Maines Massimiliano, Catanzariti Domenico, Angheben Carlo, Valsecchi Sergio, Comisso Jennifer, Vergara Giuseppe
Division of Cardiology, Santa Maria del Carmine Hospital, Rovereto (TN), Italy.
Pacing Clin Electrophysiol. 2011 Aug;34(8):968-74. doi: 10.1111/j.1540-8159.2011.03072.x. Epub 2011 Apr 7.
Echographic examination of the lung surface may reveal multiple ultrasound lung comets (ULCs) originating from water-thickened interlobular septa. These images were demonstrated to be useful for noninvasive assessment of interstitial pulmonary edema. Similarly, the correlation between implantable defibrillator-measured intrathoracic impedance and pulmonary capillary wedge pressure (PCWP) was demonstrated in heart failure (HF) patients. The aims of this analysis were to assess the agreement between defibrillator-detected impedance decrease and the presence of ULCs, as well as to compare the performance of the impedance-detection algorithm and the ULCs assessment in predicting HF worsening.
We studied 23 HF patients implanted with a defibrillator capable of intrathoracic impedance measurement and alerting for fluid accumulation diagnosis. At regular follow-up and at visits for HF decompensation or device alert, clinical status was assessed, chest ultrasound was performed, and PCWP was noninvasively estimated with Doppler echocardiography. During 23 ± 11 months of follow-up, 45 paired assessments of defibrillator-measured intrathoracic impedance and ULCs were performed. The number of ULCs resulted significantly correlated to the paired PCWP estimations (r = 0.917, P < 0.001) and to the impedance fluid index (r = 0.669, P < 0.001). During follow-up, 12 episodes of HF decompensation were reported in 12 patients. The impedance alert detected clinical HF deterioration with 92% sensitivity and 69% positive predictive value. The presence of ≥5 ULCs showed 83% sensitivity and 91% positive predictive value.
These data demonstrate the correlation between intrathoracic impedance and the number of ULCs at chest ultrasound, and a good agreement between the defibrillator warning for fluid index and the detection of multiple ULCs.
对肺表面进行超声检查可能会发现源自水增厚小叶间隔的多个超声肺彗星征（ULC）。这些图像已被证明有助于间质性肺水肿的无创评估。同样，在心力衰竭（HF）患者中，已证明植入式除颤器测量的胸内阻抗与肺毛细血管楔压（PCWP）之间存在相关性。本分析的目的是评估除颤器检测到的阻抗降低与ULC的存在之间的一致性，以及比较阻抗检测算法和ULC评估在预测HF恶化方面的性能。
我们研究了23例植入了能够测量胸内阻抗并对液体蓄积诊断发出警报的除颤器的HF患者。在定期随访以及因HF失代偿或设备警报而就诊时，评估临床状态，进行胸部超声检查，并通过多普勒超声心动图无创估计PCWP。在23±11个月的随访期间，对除颤器测量的胸内阻抗和ULC进行了45次配对评估。ULC的数量与配对的PCWP估计值（r = 0.917，P < 0.001）和阻抗液体指数（r = 0.669，P < 0.001）显著相关。在随访期间，12例患者报告了12次HF失代偿发作。阻抗警报检测到临床HF恶化的敏感性为92%，阳性预测值为69%。≥5个ULC的存在显示出83%的敏感性和91%的阳性预测值。
这些数据证明了胸内阻抗与胸部超声检查中ULC数量之间的相关性，以及除颤器对液体指数的警报与多个ULC检测之间的良好一致性。
