Visualizing congestion with ultrasound - diagnostic and therapeutic implications :

Focused cardiothoracic ultrasound protocol of the heart and lungs (caTUS)

Jonas Öhman

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Background The syndrome of Acute Heart Failure (AHF) is a very common cause for hospitalization, and carries a poor prognosis both in hospital and after discharge. The syndrome is caused by a various disease of the cardiovascular system and the heart. Congestion due to elevated cardiac filling pressures is the key physiological feature in AHF. There is to date very little evidence-based therapy existing for AHF and hospitalizations are lengthy and expensive. The aim of this thesis is to investigate a cardiothoracic rapid ultrasound protocol (CaTUS) in allowing an individual approach to be taken considering diagnosis, treatment monitoring and treatment guidance in AHF. Methods We enrolled 4 partly overlapping populations for this thesis. In our first study, we enrolled a total of 100 dyspneic ED patients in whom we tested CaTUS for diagnosing AHF, with the protocol done immediately upon arrival in the ED. Except for diagnosing AHF, CaTUS was also tested for diagnosing other conditions causing dyspnea in this study. In our second study on early monitoring of AHF, we enrolled 60 hospitalized AHF patients who had CaTUS done 3 times during the first 24 hours, thereafter 24 hours later and finally once more prior to discharge. In our third study evaluating the prognostic impact of CaTUS among other congestion parameters, we enrolled a sample of 100 hospitalized AHF patients, to whom CaTUS was done at baseline, at 24 and 48 hours and finally at the day of discharge. In our fourth study, we enrolled a small 20-patient AHF population, who had their treatment guided by the CaTUS protocol. The treatment results in this population were compared with treatment results in the previously enrolled 100-patient population enrolled before, who had received conventional in-hospital treatment for AHF. Results The CaTUS protocol performed very well for diagnosing AHF, as well as for differential diagnostics in dyspneic patients. Sensitivity was 100 % and specificity 95.8 % for diagnosing AHF as compared to a golden standard consisting of a brain natriuretic peptide-value of > 400 ng/l or > 100 ng/l in combination on chest x-ray as evaluated by an independent radiologist on the radiology ward . During early treatment, CaTUS was able to identify early treatment responders and disgtinguish them from non-responders, which seemed to be relevant since early responders often expressed a favorable treatment response throughout hospitalization and a significantly better post-discharge prognosis. For determining post-discharge prognosis, inferior vena cava index at discharge seemed to be the most relevant congestion parameter, indicating whether an AHF patient is sufficiently decongested. Finally, CaTUS-guided decongestive therapy seemed safe, was associated with greater decongestion by all parameters, and seems to have been associated with fewer re-hospitalizations due to AHF. Conclusion CaTUS seems useful for diagnosing, monitoring and guiding decongestive therapy in AHF
Original languageEnglish
Supervisors/Advisors
  • Harjola, Veli-Pekka, Supervisor
  • Karjalainen, Pasi , Supervisor
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4821-6
Electronic ISBNs978-951-51-4822-3
Publication statusPublished - 2019
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Heart Failure
  • +diagnosis
  • +diagnostic imaging
  • +therapy
  • Dyspnea
  • Echocardiography
  • Hospitalization
  • Natriuretic Peptide, Brain
  • Patient Discharge
  • Vena Cava, Inferior
  • Treatment Outcome
  • Acute Disease
  • Lung
  • Emergencies
  • 3121 Internal medicine

Cite this

@phdthesis{aa796dc81d744f52a865ac95554dc393,
title = "Visualizing congestion with ultrasound - diagnostic and therapeutic implications :: Focused cardiothoracic ultrasound protocol of the heart and lungs (caTUS)",
abstract = "Background The syndrome of Acute Heart Failure (AHF) is a very common cause for hospitalization, and carries a poor prognosis both in hospital and after discharge. The syndrome is caused by a various disease of the cardiovascular system and the heart. Congestion due to elevated cardiac filling pressures is the key physiological feature in AHF. There is to date very little evidence-based therapy existing for AHF and hospitalizations are lengthy and expensive. The aim of this thesis is to investigate a cardiothoracic rapid ultrasound protocol (CaTUS) in allowing an individual approach to be taken considering diagnosis, treatment monitoring and treatment guidance in AHF. Methods We enrolled 4 partly overlapping populations for this thesis. In our first study, we enrolled a total of 100 dyspneic ED patients in whom we tested CaTUS for diagnosing AHF, with the protocol done immediately upon arrival in the ED. Except for diagnosing AHF, CaTUS was also tested for diagnosing other conditions causing dyspnea in this study. In our second study on early monitoring of AHF, we enrolled 60 hospitalized AHF patients who had CaTUS done 3 times during the first 24 hours, thereafter 24 hours later and finally once more prior to discharge. In our third study evaluating the prognostic impact of CaTUS among other congestion parameters, we enrolled a sample of 100 hospitalized AHF patients, to whom CaTUS was done at baseline, at 24 and 48 hours and finally at the day of discharge. In our fourth study, we enrolled a small 20-patient AHF population, who had their treatment guided by the CaTUS protocol. The treatment results in this population were compared with treatment results in the previously enrolled 100-patient population enrolled before, who had received conventional in-hospital treatment for AHF. Results The CaTUS protocol performed very well for diagnosing AHF, as well as for differential diagnostics in dyspneic patients. Sensitivity was 100 {\%} and specificity 95.8 {\%} for diagnosing AHF as compared to a golden standard consisting of a brain natriuretic peptide-value of > 400 ng/l or > 100 ng/l in combination on chest x-ray as evaluated by an independent radiologist on the radiology ward . During early treatment, CaTUS was able to identify early treatment responders and disgtinguish them from non-responders, which seemed to be relevant since early responders often expressed a favorable treatment response throughout hospitalization and a significantly better post-discharge prognosis. For determining post-discharge prognosis, inferior vena cava index at discharge seemed to be the most relevant congestion parameter, indicating whether an AHF patient is sufficiently decongested. Finally, CaTUS-guided decongestive therapy seemed safe, was associated with greater decongestion by all parameters, and seems to have been associated with fewer re-hospitalizations due to AHF. Conclusion CaTUS seems useful for diagnosing, monitoring and guiding decongestive therapy in AHF",
keywords = "Heart Failure, +diagnosis, +diagnostic imaging, +therapy, Dyspnea, Echocardiography, Hospitalization, Natriuretic Peptide, Brain, Patient Discharge, Vena Cava, Inferior, Treatment Outcome, Acute Disease, Lung, Emergencies, 3121 Internal medicine",
author = "Jonas {\"O}hman",
year = "2019",
language = "English",
isbn = "978-951-51-4821-6",
publisher = "[J. {\"O}hman]",
address = "Finland",

}

Visualizing congestion with ultrasound - diagnostic and therapeutic implications : Focused cardiothoracic ultrasound protocol of the heart and lungs (caTUS). / Öhman, Jonas.

Helsinki : [J. Öhman], 2019. 85 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Visualizing congestion with ultrasound - diagnostic and therapeutic implications :

T2 - Focused cardiothoracic ultrasound protocol of the heart and lungs (caTUS)

AU - Öhman, Jonas

PY - 2019

Y1 - 2019

N2 - Background The syndrome of Acute Heart Failure (AHF) is a very common cause for hospitalization, and carries a poor prognosis both in hospital and after discharge. The syndrome is caused by a various disease of the cardiovascular system and the heart. Congestion due to elevated cardiac filling pressures is the key physiological feature in AHF. There is to date very little evidence-based therapy existing for AHF and hospitalizations are lengthy and expensive. The aim of this thesis is to investigate a cardiothoracic rapid ultrasound protocol (CaTUS) in allowing an individual approach to be taken considering diagnosis, treatment monitoring and treatment guidance in AHF. Methods We enrolled 4 partly overlapping populations for this thesis. In our first study, we enrolled a total of 100 dyspneic ED patients in whom we tested CaTUS for diagnosing AHF, with the protocol done immediately upon arrival in the ED. Except for diagnosing AHF, CaTUS was also tested for diagnosing other conditions causing dyspnea in this study. In our second study on early monitoring of AHF, we enrolled 60 hospitalized AHF patients who had CaTUS done 3 times during the first 24 hours, thereafter 24 hours later and finally once more prior to discharge. In our third study evaluating the prognostic impact of CaTUS among other congestion parameters, we enrolled a sample of 100 hospitalized AHF patients, to whom CaTUS was done at baseline, at 24 and 48 hours and finally at the day of discharge. In our fourth study, we enrolled a small 20-patient AHF population, who had their treatment guided by the CaTUS protocol. The treatment results in this population were compared with treatment results in the previously enrolled 100-patient population enrolled before, who had received conventional in-hospital treatment for AHF. Results The CaTUS protocol performed very well for diagnosing AHF, as well as for differential diagnostics in dyspneic patients. Sensitivity was 100 % and specificity 95.8 % for diagnosing AHF as compared to a golden standard consisting of a brain natriuretic peptide-value of > 400 ng/l or > 100 ng/l in combination on chest x-ray as evaluated by an independent radiologist on the radiology ward . During early treatment, CaTUS was able to identify early treatment responders and disgtinguish them from non-responders, which seemed to be relevant since early responders often expressed a favorable treatment response throughout hospitalization and a significantly better post-discharge prognosis. For determining post-discharge prognosis, inferior vena cava index at discharge seemed to be the most relevant congestion parameter, indicating whether an AHF patient is sufficiently decongested. Finally, CaTUS-guided decongestive therapy seemed safe, was associated with greater decongestion by all parameters, and seems to have been associated with fewer re-hospitalizations due to AHF. Conclusion CaTUS seems useful for diagnosing, monitoring and guiding decongestive therapy in AHF

AB - Background The syndrome of Acute Heart Failure (AHF) is a very common cause for hospitalization, and carries a poor prognosis both in hospital and after discharge. The syndrome is caused by a various disease of the cardiovascular system and the heart. Congestion due to elevated cardiac filling pressures is the key physiological feature in AHF. There is to date very little evidence-based therapy existing for AHF and hospitalizations are lengthy and expensive. The aim of this thesis is to investigate a cardiothoracic rapid ultrasound protocol (CaTUS) in allowing an individual approach to be taken considering diagnosis, treatment monitoring and treatment guidance in AHF. Methods We enrolled 4 partly overlapping populations for this thesis. In our first study, we enrolled a total of 100 dyspneic ED patients in whom we tested CaTUS for diagnosing AHF, with the protocol done immediately upon arrival in the ED. Except for diagnosing AHF, CaTUS was also tested for diagnosing other conditions causing dyspnea in this study. In our second study on early monitoring of AHF, we enrolled 60 hospitalized AHF patients who had CaTUS done 3 times during the first 24 hours, thereafter 24 hours later and finally once more prior to discharge. In our third study evaluating the prognostic impact of CaTUS among other congestion parameters, we enrolled a sample of 100 hospitalized AHF patients, to whom CaTUS was done at baseline, at 24 and 48 hours and finally at the day of discharge. In our fourth study, we enrolled a small 20-patient AHF population, who had their treatment guided by the CaTUS protocol. The treatment results in this population were compared with treatment results in the previously enrolled 100-patient population enrolled before, who had received conventional in-hospital treatment for AHF. Results The CaTUS protocol performed very well for diagnosing AHF, as well as for differential diagnostics in dyspneic patients. Sensitivity was 100 % and specificity 95.8 % for diagnosing AHF as compared to a golden standard consisting of a brain natriuretic peptide-value of > 400 ng/l or > 100 ng/l in combination on chest x-ray as evaluated by an independent radiologist on the radiology ward . During early treatment, CaTUS was able to identify early treatment responders and disgtinguish them from non-responders, which seemed to be relevant since early responders often expressed a favorable treatment response throughout hospitalization and a significantly better post-discharge prognosis. For determining post-discharge prognosis, inferior vena cava index at discharge seemed to be the most relevant congestion parameter, indicating whether an AHF patient is sufficiently decongested. Finally, CaTUS-guided decongestive therapy seemed safe, was associated with greater decongestion by all parameters, and seems to have been associated with fewer re-hospitalizations due to AHF. Conclusion CaTUS seems useful for diagnosing, monitoring and guiding decongestive therapy in AHF

KW - Heart Failure

KW - +diagnosis

KW - +diagnostic imaging

KW - +therapy

KW - Dyspnea

KW - Echocardiography

KW - Hospitalization

KW - Natriuretic Peptide, Brain

KW - Patient Discharge

KW - Vena Cava, Inferior

KW - Treatment Outcome

KW - Acute Disease

KW - Lung

KW - Emergencies

KW - 3121 Internal medicine

M3 - Doctoral Thesis

SN - 978-951-51-4821-6

PB - [J. Öhman]

CY - Helsinki

ER -