 vs. 28 vs. 29%; all P < 0.05). Presence of peripheral congestion on admission was independent predictor for all-cause mortality within 1 year [hazard ratio (95% confidence interval): 2.68 (1.06-6.79); P = 0.04]. Conclusions Patterns of congestion in AHF are associated with differences in clinical characteristics, treatment response, and outcomes. It needs to be considered once planning clinical trials in AHF.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes

et al. 2020

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“…Indeed the added value of B-lines is being a sign of pulmonary congestion, independent of the degree of hemodynamic congestion. Platz et al also investigated patients with unexplained dyspnea with invasive hemodynamic measurements and LUS: the number of B-lines at rest was correlated to PCWP and mean pulmonary artery pressure ( Platz et al, 2019 ). Reddy et al showed that stress-induced B-lines elevation was mainly dependent on RV dysfunction and pulmonary hemodynamics ( Reddy et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lung Ultrasound in Aortic Stenosis

et al. 2022

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Background: Aortic stenosis (AS) is the most common primary valve lesion requiring intervention in Europe and North America. It has a prolonged subclinical period during which, as AS worsens, left ventricular adaptation becomes inadequate and impaired systolic and/or diastolic dysfunction may lead to overt heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a cardinal feature in HF, and lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, noninvasive tool to assess pulmonary congestion.Aim: To assess the presence and the prognostic value of sonographic pulmonary congestion in patients with moderate or severe AS.Methods: 75 consecutive patients (39 women, mean age 73.85 ± 7.7 years) with moderate or severe AS were enrolled. All patients underwent comprehensive echocardiography and LUS with the 28 scanning-site assessment. Patients were followed-up for 13.4 ± 6 months to establish the prognostic value of LUS. A composite endpoint of death (of any cause), hospitalization for HF and intensification of loop diuretic therapy was considered.Results: We found a severe degree of B-lines (≥30) in 29.33% of patients. The number of B-lines correlated with the estimated pulmonary artery systolic pressure (p < 0.001, r = 0.574) and increased along with NYHA class (p < 0.05, rho = 0.383). At multivariable analysis, B-lines ≥30, and mean gradient were the independent predictors of events [B-lines: 2.79 (CI 1.03–7.54), p = 0.04; mean gradient: 1.04 (CI 1.01–1.07), p = 0.004].Conclusion: Evaluation of B-lines is a simple, highly feasible method to detect pulmonary congestion in AS. The number of B-lines correlates with the hemodynamic changes caused by AS and with the functional status of patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events.

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“…B-lines may develop or quickly worsen in response to exercise in patients with HF, and “wet spots” may appear in the third intercostal space in two regions along the anterior axillary and mid-axillary lines, where B-lines most prominently develop during supine exercise [ 62 ]. An increased number of B-lines during exercise is correlated with hemodynamic congestion ( Figure 2 ) (higher PCWP and pulmonary arterial pressures), as well as with reduced exercise capacity and worse clinical outcomes in HFpEF [ 63 , 64 , 65 , 66 , 67 ].…”

Section: Exercise Echocardiography Methodsmentioning

confidence: 99%

Exercise Stress Echocardiography in the Diagnostic Evaluation of Heart Failure with Preserved Ejection Fraction

Harada

Kagami

Kato

et al. 2022

JCDD

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More than half of patients with heart failure have a preserved ejection fraction (HFpEF). The prevalence of HFpEF has been increasing worldwide and is expected to increase further, making it an important health-care problem. The diagnosis of HFpEF is straightforward in the presence of obvious objective signs of congestion; however, it is challenging in patients presenting with a low degree of congestion because abnormal elevation in intracardiac pressures may occur only during physiological stress conditions, such as during exercise. On the basis of this hemodynamic background, current consensus guidelines have emphasized the importance of exercise stress testing to reveal abnormalities during exercise, and exercise stress echocardiography (i.e., diastolic stress echocardiography) may be used as an initial diagnostic approach to HFpEF owing to its noninvasive nature and wide availability. However, evidence supporting the use of this method remains limited and many knowledge gaps exist with respect to diastolic stress echocardiography. This review summarizes the current understanding of the use of diastolic stress echocardiography in the diagnostic evaluation of HFpEF and discusses its strengths and limitations to encourage future studies on this subject.

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Association between lung ultrasound findings and invasive exercise haemodynamics in patients with undifferentiated dyspnoea

Cited by 12 publications

References 16 publications

Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes

Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes

Prognostic Value of Lung Ultrasound in Aortic Stenosis

Exercise Stress Echocardiography in the Diagnostic Evaluation of Heart Failure with Preserved Ejection Fraction

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