Lung Comets Research Articles

Ultrasound lung comets: A clinically useful sign in acute respiratory distress syndrome/acute lung injury*

Ultrasound lung comets: A clinically useful sign in acute respiratory distress syndrome/acute lung injury*

Prognostic Value of Extravascular Lung Water Assessed With Ultrasound Lung Comets by Chest Sonography in Patients With Dyspnea and/or Chest Pain

Background 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. Methods and Results 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). Conclusion 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.

Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation.

341 Ultrasound lung comets provide an early marker of acute oleic acid lung injury in pigs

341 Ultrasound lung comets provide an early marker of acute oleic acid lung injury in pigs

648 Ultrasound lung comets for differential diagnosis of dyspnea: comparison with plasma cardiac peptides

648 Ultrasound lung comets for differential diagnosis of dyspnea: comparison with plasma cardiac peptides

666 The prognostic value of ultrasound lung comets in patients with dyspnea and/or chest pain

666 The prognostic value of ultrasound lung comets in patients with dyspnea and/or chest pain

Clinical and echocardiographic determinants of ultrasound lung comets☆

Ultrasound lung comets (ULCs) are an echographic sign of extravascular lung water, that originate from water-thickened interlobular septa. To establish the echocardiographic correlates of ULCs. 340 in-hospital patients (68 +/- 12years, 115 females) admitted to adult cardiology department underwent upon admission a separate evaluation of chest ULCs and a comprehensive 2D and Doppler echocardiography assessment, including the degree of left ventricular diastolic dysfunction (from 0 = normal to 3 = restrictive pattern). A patient ULC score has been obtained by summing the number of ULCs from each of the scanning spaces in the anterior right and left chest, from second to fifth intercostal space. Multivariate linear regression analysis identified New York Heart Association (NYHA) class (OR = 2.1, CI = 1.4-2.9), ejection fraction (OR 0.954, CI = 0.928-0.981) and degree of diastolic dysfunction (OR = 2.438, CI = 1.418-4.190) as the only parameters independently associated to the number of ULCs. ULCs are a simple echographic sign of extravascular lung water, more frequently associated with left ventricular diastolic and/or systolic dysfunction. ULCs can usefully integrate the clinical and pathophysiological information provided by conventional 2D and Doppler echocardiography, in patients with known or suspected heart failure and dyspnoea as a presenting symptom.

Assessment of Stress-induced Pulmonary Interstitial Edema by Chest Ultrasound During Exercise Echocardiography and its Correlation with Left Ventricular Function

Ultrasound lung comet images (ULC) are useful for the noninvasive assessment of extravascular lung water (EVLW). We investigated the modification of EVLW, its relation to indices of left ventricular systolic and diastolic function, and noninvasively determined pulmonary capillary wedge pressure (PCWP) (PCWP = 1.24 ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus [E/Em] + 1.9) at rest and its variation during exercise echocardiography. A total of 72 patients (mean age 66.4 +/- 8.4 years) with mean ejection fraction of 41.2 +/- 14.4% underwent symptoms-limited exercise echocardiography. The sum of the ULC yielded a score of EVLW. The ULC increased significantly from baseline to postexercise (5.9 +/- 14.9 vs 11 +/- 20.7, P = .0001). Positive linear correlations were found between baseline ULC score and baseline ejection fraction (r = -0.37, P = .002), systolic pulmonary artery pressure (r = 0.69, P = .0001), E/Em (r = 0.70, P = .0001), and estimated PCWP (r = 0.69, P = .0001). The variation between postexercise and baseline ULC score correlated significantly with the variation between peak stress and rest PCWP (r = 0.62, P = .0001), systolic pulmonary artery pressure (r = 0.44, P = .0001), wall-motion score index (r = 0.30, P = .01), and peak stress E/Em (r = 0.71, P = .0001), whereas no significant correlations were found between variations of ULC score and ejection fraction. This study shows that ULC represents a simple way to assess the presence of excess EVLW. Increased EVLW is associated with estimated PCWP and indices of left ventricular systolic and diastolic dysfunction. The additional exercise-induced increase of PCWP, the worsening of left ventricular diastolic function, and extensive wall-motion abnormalities correlate with variations of EVLW.

The best of 2005 in echocardiography back from EuroEcho 9 – Florence, Italy

The ninth edition of the congress of the European Association of Echocardiography (EAE) (former working group of Echocardiography) held in Florence has just finished with a great success of participant attendance (2.842) and abstract submissions. Hot topics at EuroEcho 9 were: 1-live 3-dimensional echocardiography and surgical decision making; in pediatric cardiology; in resynchronization therapy 2- stress echocardiography beyond wall motion: from valve diseases to contractility to coronary flow reserve to diastolic function; 3- pulmonary cardiogenic interstitial thickening recognized by ultrasonic lung comets; 4- the "proven clinical inefficacy" of the many technologies sold as breakthrough: color kinesis, tissue characterization, strain rate, tissue Doppler, applied to stress echocardiography.

262 Changes in ultrasound lung comets as a guide to treatment in heart failure patients: correlation with NT-proBNP

262 Changes in ultrasound lung comets as a guide to treatment in heart failure patients: correlation with NT-proBNP

275 Ultrasound lung comet as a bedside sign of cardiogenic dyspnea

275 Ultrasound lung comet as a bedside sign of cardiogenic dyspnea

Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water

The “comet-tail” is an ultrasound sign detectable with ultrasound chest instruments; this sign consists of multiple comet-tails fanning out from the lung surface. They originate from water-thickened interlobular septa and would be ideal for nonradiologic bedside assessment of extravascular lung water. To assess the feasibility and value of ultrasonic comet signs, we studied 121 consecutive hospitalized patients (43 women and 78 men; aged 67 ± 12 years) admitted to our combined cardiology-pneumology department (including cardiac intensive care unit); the study was conducted with commercially available echocardiographic systems including a portable unit. Transducer frequencies (range 2.5 to 3.5 MHz) were used. In each patient, the right and left chest was scanned by examining predefined locations in multiple intercostal spaces. Examiners blinded to clinical diagnoses noted the presence and numbers of lung comets at each examining site. A patient lung comet score was obtained by summing the number of comets in each of the scanning spaces. Within a few minutes, patients underwent chest x-ray, with specific assessment of extravascular lung water score by 2 pneumologist-radiologists blinded to clinical and echo findings. The chest ultrasound scan was obtained in all patients (feasibility 100%). The imaging time per examination was always <3 minutes. There was a linear correlation between echocardiographic comet score and radiologic lung water score (r = 0.78, p <0.01). Intrapatient variations (n = 15) showed an even stronger correlation between changes in echocardiographic lung comet and radiologic lung water scores (r = 0.89; p <0.01). In 121 consecutive hospitalized patients, we found a linear correlation between echocardiographic comet scores and radiologic extravascular lung water scores. Thus, the comet-tail is a simple, non–time-consuming, and reasonably accurate chest ultrasound sign of extravascular lung water that can be obtained at bedside (also with portable echocardiographic equipment) and is not restricted by cardiac acoustic window limitations.