Lung ultrasound and transthoracic impedance for noninvasive evaluation of pulmonary congestion in heart failure

作者：Camilla Facchini, Gabriella Malfatto, Alessia Giglio, Mario Facchini, Gianfranco Parati, Giovanna Branzi · 发表于：Journal of Cardiovascular Medicine · 年份：2015 · DOI：10.2459/jcm.0000000000000226 · 被引用次数：60 · 研究领域：Ultrasound in Clinical Applications、Hemodynamic Monitoring and Therapy、Phonocardiography and Auscultation Techniques

BACKGROUND: In patients with heart failure, many indexes are available for noninvasive identification of pulmonary congestion: E/E' at echocardiography; plasma levels of brain natriuretic peptide (BNP) (pg/ml); number of B-lines at lung ultrasound; and transthoracic conductance [thoracic fluid content (TFC)TT = 1/Ω] at impedance cardiography (ICG). METHODS: We obtained 75 measures from 50 patients (72 ± 10 years, NYHA 2.4 ± 0.7, ejection fraction 31 ± 7%), 25 of them studied before and after intravenous diuretics, in whom we assessed the following: E/e' from Doppler echocardiogram; BNP plasma levels; presence and number of B-lines at lung ultrasound; and TFCTT from ICG. We determined the relationship among these indexes and their change with treatment, and compared B-lines and TFC for the diagnosis of pulmonary congestion. Finally, we considered the timing and the personnel required for performing and interpreting each test. RESULTS: A mutual relationship was observed between all the variables. After clinical improvement, changes in each variable were of similar direction and magnitude. Congestion (estimated by chest radiograph) was present in 59% of the patients: TFC value and B-line number had the best sensitivity and specificity for its detection. BNP determination and ICG assessment were performed by a nurse (15 min), and echocardiography and lung ultrasound were performed by a cardiologist (15 min). CONCLUSION: The correlation between all indexes and their consensual cha...