Association between lung ultrasound B-lines and exercise-induced pulmonary hypertension in patients with connective tissue disease
Kazuki Kagami MD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
Search for more papers by this authorTomonari Harada MD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorKoichi Yamaguchi MD, PhD
Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorShunichi Kouno MD
Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorTakahiro Ikoma RMS
Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
Search for more papers by this authorKuniko Yoshida MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorToshimitsu Kato MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
Search for more papers by this authorJunichi Tomono MD, PhD
Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorNaoki Wada MD, PhD
Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorTakeshi Adachi MD, PhD
Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
Search for more papers by this authorMasahiko Kurabayashi MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorCorresponding Author
Masaru Obokata MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Correspondence
Masaru Obokata, MD, PhD, Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371–8511, Japan.
Email: [email protected]
Search for more papers by this authorKazuki Kagami MD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
Search for more papers by this authorTomonari Harada MD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorKoichi Yamaguchi MD, PhD
Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorShunichi Kouno MD
Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorTakahiro Ikoma RMS
Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
Search for more papers by this authorKuniko Yoshida MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorToshimitsu Kato MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
Search for more papers by this authorJunichi Tomono MD, PhD
Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorNaoki Wada MD, PhD
Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorTakeshi Adachi MD, PhD
Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
Search for more papers by this authorMasahiko Kurabayashi MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Search for more papers by this authorCorresponding Author
Masaru Obokata MD, PhD
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Correspondence
Masaru Obokata, MD, PhD, Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371–8511, Japan.
Email: [email protected]
Search for more papers by this authorKazuki Kagami and Tomonari Harada these authors equally contributed to this work.
Abstract
Background
Identification of elevation in pulmonary pressures during exercise may provide prognostic and therapeutic implications in patients with connective tissue disease (CTD). Interstitial lung disease (ILD) is common in CTD patients and subtle interstitial abnormalities detected by lung ultrasound could predict exercise-induced pulmonary hypertension (PH).
Methods and Results
Echocardiography and lung ultrasound were performed at rest and bicycle exercise in CTD patients (n = 41) and control subjects without CTD (n = 24). Ultrasound B-lines were quantified by scanning four intercostal spaces in the right hemithorax. We examined the association between total B-lines at rest and the development of exercise-induced PH during ergometry exercise. Compared to controls, the number of total B-lines at rest was higher in CTD patients (0 [0, 0] vs 2 [0, 9], P < .0001) and was correlated with radiological severity of ILD assessed by computed tomography (fibrosis score, r = .70, P < .0001). Pulmonary artery systolic pressure (PASP) was increased with ergometry exercise in CTD compared to controls (48 ± 14 vs 35 ± 13 mm Hg, P = .0006). The number of total B-lines at rest was highly correlated with higher PASP (r = .52, P < .0001) and poor right ventricular pulmonary artery coupling (tricuspid annular plane systolic excursion/PASP ratio, r = -.31, P = .01) during peak exercise. The number of resting B-lines predicted the development of exercise-induced PH with an area under the curve .79 (P = .0003).
Conclusions
These data may suggest the value of a simple resting assessment of lung ultrasound as a potential tool for assessing the risk of exercise-induced PH in CTD patients.
Supporting Information
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| echo15141-sup-0001-FigureS1.tif1.4 MB | Supporting information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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