Noninvasive Imaging Methods for Quantification of Pulmonary Edema and Congestion

Lindow, Thomas; Quadrelli, Scott; Ugander, Martin

doi:10.1016/j.jcmg.2023.06.023

Cited by 4 publications

(3 citation statements)

References 132 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The weak relationship observed between LWD and conventional CMR markers can be explained by the underlying pathophysiology of pulmonary oedema. Pulmonary oedema occurs in heart failure when LA pressure exceeds a critical threshold, resulting in increased pulmonary capillary hydrostatic pressure [1]. That threshold is variable, depending on the presence of a number of pulmonary adaptations, including reduced capillary filtration due to pulmonary vascular remodelling and endothelial dysfunction, enhanced alveolar fluid clearance and increased lymphatic drainage [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary oedema is the accumulation of extravascular fluid in the lung parenchyma. Cardiogenic pulmonary oedema occurs in heart failure due to an increase in hydrostatic pressure in the pulmonary capillaries resulting from increased left atrial pressure and is associated with a poor long-term prognosis [1–3]. Current methods to assess pulmonary oedema are either invasive (transpulmonary thermodilution), semi-quantitative (chest x-Ray and lung ultrasound) or require the use of ionising radiation (nuclear imaging and computed tomography).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lung water density is increased in patients at risk of heart failure and is largely independent of conventional CMR measures

Iyer,

Bryant,

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

AimsNon-invasive methods to quantify pulmonary congestion are lacking in clinical practice. Cardiovascular magnetic resonance (CMR) lung water density (LWD) mapping is accurate, reproducible, and has prognostic value. However, it is not known whether LWD is associated with routinely acquired CMR parameters.Methods and ResultsThis was a prospective, observational cohort including healthy controls and patients at risk of heart failure. Lung water density was measured using CMR with a free-breathing short echo time 3D cartesian gradient-echo sequence with a respiratory navigator at 1.5T. Associations were assessed between LWD, lung water volume (LWV) and cardiac volumes, left ventricular (LV) mass and function, myocardial native T1 and extracellular volume fraction (ECV). In patients at risk for heart failure (n=155), LWD was greater than in healthy controls (n=15) (30.4±5.0 vs 27.2±4.3%, p=0.02). Using receiver operating characteristic analysis, the optimal cut-off for LWD was 27.6% to detect at-risk patients (sensitivity 72%, specificity 73%, positive likelihood ratio 2.7, inverse negative likelihood ratio 2.6). LWD was univariably associated with body mass index (BMI), hypertension, right atrial (RA) area and LV mass (p<0.05 for all). In multivariable linear regression, only BMI remained associated with LWD (R2=0.32, p<0.001). In a separate multivariable analysis including only CMR markers, only RA area remained associated with LWD (R2=0.05, p=0.006).ConclusionLWD is increased in patients at risk for heart failure compared to controls, and is only weakly explained by conventional CMR measures. LWD provides diagnostic information which is largely independent of conventional CMR measures.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lung water density is increased in patients at risk of heart failure and is largely independent of conventional CMR measures

Iyer,

Bryant,

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Such cohorts sometimes have comorbid pulmonary congestion [ 3 ]. One of the challenges of optimal congestion management is the lack of a gold standard for accurately quantifying the degree of congestion, though it remains an important surrogate marker to guide the optimization of heart failure-specific therapies to reduce the risk of readmissions [ 4 , 5 , 6 ]. Physical examination, chest X-ray, and computed tomography, together with lung ultrasound [ 7 ], are commonly used to estimate degrees of congestion.…”

Section: Introductionmentioning

confidence: 99%

A Lower Remote Dielectric Sensing Value Was Associated with Hypovolemia and Worse Clinical Outcomes

Imamura,

Izumida,

Narang

et al. 2024

JCM

View full text Add to dashboard Cite

Background: Remote dielectric sensing (ReDS) systems can estimate the amount of lung fluid non-invasively and easily without expert techniques. The correlation between the elevated ReDS value and other modalities that estimate pulmonary congestion has been validated. The clinical implications of lower ReDS values, which may indicate hypovolemia, remain unknown. Methods: A total of 138 patients who were hospitalized for various cardiovascular-related problems and underwent ReDS value measurements at the index discharge in a blinded manner to the attending clinicians were eligible for inclusion. Patients with ReDS values > 30%, indicating the presence of pulmonary congestion, were excluded. The prognostic impact of lower ReDS values on all-cause readmission after index discharge was evaluated. Results: A total of 97 patients were included. The median age was 78 years, and 48 were men. The median ReDS value at index discharge was 26% (23%, 27%). A lower ReDS value correlated with smaller inferior vena cava maximum diameters (r = 0.46, p < 0.001) and higher blood urea nitrogen/creatinine ratios (r = −0.35, p < 0.001). A lower ReDS value (≤25%) was associated with a risk of all-cause readmissions with an unadjusted hazard ratio of 2.68 (95% confidence interval 1.09–6.59, p = 0.031) and an adjusted hazard ratio of 2.30 (95% confidence interval 0.92–5.78, p = 0.076). Its calculated cutoff of 25% significantly stratified the cumulative incidence of the primary outcome (36% versus 17%, p = 0.038). Conclusions: A lower ReDS value may indicate hypovolemia and be associated with the risk of all-cause readmission in patients hospitalized for cardiovascular diseases.

show abstract

Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction

Dhont,

Verbrugge,

Verwerft

et al. 2024

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

Non-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.

show abstract

Noninvasive Imaging Methods for Quantification of Pulmonary Edema and Congestion

Cited by 4 publications

References 132 publications

Lung water density is increased in patients at risk of heart failure and is largely independent of conventional CMR measures

Lung water density is increased in patients at risk of heart failure and is largely independent of conventional CMR measures

A Lower Remote Dielectric Sensing Value Was Associated with Hypovolemia and Worse Clinical Outcomes

Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction

Contact Info

Product

Resources

About