title: Integrative Cardiopulmonary Ultrasound for Interstitial Lung Disease Assessment: Correlation between Lung Ultrasound Performance and Cardiac Involvement.
abstract: The aims of this study were to apply integrative cardiopulmonary ultrasound (thoracic ultrasound) to the evaluation of patients with interstitial lung disease (ILD) and to determine the relationship between lung ultrasound signs and echocardiographic parameters such as systolic pulmonary artery pressure (SPAP) and various right ventricular parameters. ILD patients and healthy controls underwent lung ultrasound (LUS) and echocardiographic tests. In addition to traditional echocardiographic parameters, right ventricular free wall longitudinal strain (RVLS_FW) was measured using 2-D speckle-tracking echocardiography. The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored with a semiquantitative scoring method, taking into account multiple LUS signs. Statistical analyses were performed to compare various parameters between ILD patients with and those without pulmonary hypertension. Correlations between the different parameters were then evaluated, and the LUS scores were used to predict pulmonary hypertension using a receiver operating characteristic curve analysis. Among the 90 patients who qualified for entry into this study, 30% (n = 27) had pulmonary hypertension. The patients with pulmonary hypertension had larger right ventricular dimensions, lower RVLS_FW and higher LUS scores. An effective correlation was found between ILD LUS scores and echocardiographic parameters, especially SPAP (r = 0.735, p < 0.001). The groups were comparable with respect to most echocardiographic parameters, with mild, moderate and severe pulmonary fibrosis, whereas SPAP was significantly higher in the moderate and severe groups. RVLS_FW was obviously reduced in the group with severe pulmonary fibrosis. Although RVLS_FW in the mild pulmonary fibrosis group was in the normal range, it was slightly reduced compared with that of the controls. A cutoff of more than 16 LUS points had 85.2% sensitivity and 80.3% specificity in predicting elevated SPAP (>36 mm Hg). Thoracic ultrasound is useful in the assessment of ILD. As ILD progresses, the structure or function of the right ventricle gradually deteriorates. LUS not only detects lung conditions in ILD, but also indirectly reflects SPAP and right ventricular function. Integrated use of LUS and echocardiography will provide an invaluable point-of-care imaging modality to facilitate the diagnosis, management and treatment of patients with ILD.
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Zhu
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Yi-Dan
authors.initials: YD
authors.lastname: Li
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China. Electronic address: Lxz_echo@163.com.
authors.forename: Xiu-Zhang
authors.initials: XZ
authors.lastname: Lu
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Ling-Yun
authors.initials: LY
authors.lastname: Kong
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao-Guang
authors.initials: XG
authors.lastname: Ye
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Qi-Zhe
authors.initials: QZ
authors.lastname: Cai
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Lan-Lan
authors.initials: LL
authors.lastname: Sun
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
mesh_terms: D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Integrative cardiopulmonary ultrasound; Interstitial lung disease; Right ventricular parameters; Systolic pulmonary artery pressure