Frassi Francesca, Gargani Luna, Tesorio Paola, Raciti Mauro, Mottola Gaetano, Picano Eugenio
Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, Pisa, Italy.
J Card Fail. 2007 Dec;13(10):830-5. doi: 10.1016/j.cardfail.2007.07.003.
Ultrasound lung comets (ULCs) consist of multiple comet tails originating from water-thickened interlobular septa. They are a new echographic tool to assess the pathologic increase in extravascular lung water, which is a possible harbinger of impending acute heart failure. The objective was to assess the prognostic value of ULCs in patients with dyspnea and/or chest pain syndrome at hospital admission.
A total of 290 consecutive in-hospital patients (aged 68 +/- 13 years) admitted for dyspnea and/or chest pain syndrome were evaluated on admission with a comprehensive two-dimensional and Doppler echocardiographic evaluation and chest sonography with ULC assessment. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithoraxes, from the second to fifth intercostal spaces. All patients were followed up for a median period of 16 months (interquartile range: 2.8-29.1 months). During the follow-up, 62 events occurred: 19 cardiac deaths, 3 nonfatal myocardial infarctions, 20 acute heart failures requiring hospitalization, and 20 noncardiac deaths. The 16-month event-free survival was highest in patients with no ULCs and lowest in patients with severe (>30) ULCs at entry (70% vs 19%, P = .0007). At univariate analysis, ULCs (hazard ratio [HR] 2.349; confidence interval [CI] 1.364-4.044) were more powerful predictors than other echocardiographic variables of recognized prognostic value, including ejection fraction (HR 0.974; 95% CI 0.958-0.99) and wall motion score index (HR 1.628; CI 1.15-2.304). On multivariable analysis, ULCs provided additional prognostic information (HR 1.9; 95% CI 1.1-3.4) on diabetes (HR 2.05; 95% CI 1.2-3.5) and New York Heart Association class (HR 1.3; 95% CI 1.0-1.6).
ULCs are a simple user-friendly, radiation-free bedside sign of extravascular lung water. They provide useful information for the prognostic stratification of patients with dyspnea and/or chest pain syndrome.
超声肺彗星征（ULCs）由源自水增厚的小叶间隔的多个彗尾组成。它们是一种评估血管外肺水病理性增加的新型超声检查工具，而血管外肺水病理性增加可能是即将发生急性心力衰竭的先兆。目的是评估入院时出现呼吸困难和/或胸痛综合征患者中ULCs的预后价值。
共有290例因呼吸困难和/或胸痛综合征连续入院的患者（年龄68±13岁）在入院时接受了全面的二维和多普勒超声心动图评估以及带有ULCs评估的胸部超声检查。通过计算右前和左前半胸从第二到第五肋间空间每个扫描区域的彗尾数量得出患者的ULCs评分。所有患者随访中位时间为16个月（四分位间距：2.8 - 29.1个月）。随访期间发生62起事件：19例心源性死亡、3例非致命性心肌梗死、20例需要住院治疗的急性心力衰竭以及20例非心源性死亡。入院时无ULCs的患者16个月无事件生存率最高，严重（>30）ULCs的患者最低（70%对19%，P = 0.0007）。单因素分析中，ULCs（风险比[HR] 2.349；置信区间[CI] 1.364 - 4.044）比其他具有公认预后价值的超声心动图变量更具预测力，包括射血分数（HR 0.974；95% CI 0.958 - 0.99）和室壁运动评分指数（HR 1.628；CI 1.15 - 2.304）。多变量分析中，ULCs在糖尿病（HR 2.05；95% CI 1.2 - 3.5）和纽约心脏协会分级（HR 1.3；95% CI 1.0 - 1.6）方面提供了额外的预后信息（HR 1.9；95% CI 1.1 - 3.4）。
ULCs是一种简单、用户友好、无辐射的血管外肺水床边体征。它们为呼吸困难和/或胸痛综合征患者的预后分层提供了有用信息。
