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Tesi etd-06212017-093658


Thesis type
Tesi di specializzazione (5 anni)
Author
BARLETTA, VALENTINA
URN
etd-06212017-093658
Title
Non invasive assessment of hemodynamic threshold in heart failure patients
Struttura
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
MALATTIE DELL'APPARATO CARDIOVASCOLARE
Commissione
relatore Marzilli, Mario
Parole chiave
  • comets
  • heart failure
  • B-lines
  • echocardiography
  • lung sonography
Data inizio appello
10/07/2017;
Consultabilità
parziale
Data di rilascio
10/07/2020
Riassunto analitico
BACKGROUND<br>According to ESC Guidelines recently published, heart failure (HF) is a clinical syndrome characterized by typical symptoms (breathlessness, ankle swelling and fatigue) that may be accompanied by signs (elevated jugular venous pressure, pulmonary crackles and peripheral edema) caused by a structural or functional cardiac abnormality, resulting in reduced cardiac output and elevated intracardiac pressure at rest or during stress. Typically, symptoms and signs of acute decompensated HF reflect fluid overload (pulmonary congestion and/or peripheral edema), therefore the quantitative assessment of adequate peripheral and pulmonary decongestion represents a challenge for the clinician.<br>Despite the importance of dyspnea, a validated instrument that is accurate, reliable, reproducible and sensitive does not currently exist.<br>Cardiac imaging plays a central role in the diagnosis of HF and in guiding treatment, and especially lung ultrasound (LUS) is increasingly used in the acute care setting and has improved diagnostic accuracy compared with clinical assessment and chest radiography. Briefly, B-lines are mostly attributed to water-thickened subpleural interlobular septa and invariably associated with increased extravascular lung water. They present as discrete, laser-like, vertical and hyper-echoic artefacts that develop from the pleural line extending down to the bottom of the screen. <br><br>AIM<br>The aim of the study was to describe the presence and changes of LUS findings in patients admitted to our Cardiology Care Unit with ADHF. In particular, the primary aim was to describe the changes achieved with diuretic therapy in B-lines and other biomarkers commonly employed, such as systolic pulmonary artery pressure (sPAP) and E/e’ ratio at transthoracic echocardiography, and BNP values on blood sampling.<br>Secondary, we speculated that it is possible to assess the modification of extravascular lung water (EVLW) by the appearance of B-lines in compensated heart failure patients, undergone to exercise test before discharge from hospital.<br> <br>CONCLUSION<br>B-lines are increased on admission in ADHF and rapidly decrease with pulmonary decongestion achieved with diuretic therapy. Therefore, they provide an objective, real time, easily accessibly, non-invasive index of pulmonary congestion and decongestion.<br>Moreover, the acute increase in B-lines detected by LUS during exercise test is a feasible way for demonstrating that the symptom dyspnea is related to pulmonary congestion due to backward heart failure, especially in patients in good hemodynamic compensation conditions.<br>
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