This study sought to investigate clinical and echocardiographic correlates of the
lung comets score.
Early detection of pulmonary congestion is a fundamental goal for the prevention of
congestive heart failure in high-risk patients.
We undertook an inclusive survey by a validated ultrasound (US) technique in a hemodialysis
center to estimate the prevalence of pulmonary congestion and its reversibility after
dialysis in a population of 75 hemodialysis patients.
Chest US examinations were successfully completed in all patients (N = 75). Before
dialysis, 47 patients (63%) exhibited moderate to severe lung congestion. This alteration
was commonly observed in patients with heart failure but also in the majority of asymptomatic
(32 of 56, 57%) and normohydrated (19 of 38, 50%) patients. Lung water excess was
unrelated with hydration status but it was strongly associated with New York Heart
Association functional class (p < 0.0001), left ventricular ejection fraction (r =
-0.55, p < 0.001), early filling to early diastolic mitral annular velocity (r = 0.48,
p < 0.001), left atrial volume (r = 0.39, p = 0.001), and pulmonary pressure (r =
0.36, p = 0.002). Lung water reduced after dialysis, but 23 patients (31%) still had
pulmonary congestion of moderate to severe degree. Lung water after dialysis maintained
a strong association with left ventricular ejection fraction (r = -0.59, p < 0.001),
left atrial volume (r = 0.30, p = 0.01), and pulmonary pressure (r = 0.32, p = 0.006)
denoting the critical role of cardiac performance in the control of this water compartment
in end-stage renal disease. In a multiple regression model including traditional and
nontraditional risk factors only left ventricular ejection fraction maintained an
independent link with lung water excess (beta = -0.61, p < 0.001). Repeatability studies
of the chest US technique (Bland-Altman plots) showed good interobserver and inter-US
probes reproducibility.
Pulmonary congestion is highly prevalent in symptomatic (New York Heart Association
functional class III to IV) and asymptomatic dialysis patients. Chest ultrasound is
a reliable technique that detects pulmonary congestion at a pre-clinical stage in
end-stage renal disease.
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc.
All rights reserved.